hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|[state],"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
yuma_disctrict_hospital,1/1/2024,2.0.0,yuma_disctrict_hospital,"1000 W 8th Ave Yuma, CO 80759",84-0420041 | CO,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|Aetna|Commercial|negotiated_dollar,standard_charge|Aetna|Commercial|negotiated_percentage,standard_charge|Aetna|Commercial|negotiated_algorithm,estimated_amount|Aetna|Commercial,standard_charge|min,standard_charge|max,standard_charge|Aetna|Commercial|methodology,additional_generic_notes,additional_payer_notes|Aetna|Commercial,standard_charge|Aetna|Medicare|negotiated_dollar,standard_charge|Aetna|Medicare|negotiated_percentage,standard_charge|Aetna|Medicare|negotiated_algorithm,estimated_amount|Aetna|Medicare,standard_charge|min,standard_charge|max,standard_charge|Aetna|Medicare|methodology,additional_generic_notes,additional_payer_notes|Aetna|Medicare,standard_charge|Align_Networks|Commercial|negotiated_dollar,standard_charge|Align_Networks|Commercial|negotiated_percentage,standard_charge|Align_Networks|Commercial|negotiated_algorithm,estimated_amount|Align_Networks|Commercial,standard_charge|min,standard_charge|max,standard_charge|Align_Networks|Commercial|methodology,additional_generic_notes,additional_payer_notes|Align_Networks|Commercial,standard_charge|Anthem_Blue_Cross|Commercial|negotiated_dollar,standard_charge|Anthem_Blue_Cross|Commercial|negotiated_percentage,standard_charge|Anthem_Blue_Cross|Commercial|negotiated_algorithm,estimated_amount|Anthem_Blue_Cross|Commercial,standard_charge|min,standard_charge|max,standard_charge|Anthem_Blue_Cross|Commercial|methodology,additional_generic_notes,additional_payer_notes|Anthem_Blue_Cross|Commercial,standard_charge|Anthem_Blue_Cross|Work_Comp|negotiated_dollar,standard_charge|Anthem_Blue_Cross|Work_Comp|negotiated_percentage,standard_charge|Anthem_Blue_Cross|Work_Comp|negotiated_algorithm,estimated_amount|Anthem_Blue_Cross|Work_Comp,standard_charge|min,standard_charge|max,standard_charge|Anthem_Blue_Cross|Work_Comp|methodology,additional_generic_notes,additional_payer_notes|Anthem_Blue_Cross|Work_Comp,standard_charge|Anthem_Blue_Cross|Medicare|negotiated_dollar,standard_charge|Anthem_Blue_Cross|Medicare|negotiated_percentage,standard_charge|Anthem_Blue_Cross|Medicare|negotiated_algorithm,estimated_amount|Anthem_Blue_Cross|Medicare,standard_charge|min,standard_charge|max,standard_charge|Anthem_Blue_Cross|Medicare|methodology,additional_generic_notes,additional_payer_notes|Anthem_Blue_Cross|Medicare,standard_charge|Cigna|Commercial|negotiated_dollar,standard_charge|Cigna|Commercial|negotiated_percentage,standard_charge|Cigna|Commercial|negotiated_algorithm,estimated_amount|Cigna|Commercial,standard_charge|min,standard_charge|max,standard_charge|Cigna|Commercial|methodology,additional_generic_notes,additional_payer_notes|Cigna|Commercial,standard_charge|Cofinity|Preferred|negotiated_dollar,standard_charge|Cofinity|Preferred|negotiated_percentage,standard_charge|Cofinity|Preferred|negotiated_algorithm,estimated_amount|Cofinity|Preferred,standard_charge|min,standard_charge|max,standard_charge|Cofinity|Preferred|methodology,additional_generic_notes,additional_payer_notes|Cofinity|Preferred,standard_charge|Corvel|Commercial|negotiated_dollar,standard_charge|Corvel|Commercial|negotiated_percentage,standard_charge|Corvel|Commercial|negotiated_algorithm,estimated_amount|Corvel|Commercial,standard_charge|min,standard_charge|max,standard_charge|Corvel|Commercial|methodology,additional_generic_notes,additional_payer_notes|Corvel|Commercial,standard_charge|Friday_Health_Plan|Commercial|negotiated_dollar,standard_charge|Friday_Health_Plan|Commercial|negotiated_percentage,standard_charge|Friday_Health_Plan|Commercial|negotiated_algorithm,estimated_amount|Friday_Health_Plan|Commercial,standard_charge|min,standard_charge|max,standard_charge|Friday_Health_Plan|Commercial|methodology,additional_generic_notes,additional_payer_notes|Friday_Health_Plan|Commercial,standard_charge|Humana|Choicecare|negotiated_dollar,standard_charge|Humana|Choicecare|negotiated_percentage,standard_charge|Humana|Choicecare|negotiated_algorithm,estimated_amount|Humana|Choicecare,standard_charge|min,standard_charge|max,standard_charge|Humana|Choicecare|methodology,additional_generic_notes,additional_payer_notes|Humana|Choicecare,standard_charge|Medicare|Medicare|negotiated_dollar,standard_charge|Medicare|Medicare|negotiated_percentage,standard_charge|Medicare|Medicare|negotiated_algorithm,estimated_amount|Medicare|Medicare,standard_charge|min,standard_charge|max,standard_charge|Medicare|Medicare|methodology,additional_generic_notes,additional_payer_notes|Medicare|Medicare,standard_charge|Medrisk|Preferred|negotiated_dollar,standard_charge|Medrisk|Preferred|negotiated_percentage,standard_charge|Medrisk|Preferred|negotiated_algorithm,estimated_amount|Medrisk|Preferred,standard_charge|min,standard_charge|max,standard_charge|Medrisk|Preferred|methodology,additional_generic_notes,additional_payer_notes|Medrisk|Preferred,standard_charge|Midlands_Choice|Commercial|negotiated_dollar,standard_charge|Midlands_Choice|Commercial|negotiated_percentage,standard_charge|Midlands_Choice|Commercial|negotiated_algorithm,estimated_amount|Midlands_Choice|Commercial,standard_charge|min,standard_charge|max,standard_charge|Midlands_Choice|Commercial|methodology,additional_generic_notes,additional_payer_notes|Midlands_Choice|Commercial,standard_charge|Multiplan|Open_Access|negotiated_dollar,standard_charge|Multiplan|Open_Access|negotiated_percentage,standard_charge|Multiplan|Open_Access|negotiated_algorithm,estimated_amount|Multiplan|Open_Access,standard_charge|min,standard_charge|max,standard_charge|Multiplan|Open_Access|methodology,additional_generic_notes,additional_payer_notes|Multiplan|Open_Access,standard_charge|Multiplan|PPO|negotiated_dollar,standard_charge|Multiplan|PPO|negotiated_percentage,standard_charge|Multiplan|PPO|negotiated_algorithm,estimated_amount|Multiplan|PPO,standard_charge|min,standard_charge|max,standard_charge|Multiplan|PPO|methodology,additional_generic_notes,additional_payer_notes|Multiplan|PPO,standard_charge|Rocky_Mountain_Health_Plan|Commercial|negotiated_dollar,standard_charge|Rocky_Mountain_Health_Plan|Commercial|negotiated_percentage,standard_charge|Rocky_Mountain_Health_Plan|Commercial|negotiated_algorithm,estimated_amount|Rocky_Mountain_Health_Plan|Commercial,standard_charge|min,standard_charge|max,standard_charge|Rocky_Mountain_Health_Plan|Commercial|methodology,additional_generic_notes,additional_payer_notes|Rocky_Mountain_Health_Plan|Commercial,standard_charge|Three_Rivers|Commercial|negotiated_dollar,standard_charge|Three_Rivers|Commercial|negotiated_percentage,standard_charge|Three_Rivers|Commercial|negotiated_algorithm,estimated_amount|Three_Rivers|Commercial,standard_charge|min,standard_charge|max,standard_charge|Three_Rivers|Commercial|methodology,additional_generic_notes,additional_payer_notes|Three_Rivers|Commercial,standard_charge|Triwest|Commercial|negotiated_dollar,standard_charge|Triwest|Commercial|negotiated_percentage,standard_charge|Triwest|Commercial|negotiated_algorithm,estimated_amount|Triwest|Commercial,standard_charge|min,standard_charge|max,standard_charge|Triwest|Commercial|methodology,additional_generic_notes,additional_payer_notes|Triwest|Commercial,standard_charge|UC_Health_Plan|Commercial|negotiated_dollar,standard_charge|UC_Health_Plan|Commercial|negotiated_percentage,standard_charge|UC_Health_Plan|Commercial|negotiated_algorithm,estimated_amount|UC_Health_Plan|Commercial,standard_charge|min,standard_charge|max,standard_charge|UC_Health_Plan|Commercial|methodology,additional_generic_notes,additional_payer_notes|UC_Health_Plan|Commercial,standard_charge|UHC|Medicare|negotiated_dollar,standard_charge|UHC|Medicare|negotiated_percentage,standard_charge|UHC|Medicare|negotiated_algorithm,estimated_amount|UHC|Medicare,standard_charge|min,standard_charge|max,standard_charge|UHC|Medicare|methodology,additional_generic_notes,additional_payer_notes|UHC|Medicare,standard_charge|UHC|Commercial|negotiated_dollar,standard_charge|UHC|Commercial|negotiated_percentage,standard_charge|UHC|Commercial|negotiated_algorithm,estimated_amount|UHC|Commercial,standard_charge|min,standard_charge|max,standard_charge|UHC|Commercial|methodology,additional_generic_notes,additional_payer_notes|UHC|Commercial
27096,8873469,CDM,352,RC,27096,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62323 Lumbar Injection with Imaging Guidance,9021871,CDM,761,RC,62323,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
70498 CTA NECK YUMA,8815866,CDM,352,RC,70498,HCPCS,outpatient,,,"$2,750.00 ","$2,062.50 ",,"$2,530.00 ",92,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,512.50 ",55,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,512.50 ","$2,667.50 ",other,,Not applicable. No negotiated rates per contract,"$2,365.00 ",86,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,200.00 ",80,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,512.50 ",55,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,612.50 ",95,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,612.50 ",95,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,062.50 ",75,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,337.50 ",85,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,667.50 ",97,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,512.50 ",55,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,475.00 ",90,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,667.50 ",97,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,667.50 ",97,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,667.50 ",97,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,337.50 ",85,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,475.00 ",90,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,512.50 ",55,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,612.50 ",90,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,512.50 ",55,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,557.50 ",93,,,"$1,512.50 ","$2,667.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
71275 CTA CHEST YUMA,8815865,CDM,352,RC,71275,HCPCS,outpatient,,,"$3,299.00 ","$2,474.25 ",,"$3,035.08 ",92,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,814.45 ","$3,200.03 ",other,,Not applicable. No negotiated rates per contract,"$2,837.14 ",86,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,639.20 ",80,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,134.05 ",95,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,134.05 ",95,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,474.25 ",75,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,804.15 ",85,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,969.10 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,804.15 ",85,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,969.10 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,134.05 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,068.07 ",93,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
74176 CT ABD AND PELVIS W/O CONTRAST YUMA,8815869,CDM,352,RC,74176,HCPCS,outpatient,,,"$3,792.00 ","$2,844.00 ",,"$3,488.64 ",92,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,085.60 ","$3,678.24 ",other,,Not applicable. No negotiated rates per contract,"$3,261.12 ",86,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,033.60 ",80,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,602.40 ",95,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,602.40 ",95,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,844.00 ",75,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,223.20 ",85,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,412.80 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,223.20 ",85,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,412.80 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,602.40 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,526.56 ",93,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,93% of total billed charges for outpatient setting
74177 CT ABD AND PELVIS W/CONTRAST YUMA,8815868,CDM,352,RC,74177,HCPCS,outpatient,,,"$3,868.00 ","$2,901.00 ",,"$3,558.56 ",92,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,127.40 ",55,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,127.40 ","$3,751.96 ",other,,Not applicable. No negotiated rates per contract,"$3,326.48 ",86,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,094.40 ",80,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,127.40 ",55,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,674.60 ",95,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,674.60 ",95,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,901.00 ",75,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,287.80 ",85,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,751.96 ",97,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,127.40 ",55,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,481.20 ",90,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,751.96 ",97,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,751.96 ",97,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,751.96 ",97,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,287.80 ",85,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,481.20 ",90,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,127.40 ",55,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,674.60 ",90,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,127.40 ",55,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,597.24 ",93,,,"$2,127.40 ","$3,751.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
74178 CT ABD AND PELVIS W & W/O CONTRAST YUMA,8815867,CDM,352,RC,74178,HCPCS,outpatient,,,"$4,248.00 ","$3,186.00 ",,"$3,908.16 ",92,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,336.40 ","$4,120.56 ",other,,Not applicable. No negotiated rates per contract,"$3,653.28 ",86,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,398.40 ",80,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,035.60 ",95,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,035.60 ",95,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,186.00 ",75,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,610.80 ",85,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,823.20 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,610.80 ",85,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,823.20 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,035.60 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,950.64 ",93,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,93% of total billed charges for outpatient setting
77063 MG Mammo Screening,8872746,CDM,403,RC,77063,HCPCS,outpatient,,,$187.00 ,$140.25 ,,$172.04 ,92,,,$102.85 ,$181.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.85 ,$181.39 ,other,,Not applicable. No negotiated rates per contract,$160.82 ,86,,,$102.85 ,$181.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$149.60 ,80,,,$102.85 ,$181.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,95,,,$102.85 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.65 ,95,,,$102.85 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.25 ,75,,,$102.85 ,$181.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.95 ,85,,,$102.85 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.30 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.95 ,85,,,$102.85 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.30 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.91 ,93,,,$102.85 ,$181.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
77063 Tomo,8872731,CDM,403,RC,77063,HCPCS,outpatient,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
77065 MG Mammo Diagnostic Unilateral,8819010,CDM,401,RC,77065,HCPCS,outpatient,,,$213.00 ,$159.75 ,,$195.96 ,92,,,$117.15 ,$206.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.15 ,$206.61 ,other,,Not applicable. No negotiated rates per contract,$183.18 ,86,,,$117.15 ,$206.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$170.40 ,80,,,$117.15 ,$206.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.75 ,75,,,$117.15 ,$206.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.09 ,93,,,$117.15 ,$206.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
77066 MG Mammo Diagnostic Bilateral,8819009,CDM,401,RC,77066,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$149.05 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.05 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$233.06 ,86,,,$149.05 ,$262.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.80 ,80,,,$149.05 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$149.05 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$149.05 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
77067 MG Mammo Screening Bilateral,8819013,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
77067 MG Mammo Screening Unilateral,8819014,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
88185,8988550,CDM,311,RC,88185,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
88189,8988551,CDM,311,RC,88189,HCPCS,outpatient,,,$120.00 ,$90.00 ,,$110.40 ,92,,,$66.00 ,$116.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.00 ,55,,,$66.00 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.00 ,$116.40 ,other,,Not applicable. No negotiated rates per contract,$103.20 ,86,,,$66.00 ,$116.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.00 ,80,,,$66.00 ,$116.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.00 ,55,,,$66.00 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.00 ,95,,,$66.00 ,$116.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.00 ,95,,,$66.00 ,$116.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.00 ,75,,,$66.00 ,$116.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.00 ,85,,,$66.00 ,$116.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.40 ,97,,,$66.00 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.00 ,55,,,$66.00 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.00 ,90,,,$66.00 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.40 ,97,,,$66.00 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.40 ,97,,,$66.00 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.40 ,97,,,$66.00 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.00 ,85,,,$66.00 ,$116.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.00 ,90,,,$66.00 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.00 ,55,,,$66.00 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.00 ,90,,,$66.00 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.00 ,55,,,$66.00 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.60 ,93,,,$66.00 ,$116.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93010 EKG POC,8854483,CDM,521,RC,93010,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
Albumin,8871469,CDM,301,RC,82043,HCPCS,outpatient,,,$130.00 ,$97.50 ,,$119.60 ,92,,,$2.54 ,$126.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$71.50 ,55,,,$2.54 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.54 ,$126.10 ,other,,Not applicable. No negotiated rates per contract,$2.54 ,44,,,$2.54 ,$126.10 ,fee schedule,,44% of CMS Medicare lab fee schedule,$104.00 ,80,,,$2.54 ,$126.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$71.50 ,55,,,$2.54 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,95,,,$2.54 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.50 ,95,,,$2.54 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$97.50 ,75,,,$2.54 ,$126.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$110.50 ,85,,,$2.54 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.10 ,97,,,$2.54 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.50 ,55,,,$2.54 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.00 ,90,,,$2.54 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.10 ,97,,,$2.54 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$2.54 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$2.54 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.50 ,85,,,$2.54 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.00 ,90,,,$2.54 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$2.54 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,90,,,$2.54 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$2.54 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.90 ,93,,,$2.54 ,$126.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Anesthesia Charge - Tech/Pro,8860199,CDM,370,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BLOOD TYPING,4630040,CDM,390,RC,86901,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$1.32 ,$101.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$101.85 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$101.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.00 ,80,,,$1.32 ,$101.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$1.32 ,$101.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.65 ,93,,,$1.32 ,$101.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture ID (BioFire) x 12,8775250,CDM,306,RC,87150,HCPCS,outpatient,,,$56.00 ,$42.00 ,,$51.52 ,92,,,$15.44 ,$54.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.80 ,55,,,$15.44 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$54.32 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$54.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,$44.80 ,80,,,$15.44 ,$54.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.80 ,55,,,$15.44 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,95,,,$15.44 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.20 ,95,,,$15.44 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.00 ,75,,,$15.44 ,$54.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.60 ,85,,,$15.44 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.32 ,97,,,$15.44 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.80 ,55,,,$15.44 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.40 ,90,,,$15.44 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.32 ,97,,,$15.44 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$15.44 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$15.44 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.60 ,85,,,$15.44 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.40 ,90,,,$15.44 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$15.44 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,90,,,$15.44 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$15.44 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.08 ,93,,,$15.44 ,$54.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture ID (BioFire) x 15,8775251,CDM,306,RC,87150,HCPCS,outpatient,,,$464.00 ,$348.00 ,,$426.88 ,92,,,$15.44 ,$450.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$450.08 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$450.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$371.20 ,80,,,$15.44 ,$450.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,95,,,$15.44 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.80 ,95,,,$15.44 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.00 ,75,,,$15.44 ,$450.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$394.40 ,85,,,$15.44 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.60 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.40 ,85,,,$15.44 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.60 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.52 ,93,,,$15.44 ,$450.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bun,8871476,CDM,301,RC,84520,HCPCS,outpatient,,,$81.00 ,$60.75 ,,$74.52 ,92,,,$1.74 ,$78.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.74 ,$78.57 ,other,,Not applicable. No negotiated rates per contract,$1.74 ,44,,,$1.74 ,$78.57 ,fee schedule,,44% of CMS Medicare lab fee schedule,$64.80 ,80,,,$1.74 ,$78.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.95 ,95,,,$1.74 ,$78.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.95 ,95,,,$1.74 ,$78.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.75 ,75,,,$1.74 ,$78.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.85 ,85,,,$1.74 ,$78.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.90 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.85 ,85,,,$1.74 ,$78.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.90 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.95 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.33 ,93,,,$1.74 ,$78.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Chlamydia STD Panel (PCR) Visby,10310443,CDM,306,RC,87491,HCPCS,outpatient,,,$79.00 ,$59.25 ,,$72.68 ,92,,,$15.44 ,$76.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$76.63 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$76.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$63.20 ,80,,,$15.44 ,$76.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.25 ,75,,,$15.44 ,$76.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.47 ,93,,,$15.44 ,$76.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatine Kinase,8871475,CDM,301,RC,82550,HCPCS,outpatient,,,$147.00 ,$110.25 ,,$135.24 ,92,,,$2.86 ,$142.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.85 ,55,,,$2.86 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.86 ,$142.59 ,other,,Not applicable. No negotiated rates per contract,$2.86 ,44,,,$2.86 ,$142.59 ,fee schedule,,44% of CMS Medicare lab fee schedule,$117.60 ,80,,,$2.86 ,$142.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.85 ,55,,,$2.86 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,95,,,$2.86 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.65 ,95,,,$2.86 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.25 ,75,,,$2.86 ,$142.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.95 ,85,,,$2.86 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.59 ,97,,,$2.86 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.85 ,55,,,$2.86 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.30 ,90,,,$2.86 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.59 ,97,,,$2.86 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$2.86 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$2.86 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.95 ,85,,,$2.86 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.30 ,90,,,$2.86 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$2.86 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,90,,,$2.86 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$2.86 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.71 ,93,,,$2.86 ,$142.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine,8871477,CDM,301,RC,82565,HCPCS,outpatient,,,$136.00 ,$102.00 ,,$125.12 ,92,,,$2.25 ,$131.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.25 ,$131.92 ,other,,Not applicable. No negotiated rates per contract,$2.25 ,44,,,$2.25 ,$131.92 ,fee schedule,,44% of CMS Medicare lab fee schedule,$108.80 ,80,,,$2.25 ,$131.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,95,,,$2.25 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$129.20 ,95,,,$2.25 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.00 ,75,,,$2.25 ,$131.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$115.60 ,85,,,$2.25 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.40 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.60 ,85,,,$2.25 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.40 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.48 ,93,,,$2.25 ,$131.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine,8871470,CDM,301,RC,82570,HCPCS,outpatient,,,$106.00 ,$79.50 ,,$97.52 ,92,,,$2.28 ,$102.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$102.82 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$102.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.80 ,80,,,$2.28 ,$102.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,95,,,$2.28 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.70 ,95,,,$2.28 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.50 ,75,,,$2.28 ,$102.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.10 ,85,,,$2.28 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.40 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.10 ,85,,,$2.28 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.40 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.58 ,93,,,$2.28 ,$102.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Femitin,8871473,CDM,301,RC,82728,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$6.00 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.00 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$6.00 ,44,,,$6.00 ,$174.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,$144.00 ,80,,,$6.00 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$6.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$6.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$6.00 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$6.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$6.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$6.00 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gardnerella vaginalis,10043781,CDM,306,RC,87510,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$8.82 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.82 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$8.82 ,44,,,$8.82 ,$114.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$94.40 ,80,,,$8.82 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$8.82 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$8.82 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gonorrhoeae STD Panel (PCR) Visby,10072411,CDM,306,RC,87591,HCPCS,outpatient,,,$79.00 ,$59.25 ,,$72.68 ,92,,,$15.44 ,$76.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$76.63 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$76.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$63.20 ,80,,,$15.44 ,$76.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.25 ,75,,,$15.44 ,$76.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.47 ,93,,,$15.44 ,$76.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hematocrit,8871454,CDM,305,RC,85014,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$1.04 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$1.04 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$47.53 ,fee schedule,,44% of CMS Medicare lab fee schedule,$39.20 ,80,,,$1.04 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$1.04 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$1.04 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$1.04 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$1.04 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$1.04 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$1.04 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$1.04 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$1.04 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$1.04 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$1.04 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$1.04 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$1.04 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$1.04 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$1.04 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$1.04 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$1.04 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.57 ,93,,,$1.04 ,$47.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hemoglobin,8871453,CDM,305,RC,85018,HCPCS,outpatient,,,$50.00 ,$37.50 ,,$46.00 ,92,,,$1.04 ,$48.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.50 ,55,,,$1.04 ,$48.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$48.50 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$48.50 ,fee schedule,,44% of CMS Medicare lab fee schedule,$40.00 ,80,,,$1.04 ,$48.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.50 ,55,,,$1.04 ,$48.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.50 ,95,,,$1.04 ,$48.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.50 ,95,,,$1.04 ,$48.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.50 ,75,,,$1.04 ,$48.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.50 ,85,,,$1.04 ,$48.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.50 ,97,,,$1.04 ,$48.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,55,,,$1.04 ,$48.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.00 ,90,,,$1.04 ,$48.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.50 ,97,,,$1.04 ,$48.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.50 ,97,,,$1.04 ,$48.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.50 ,97,,,$1.04 ,$48.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.50 ,85,,,$1.04 ,$48.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.00 ,90,,,$1.04 ,$48.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,55,,,$1.04 ,$48.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.50 ,90,,,$1.04 ,$48.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,55,,,$1.04 ,$48.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.50 ,93,,,$1.04 ,$48.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV Start w/Fluid,8938930,CDM,270,RC,,HCPCS,outpatient,,,$492.00 ,$369.00 ,,$452.64 ,92,,,$270.60 ,$477.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$270.60 ,$477.24 ,other,,Not applicable. No negotiated rates per contract,$423.12 ,86,,,$270.60 ,$477.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$393.60 ,80,,,$270.60 ,$477.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$369.00 ,75,,,$270.60 ,$477.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.56 ,93,,,$270.60 ,$477.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV Start w/o Fluid,8938929,CDM,270,RC,,HCPCS,outpatient,,,$324.00 ,$243.00 ,,$298.08 ,92,,,$178.20 ,$314.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$178.20 ,55,,,$178.20 ,$314.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$178.20 ,$314.28 ,other,,Not applicable. No negotiated rates per contract,$278.64 ,86,,,$178.20 ,$314.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$259.20 ,80,,,$178.20 ,$314.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$178.20 ,55,,,$178.20 ,$314.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.80 ,95,,,$178.20 ,$314.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$307.80 ,95,,,$178.20 ,$314.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.00 ,75,,,$178.20 ,$314.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$275.40 ,85,,,$178.20 ,$314.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$314.28 ,97,,,$178.20 ,$314.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.20 ,55,,,$178.20 ,$314.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$291.60 ,90,,,$178.20 ,$314.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$314.28 ,97,,,$178.20 ,$314.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$314.28 ,97,,,$178.20 ,$314.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$314.28 ,97,,,$178.20 ,$314.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.40 ,85,,,$178.20 ,$314.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.60 ,90,,,$178.20 ,$314.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.20 ,55,,,$178.20 ,$314.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.80 ,90,,,$178.20 ,$314.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.20 ,55,,,$178.20 ,$314.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.32 ,93,,,$178.20 ,$314.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Iron,8871471,CDM,301,RC,83540,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$2.85 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$2.85 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$2.85 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$2.85 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Iron Binding Capacity,8871472,CDM,301,RC,83550,HCPCS,outpatient,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$3.85 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$3.85 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.85 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$3.85 ,44,,,$3.85 ,$117.37 ,fee schedule,,44% of CMS Medicare lab fee schedule,$96.80 ,80,,,$3.85 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$3.85 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$3.85 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$3.85 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$3.85 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$3.85 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$3.85 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$3.85 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$3.85 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$3.85 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$3.85 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$3.85 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$3.85 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$3.85 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$3.85 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$3.85 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$3.85 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$3.85 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Oxygen set-up,8938928,CDM,270,RC,,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$55.00 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.00 ,$97.00 ,other,,Not applicable. No negotiated rates per contract,$86.00 ,86,,,$55.00 ,$97.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.00 ,80,,,$55.00 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$55.00 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$55.00 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sodium CL 0.9% flush 3ml,8984477,CDM,250,RC,,HCPCS,outpatient,3,ml,$12.00 ,$9.00 ,,$11.04 ,92,,,$6.60 ,$11.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$11.64 ,other,,Not applicable. No negotiated rates per contract,$10.32 ,86,,,$6.60 ,$11.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$9.60 ,80,,,$6.60 ,$11.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$9.00 ,75,,,$6.60 ,$11.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.16 ,93,,,$6.60 ,$11.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sodium Cl 0.9% flush 10ml,8984478,CDM,250,RC,,HCPCS,outpatient,10,ml,$12.00 ,$9.00 ,,$11.04 ,92,,,$6.60 ,$11.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$11.64 ,other,,Not applicable. No negotiated rates per contract,$10.32 ,86,,,$6.60 ,$11.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$9.60 ,80,,,$6.60 ,$11.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$9.00 ,75,,,$6.60 ,$11.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.16 ,93,,,$6.60 ,$11.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Trauma Activation Fee,8961949,CDM,681,RC,,HCPCS,outpatient,,,"$1,882.00 ","$1,411.50 ",,"$1,731.44 ",92,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,035.10 ",55,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,035.10 ","$1,825.54 ",other,,Not applicable. No negotiated rates per contract,"$1,618.52 ",86,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,505.60 ",80,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,035.10 ",55,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,787.90 ",95,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,787.90 ",95,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,411.50 ",75,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,599.70 ",85,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,825.54 ",97,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,035.10 ",55,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,693.80 ",90,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,825.54 ",97,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,825.54 ",97,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,825.54 ",97,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,599.70 ",85,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,693.80 ",90,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,035.10 ",55,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,787.90 ",90,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,035.10 ",55,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,750.26 ",93,,,"$1,035.10 ","$1,825.54 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Trauma Alert Fee,8961953,CDM,681,RC,,HCPCS,outpatient,,,$940.00 ,$705.00 ,,$864.80 ,92,,,$517.00 ,$911.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$517.00 ,55,,,$517.00 ,$911.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$517.00 ,$911.80 ,other,,Not applicable. No negotiated rates per contract,$808.40 ,86,,,$517.00 ,$911.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$752.00 ,80,,,$517.00 ,$911.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$517.00 ,55,,,$517.00 ,$911.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$893.00 ,95,,,$517.00 ,$911.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$893.00 ,95,,,$517.00 ,$911.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$705.00 ,75,,,$517.00 ,$911.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$799.00 ,85,,,$517.00 ,$911.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$911.80 ,97,,,$517.00 ,$911.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$517.00 ,55,,,$517.00 ,$911.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$846.00 ,90,,,$517.00 ,$911.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$911.80 ,97,,,$517.00 ,$911.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$911.80 ,97,,,$517.00 ,$911.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$911.80 ,97,,,$517.00 ,$911.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$799.00 ,85,,,$517.00 ,$911.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$846.00 ,90,,,$517.00 ,$911.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$517.00 ,55,,,$517.00 ,$911.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$893.00 ,90,,,$517.00 ,$911.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$517.00 ,55,,,$517.00 ,$911.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$874.20 ,93,,,$517.00 ,$911.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Trichomonas vaginalis,10043782,CDM,306,RC,87660,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$8.82 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.82 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$8.82 ,44,,,$8.82 ,$114.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$94.40 ,80,,,$8.82 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$8.82 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$8.82 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tricomonas STD Panel (PCR) Visby,10072412,CDM,306,RC,87661,HCPCS,outpatient,,,$79.00 ,$59.25 ,,$72.68 ,92,,,$15.44 ,$76.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$76.63 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$76.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$63.20 ,80,,,$15.44 ,$76.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.25 ,75,,,$15.44 ,$76.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.47 ,93,,,$15.44 ,$76.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Troponin,8871474,CDM,301,RC,84484,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$161.00 ,92,,,$5.49 ,$169.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.49 ,$169.75 ,other,,Not applicable. No negotiated rates per contract,$5.49 ,44,,,$5.49 ,$169.75 ,fee schedule,,44% of CMS Medicare lab fee schedule,$140.00 ,80,,,$5.49 ,$169.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,95,,,$5.49 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.25 ,95,,,$5.49 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.25 ,75,,,$5.49 ,$169.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.75 ,85,,,$5.49 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.50 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.75 ,85,,,$5.49 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.50 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.75 ,93,,,$5.49 ,$169.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Venipuncture Manual Charge - Hospital,8961379,CDM,300,RC,36415,HCPCS,outpatient,,,$33.00 ,$24.75 ,,$30.36 ,92,,,$1.32 ,$32.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$32.01 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$32.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$26.40 ,80,,,$1.32 ,$32.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,95,,,$1.32 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.35 ,95,,,$1.32 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.75 ,75,,,$1.32 ,$32.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.05 ,85,,,$1.32 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,85,,,$1.32 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.70 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.69 ,93,,,$1.32 ,$32.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Venipuncture Manual Charge - Clinic,9151805,CDM,300,RC,36415,HCPCS,outpatient,,,,,,,,,,$1.32 ,$1.32 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.32 ,$1.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.32 ,$1.32 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$1.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.32 ,$1.32 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.32 ,$1.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.32 ,$1.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.32 ,$1.32 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.32 ,$1.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.32 ,$1.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.32 ,$1.32 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
zzAnesthesia Pro Fee,8860200,CDM,964,RC,,HCPCS,outpatient,,,,,,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
95070 Inhalation bronchial challenge testing,2388906,CDM,924,RC,95070,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
88142 Cytopathology,8404605,CDM,300,RC,88142,HCPCS,outpatient,,,,,,,,,,$8.91 ,$8.91 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.91 ,$8.91 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.91 ,$8.91 ,other,,Not applicable. No negotiated rates per contract,$8.91 ,44,,,$8.91 ,$8.91 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.91 ,$8.91 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.91 ,$8.91 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.91 ,$8.91 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.91 ,$8.91 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.91 ,$8.91 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.91 ,$8.91 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.91 ,$8.91 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
88150 Cytopathology,8680656,CDM,300,RC,88150,HCPCS,outpatient,,,,,,,,,,$7.00 ,$7.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.00 ,$7.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.00 ,$7.00 ,other,,Not applicable. No negotiated rates per contract,$7.00 ,44,,,$7.00 ,$7.00 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.00 ,$7.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.00 ,$7.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.00 ,$7.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.00 ,$7.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.00 ,$7.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.00 ,$7.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.00 ,$7.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
88160 Cytopathology,8680657,CDM,300,RC,88160,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
88305 Surgical pathology,8680658,CDM,300,RC,88305,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99173 Vision Testing POC,8240542,CDM,521,RC,99173,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
CLINIC RENT,8770576,CDM,510,RC,,HCPCS,outpatient,,,,,,,,,,$35.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$35.00 ,100,,,$35.00 ,$197.64 ,case rate,,100% case rate for treatment room,,,,,$35.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
No Charge Visit,8102386,CDM,510,RC,,HCPCS,outpatient,,,,,,,,,,$35.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$35.00 ,100,,,$35.00 ,$197.64 ,case rate,,100% case rate for treatment room,,,,,$35.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$35.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$35.00 ,$197.64 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SPECIALTY CLINIC PROCEDURE-LEVEL 1,8770570,CDM,510,RC,99211,HCPCS,outpatient,,,$293.00 ,$219.75 ,,$269.56 ,92,,,$21.73 ,$284.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$284.21 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$284.21 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$284.21 ,other,,Not seperately reimbursible per contract terms,$234.40 ,80,,,$21.73 ,$284.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$284.21 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$278.35 ,95,,,$21.73 ,$284.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.75 ,75,,,$21.73 ,$284.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$249.05 ,85,,,$21.73 ,$284.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.21 ,97,,,$21.73 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$284.21 ,case rate,,100% of clinic case rate per visit,$263.70 ,90,,,$21.73 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$284.21 ,97,,,$21.73 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.21 ,97,,,$21.73 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.21 ,97,,,$21.73 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$284.21 ,case rate,,100% case rate for treatment room,$263.70 ,90,,,$21.73 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.35 ,90,,,$21.73 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.49 ,93,,,$21.73 ,$284.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 2,8770571,CDM,510,RC,99211,HCPCS,outpatient,,,$265.00 ,$198.75 ,,$243.80 ,92,,,$21.73 ,$257.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$257.05 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$257.05 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$257.05 ,other,,Not seperately reimbursible per contract terms,$212.00 ,80,,,$21.73 ,$257.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$257.05 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$251.75 ,95,,,$21.73 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.75 ,75,,,$21.73 ,$257.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$225.25 ,85,,,$21.73 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.05 ,97,,,$21.73 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$257.05 ,case rate,,100% of clinic case rate per visit,$238.50 ,90,,,$21.73 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.05 ,97,,,$21.73 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$21.73 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$21.73 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$257.05 ,case rate,,100% case rate for treatment room,$238.50 ,90,,,$21.73 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,90,,,$21.73 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.45 ,93,,,$21.73 ,$257.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 3,8770572,CDM,510,RC,99211,HCPCS,outpatient,,,$377.00 ,$282.75 ,,$346.84 ,92,,,$21.73 ,$365.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$365.69 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$365.69 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$365.69 ,other,,Not seperately reimbursible per contract terms,$301.60 ,80,,,$21.73 ,$365.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$365.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$365.69 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$358.15 ,95,,,$21.73 ,$365.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.75 ,75,,,$21.73 ,$365.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$320.45 ,85,,,$21.73 ,$365.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.69 ,97,,,$21.73 ,$365.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$365.69 ,case rate,,100% of clinic case rate per visit,$339.30 ,90,,,$21.73 ,$365.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$365.69 ,97,,,$21.73 ,$365.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.69 ,97,,,$21.73 ,$365.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.69 ,97,,,$21.73 ,$365.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$365.69 ,case rate,,100% case rate for treatment room,$339.30 ,90,,,$21.73 ,$365.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$365.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.15 ,90,,,$21.73 ,$365.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$365.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$350.61 ,93,,,$21.73 ,$365.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 4,8770573,CDM,510,RC,99211,HCPCS,outpatient,,,$403.00 ,$302.25 ,,$370.76 ,92,,,$21.73 ,$390.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$390.91 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$390.91 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$390.91 ,other,,Not seperately reimbursible per contract terms,$322.40 ,80,,,$21.73 ,$390.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$390.91 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$382.85 ,95,,,$21.73 ,$390.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.25 ,75,,,$21.73 ,$390.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$342.55 ,85,,,$21.73 ,$390.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$390.91 ,97,,,$21.73 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$390.91 ,case rate,,100% of clinic case rate per visit,$362.70 ,90,,,$21.73 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.91 ,97,,,$21.73 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$21.73 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$21.73 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$390.91 ,case rate,,100% case rate for treatment room,$362.70 ,90,,,$21.73 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.85 ,90,,,$21.73 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.79 ,93,,,$21.73 ,$390.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 1 MC ONLY,8961008,CDM,510,RC,99211,HCPCS,outpatient,,,$60.00 ,$45.00 ,,$55.20 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$48.00 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$57.00 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.00 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.00 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,93,,,$21.73 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 2 MC ONLY,8961023,CDM,510,RC,99211,HCPCS,outpatient,,,$60.00 ,$45.00 ,,$55.20 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$48.00 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$57.00 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.00 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.00 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,93,,,$21.73 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 3 MC ONLY,8961024,CDM,510,RC,99211,HCPCS,outpatient,,,$60.00 ,$45.00 ,,$55.20 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$48.00 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$57.00 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.00 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.00 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,93,,,$21.73 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECIALTY CLINIC PROCEDURE-LEVEL 4 MC ONLY,8961025,CDM,510,RC,99211,HCPCS,outpatient,,,$60.00 ,$45.00 ,,$55.20 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$48.00 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$57.00 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.00 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.00 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,$54.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,93,,,$21.73 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Specialty Clinic Level 2 Visit,9236527,CDM,510,RC,99212,HCPCS,outpatient,,,$139.00 ,$104.25 ,,$127.88 ,92,,,$35.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$111.20 ,80,,,$35.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.72 ,100,,,$35.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$132.05 ,95,,,$35.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.25 ,75,,,$35.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.15 ,85,,,$35.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.83 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$125.10 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.83 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.83 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.83 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$35.00 ,$197.64 ,case rate,,100% case rate for treatment room,$125.10 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.05 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.27 ,93,,,$35.00 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TREATMENT ROOM,8770574,CDM,510,RC,99211,HCPCS,outpatient,,,,,,,,,,$21.73 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$21.73 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,,,,,$21.73 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$21.73 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$21.73 ,$197.64 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
TREATMENT ROOM (2ND HOUR),8770575,CDM,510,RC,99211,HCPCS,outpatient,,,,,,,,,,$21.73 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$21.73 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,,,,,$21.73 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$21.73 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$21.73 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$21.73 ,$197.64 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
0011A Moderna Covid-19 Vaccine Administration - First Dose,9246581,CDM,521,RC,0011A,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
0012A Moderna Covid-19 Vaccine Administration - Second Dose,9246582,CDM,771,RC,0012A,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not separately reimbursable per table 2 referenced in contract
0013A Moderna Vaccine 3rd Dose:100mcg,9655174,CDM,771,RC,0013A,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not separately reimbursable per table 2 referenced in contract
0064A Moderna SARSCOV2 VAC 50 MCG/0.25 ML IM Booster Dose,9763425,CDM,771,RC,0064A,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not separately reimbursable per table 2 referenced in contract
0071A Pfizer-BioNTech Covid-19 Pediatric Vaccine - Administration - First dose,9795712,CDM,771,RC,0071A,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not separately reimbursable per table 2 referenced in contract
0072A Pfizer-BioNTech Covid-19 Pediatric Vaccine - Administration - Second dose,9795713,CDM,771,RC,0072A,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not separately reimbursable per table 2 referenced in contract
90375 Rabies immune globulin (RIg),8041194,CDM,636,RC,90375,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90378 Respiratory syncytial virus,8041196,CDM,636,RC,90378,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90389 Tetanus immune globulin (TIg),8680660,CDM,636,RC,90389,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90396 Varicella-zoster immune globulin,8680662,CDM,636,RC,90396,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90460 Ped Immunization counseling and admin,8041197,CDM,521,RC,90460,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90471 Hepatitis B Immunization administration; first vaccine,8803433,CDM,521,RC,90471,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90471 INFLUENZA IMMUNIZATION ADMINISTRATION; FIRST VACCINE,8803792,CDM,521,RC,90471,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90471 Immunization administration: first vaccine,8041199,CDM,771,RC,90471,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
90471 PNEUMOCOCCAL IMMUNIZATION ADMINISTRATION; FIRST VACCINE,8803868,CDM,521,RC,90471,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$36.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$36.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$36.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$36.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$36.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$36.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$36.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$36.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$36.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$36.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$36.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$36.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$44.10 ,90,,,$36.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$36.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$36.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$36.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$36.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$36.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$36.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90471 VFC Immunization administration; first vaccine,8050261,CDM,521,RC,90471,HCPCS,outpatient,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$16.26 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$16.26 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$16.26 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$16.26 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$16.26 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$16.26 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$16.26 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$16.26 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$16.26 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$16.26 ,$197.64 ,case rate,,100% of clinic case rate per visit,$19.51 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$16.26 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.26 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90472 Hepatitis B Immunization administration; each additional vaccine,8803434,CDM,521,RC,90472,HCPCS,outpatient,,,$26.00 ,$19.50 ,,$23.92 ,92,,,$19.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$19.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$19.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$22.36 ,86,,,$19.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.80 ,80,,,$19.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,95,,,$19.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.70 ,95,,,$19.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.50 ,75,,,$19.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.10 ,85,,,$19.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$19.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$23.40 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.10 ,85,,,$19.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.40 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90472 IMMUNIZATION ADMIN  EA ADD'L VACCINE,8041200,CDM,521,RC,90472,HCPCS,outpatient,,,$27.00 ,$20.25 ,,$24.84 ,92,,,$20.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$20.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$20.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$23.22 ,86,,,$20.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.60 ,80,,,$20.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$20.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.65 ,95,,,$20.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.65 ,95,,,$20.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.25 ,75,,,$20.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.95 ,85,,,$20.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.19 ,97,,,$20.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$20.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$24.30 ,90,,,$20.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.19 ,97,,,$20.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.19 ,97,,,$20.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.19 ,97,,,$20.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.95 ,85,,,$20.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.30 ,90,,,$20.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$20.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.65 ,90,,,$20.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$20.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90472 INFLUENZA IMMUNIZATION ADMINISTRATION; EACH ADDITIONAL VACCINE,8803793,CDM,521,RC,90472,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90472 PNEUMOCOCCAL IMMUNIZATION ADMINISTRATION; EACH ADDITIONAL VACCINE,8803869,CDM,521,RC,90472,HCPCS,outpatient,,,$26.00 ,$19.50 ,,$23.92 ,92,,,$19.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$19.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$19.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$22.36 ,86,,,$19.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.80 ,80,,,$19.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,95,,,$19.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.70 ,95,,,$19.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.50 ,75,,,$19.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.10 ,85,,,$19.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$19.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$23.40 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$19.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.10 ,85,,,$19.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.40 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,90,,,$19.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$19.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90472 VFC Immunization administration; each additional vaccine,8050262,CDM,521,RC,90472,HCPCS,outpatient,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$16.26 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$16.26 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$16.26 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$16.26 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$16.26 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$16.26 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$16.26 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$16.26 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$16.26 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$16.26 ,$197.64 ,case rate,,100% of clinic case rate per visit,$19.51 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$16.26 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$16.26 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$16.26 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$16.26 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.26 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90473 Immunization administration by intranasal or oral route; first vaccine,8041201,CDM,521,RC,90473,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$39.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$39.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$39.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$39.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$39.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$39.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$39.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$39.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$39.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$39.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$46.80 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$39.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90473 VFC Immunization administration by intranasal or oral route; first vaccine,8139937,CDM,521,RC,90473,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90474 Immunization administration by intranasal or oral route; each additional vaccine,8041202,CDM,521,RC,90474,HCPCS,outpatient,,,$4.00 ,$3.00 ,,$3.68 ,92,,,$3.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$3.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$3.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$3.44 ,86,,,$3.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$3.20 ,80,,,$3.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$3.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$3.80 ,95,,,$3.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$3.80 ,95,,,$3.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$3.00 ,75,,,$3.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$3.40 ,85,,,$3.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$3.88 ,97,,,$3.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$3.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$3.60 ,90,,,$3.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$3.88 ,97,,,$3.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$3.88 ,97,,,$3.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$3.88 ,97,,,$3.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$3.40 ,85,,,$3.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$3.60 ,90,,,$3.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$3.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$3.80 ,90,,,$3.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$3.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis,8687345,CDM,636,RC,90585,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90619 Menquadfi Medication Charge,10594846,CDM,636,RC,90619,HCPCS,both,,,$248.00 ,$186.00 ,,$228.16 ,92,,,$136.40 ,$240.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.40 ,55,,,$136.40 ,$240.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.40 ,$240.56 ,other,,Not applicable. No negotiated rates per contract,$213.28 ,86,,,$136.40 ,$240.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.40 ,80,,,$136.40 ,$240.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.40 ,55,,,$136.40 ,$240.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.60 ,95,,,$136.40 ,$240.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$235.60 ,95,,,$136.40 ,$240.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.00 ,75,,,$136.40 ,$240.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$210.80 ,85,,,$136.40 ,$240.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$240.56 ,97,,,$136.40 ,$240.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.40 ,55,,,$136.40 ,$240.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.20 ,90,,,$136.40 ,$240.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$240.56 ,97,,,$136.40 ,$240.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.56 ,97,,,$136.40 ,$240.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.56 ,97,,,$136.40 ,$240.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.80 ,85,,,$136.40 ,$240.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.20 ,90,,,$136.40 ,$240.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.40 ,55,,,$136.40 ,$240.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.60 ,90,,,$136.40 ,$240.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.40 ,55,,,$136.40 ,$240.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.64 ,93,,,$136.40 ,$240.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90620 Meningococcal vaccine,8041204,CDM,636,RC,90620,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90620 VFC Meningococcal vaccine,8050234,CDM,636,RC,90620,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90621 VFC Meningococcal vaccine,8084324,CDM,636,RC,90621,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90632 Hepatitis A vaccine,8041205,CDM,636,RC,90632,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90632 VFC Hepatitis A vaccine,8680668,CDM,636,RC,90632,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90633 Havrix Hepatitis A vaccine,8050284,CDM,636,RC,90633,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90633 VFC Havrix Hepatitis A vaccine,8041206,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90634 Hepatitis A vaccine (HepA),8149537,CDM,636,RC,90634,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90634 VFC Hepatitis A vaccine (HepA),8180326,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90636 Hepatitis A and hepatitis B vaccine (HepA-HepB),8041207,CDM,636,RC,90636,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90647 Hib vaccine,8468225,CDM,636,RC,90647,HCPCS,both,,,$62.00 ,$46.50 ,,$57.04 ,92,,,$34.10 ,$60.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.10 ,55,,,$34.10 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$34.10 ,$60.14 ,other,,Not applicable. No negotiated rates per contract,$53.32 ,86,,,$34.10 ,$60.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$49.60 ,80,,,$34.10 ,$60.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.10 ,55,,,$34.10 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,95,,,$34.10 ,$60.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.90 ,95,,,$34.10 ,$60.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.50 ,75,,,$34.10 ,$60.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$52.70 ,85,,,$34.10 ,$60.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.14 ,97,,,$34.10 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.10 ,55,,,$34.10 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,90,,,$34.10 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.14 ,97,,,$34.10 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$34.10 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$34.10 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.70 ,85,,,$34.10 ,$60.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.80 ,90,,,$34.10 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.10 ,55,,,$34.10 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,90,,,$34.10 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.10 ,55,,,$34.10 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.66 ,93,,,$34.10 ,$60.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90648 Hib PRP-T Conjugate 4 dose schedule IM.,8046241,CDM,636,RC,90648,HCPCS,both,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90648 VFC Hib PRP-T Conjugate 4 dose schedule IM,8050236,CDM,636,RC,90648,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90651 HPV vaccine,8041209,CDM,636,RC,90649,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90651 VFC HPV vaccine,8139926,CDM,636,RC,90649,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90651 VFC Vaccine- Gardasil 9,8050237,CDM,636,RC,90651,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90651 Vaccine- Gardasil 9,8041210,CDM,636,RC,90651,HCPCS,both,,,$403.00 ,$302.25 ,,$370.76 ,92,,,$221.65 ,$390.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$221.65 ,55,,,$221.65 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$221.65 ,$390.91 ,other,,Not applicable. No negotiated rates per contract,$346.58 ,86,,,$221.65 ,$390.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$322.40 ,80,,,$221.65 ,$390.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$221.65 ,55,,,$221.65 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.85 ,95,,,$221.65 ,$390.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$382.85 ,95,,,$221.65 ,$390.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.25 ,75,,,$221.65 ,$390.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$342.55 ,85,,,$221.65 ,$390.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$390.91 ,97,,,$221.65 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.65 ,55,,,$221.65 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$362.70 ,90,,,$221.65 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.91 ,97,,,$221.65 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$221.65 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$221.65 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$342.55 ,85,,,$221.65 ,$390.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$362.70 ,90,,,$221.65 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.65 ,55,,,$221.65 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.85 ,90,,,$221.65 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.65 ,55,,,$221.65 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.79 ,93,,,$221.65 ,$390.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90655 VFC Influenza virus vaccine,8680670,CDM,636,RC,90655,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90656 Influenza virus vaccine,8041212,CDM,636,RC,90656,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90656 VFC Influenza virus vaccine,8680672,CDM,636,RC,90656,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90657 Influenza Virus Vaccine Trivalent (IIV3) Split IM.25ml,8046242,CDM,636,RC,90657,HCPCS,both,0.25,ml,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90657 VFC Influenza Virus Vaccine Trivalent (IIV3),8323583,CDM,636,RC,90657,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90658 Influenza virus vaccine,8041213,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90658 VFC Influenza virus vaccine,8084325,CDM,636,RC,90658,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90660 Influenza Virus Vaccine Trivalent Live (LAIV3) Intranasal,8046243,CDM,636,RC,90660,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90662 Influenza virus vaccine,8041214,CDM,636,RC,90662,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90670 Pneumococcal 13-valent conjugate vaccine,8041215,CDM,636,RC,90670,HCPCS,both,,,$374.00 ,$280.50 ,,$344.08 ,92,,,$205.70 ,$362.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.70 ,$362.78 ,other,,Not applicable. No negotiated rates per contract,$321.64 ,86,,,$205.70 ,$362.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$299.20 ,80,,,$205.70 ,$362.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,95,,,$205.70 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$355.30 ,95,,,$205.70 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$280.50 ,75,,,$205.70 ,$362.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.90 ,85,,,$205.70 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$336.60 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.90 ,85,,,$205.70 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$336.60 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.82 ,93,,,$205.70 ,$362.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90670 VFC pneumococcal 13-valent conjugate vaccine,8050238,CDM,636,RC,90670,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90672 Influenza virus vaccine,8041216,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90675 Rabies vaccine,8041217,CDM,636,RC,90675,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90677 Pneumococcal 20-Valent (Prevnar 20),10093833,CDM,636,RC,90677,HCPCS,both,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90680 Rotavirus vaccine,8041218,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90680 VFC Rotavirus vaccine,8050242,CDM,636,RC,90680,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90686 Influenza virus vaccine,8041220,CDM,636,RC,90686,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90687 Influenza virus vaccine,8084410,CDM,636,RC,90687,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90687 VFC Influenza virus vaccine,8084411,CDM,636,RC,90687,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90688 Influenza virus vaccine,8041221,CDM,636,RC,90688,HCPCS,both,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90691 Typhoid vaccine,8041222,CDM,636,RC,90691,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90696 DTaP-IPV,8041223,CDM,636,RC,90696,HCPCS,both,,,$132.00 ,$99.00 ,,$121.44 ,92,,,$72.60 ,$128.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.60 ,$128.04 ,other,,Not applicable. No negotiated rates per contract,$113.52 ,86,,,$72.60 ,$128.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$105.60 ,80,,,$72.60 ,$128.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,95,,,$72.60 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.40 ,95,,,$72.60 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.00 ,75,,,$72.60 ,$128.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.20 ,85,,,$72.60 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.80 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,85,,,$72.60 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.80 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.76 ,93,,,$72.60 ,$128.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90696 VFC DTaP-IPV,8050246,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90698 DTaP - Hib - IPV (Pentacel),8041224,CDM,636,RC,90698,HCPCS,both,,,$146.00 ,$109.50 ,,$134.32 ,92,,,$80.30 ,$141.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.30 ,$141.62 ,other,,Not applicable. No negotiated rates per contract,$125.56 ,86,,,$80.30 ,$141.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.80 ,80,,,$80.30 ,$141.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,95,,,$80.30 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.70 ,95,,,$80.30 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.50 ,75,,,$80.30 ,$141.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.10 ,85,,,$80.30 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.40 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.10 ,85,,,$80.30 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.40 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.78 ,93,,,$80.30 ,$141.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90698 VFC DTaP - Hib - IPV (Pentacel),8050247,CDM,636,RC,90698,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90700 DAPTACEL DTaP,8041225,CDM,636,RC,90700,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90700 VFC DTaP,8139917,CDM,636,RC,90700,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90701 Diphtheria,8139927,CDM,636,RC,90701,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90702 VFC Diptheria and Tetanus toxoids DT,8050435,CDM,636,RC,90702,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90702 Vaccine - Diptheria and Tetanus toxoids DT,8041226,CDM,636,RC,90702,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90707 Measles,8041227,CDM,636,RC,90707,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90707 VFC Measles,8050250,CDM,636,RC,90707,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90713 Poliovirus vaccine,8041229,CDM,636,RC,90713,HCPCS,both,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$56.10 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.10 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$87.72 ,86,,,$56.10 ,$98.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$81.60 ,80,,,$56.10 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$56.10 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.80 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$56.10 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90713 VFC Poliovirus vaccine,8050252,CDM,636,RC,90713,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90714 Tenivac - Tetanus and diphtheria toxoids (Td),8041230,CDM,636,RC,90714,HCPCS,both,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$37.40 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$37.40 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.40 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$58.48 ,86,,,$37.40 ,$65.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$54.40 ,80,,,$37.40 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$37.40 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$37.40 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$37.40 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$37.40 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$37.40 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$37.40 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$37.40 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$37.40 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$37.40 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$37.40 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$37.40 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$37.40 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$37.40 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$37.40 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$37.40 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$37.40 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$37.40 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90714 VFC Tenivac - Tetanus and diphtheria toxoids (Td),8084412,CDM,636,RC,90714,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90715 Tdap,8041231,CDM,636,RC,90715,HCPCS,both,,,$133.00 ,$99.75 ,,$122.36 ,92,,,$73.15 ,$129.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$73.15 ,55,,,$73.15 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$73.15 ,$129.01 ,other,,Not applicable. No negotiated rates per contract,$114.38 ,86,,,$73.15 ,$129.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$106.40 ,80,,,$73.15 ,$129.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$73.15 ,55,,,$73.15 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.35 ,95,,,$73.15 ,$129.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.35 ,95,,,$73.15 ,$129.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,75,,,$73.15 ,$129.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$113.05 ,85,,,$73.15 ,$129.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.01 ,97,,,$73.15 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.15 ,55,,,$73.15 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$73.15 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.01 ,97,,,$73.15 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.01 ,97,,,$73.15 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.01 ,97,,,$73.15 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.05 ,85,,,$73.15 ,$129.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.70 ,90,,,$73.15 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.15 ,55,,,$73.15 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.35 ,90,,,$73.15 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.15 ,55,,,$73.15 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.69 ,93,,,$73.15 ,$129.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90715 VFC Tdap,8050254,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90716 VFC Varicella virus vaccine,8050255,CDM,636,RC,90716,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90716 Varicella virus vaccine,8041232,CDM,636,RC,90716,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90723 DTaP-HepB-IPV (Pediarix),8041234,CDM,636,RC,90723,HCPCS,both,,,$174.00 ,$130.50 ,,$160.08 ,92,,,$95.70 ,$168.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$95.70 ,$168.78 ,other,,Not applicable. No negotiated rates per contract,$149.64 ,86,,,$95.70 ,$168.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$139.20 ,80,,,$95.70 ,$168.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,95,,,$95.70 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.30 ,95,,,$95.70 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.50 ,75,,,$95.70 ,$168.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.90 ,85,,,$95.70 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.60 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.90 ,85,,,$95.70 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.60 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.82 ,93,,,$95.70 ,$168.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90723 VFC DTaP-HepB-IPV (Pediarix),8050256,CDM,636,RC,90723,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90732 Pneumococcal polysaccharide vaccine,8041235,CDM,636,RC,90732,HCPCS,both,,,$186.00 ,$139.50 ,,$171.12 ,92,,,$102.30 ,$180.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.30 ,$180.42 ,other,,Not applicable. No negotiated rates per contract,$159.96 ,86,,,$102.30 ,$180.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$148.80 ,80,,,$102.30 ,$180.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.50 ,75,,,$102.30 ,$180.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.98 ,93,,,$102.30 ,$180.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90732 VFC Pneumococcal polysaccharide vaccine,8084413,CDM,636,RC,90633,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90734 Meningococcal conjugate vaccine,8041237,CDM,636,RC,90734,HCPCS,both,,,$261.00 ,$195.75 ,,$240.12 ,92,,,$143.55 ,$253.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.55 ,55,,,$143.55 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.55 ,$253.17 ,other,,Not applicable. No negotiated rates per contract,$224.46 ,86,,,$143.55 ,$253.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$208.80 ,80,,,$143.55 ,$253.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.55 ,55,,,$143.55 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.95 ,95,,,$143.55 ,$253.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.95 ,95,,,$143.55 ,$253.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.75 ,75,,,$143.55 ,$253.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.85 ,85,,,$143.55 ,$253.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$253.17 ,97,,,$143.55 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.55 ,55,,,$143.55 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.90 ,90,,,$143.55 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.17 ,97,,,$143.55 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.17 ,97,,,$143.55 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.17 ,97,,,$143.55 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.85 ,85,,,$143.55 ,$253.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.90 ,90,,,$143.55 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.55 ,55,,,$143.55 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.95 ,90,,,$143.55 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.55 ,55,,,$143.55 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.73 ,93,,,$143.55 ,$253.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90734 VFC Meningococcal conjugate vaccine,8050257,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90736 Zoster (shingles) vaccine,8041238,CDM,636,RC,90736,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90740 Vaccine- Hepatitis B Recombivax HB dialysis or immunosuppressed patient,8041240,CDM,636,RC,90740,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90744 Hepatitis B vaccine,8041241,CDM,636,RC,90744,HCPCS,both,,,$119.00 ,$89.25 ,,$109.48 ,92,,,$65.45 ,$115.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.45 ,$115.43 ,other,,Not applicable. No negotiated rates per contract,$102.34 ,86,,,$65.45 ,$115.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.20 ,80,,,$65.45 ,$115.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.05 ,95,,,$65.45 ,$115.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.05 ,95,,,$65.45 ,$115.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.25 ,75,,,$65.45 ,$115.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.15 ,85,,,$65.45 ,$115.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.10 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.15 ,85,,,$65.45 ,$115.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.10 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.05 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.67 ,93,,,$65.45 ,$115.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90744 VFC Hepatitis B vaccine,8050259,CDM,636,RC,90633,HCPCS,both,,,$21.68 ,$16.26 ,,$19.95 ,92,,,$11.92 ,$21.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.92 ,$21.03 ,other,,Not applicable. No negotiated rates per contract,$18.64 ,86,,,$11.92 ,$21.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.34 ,80,,,$11.92 ,$21.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.60 ,95,,,$11.92 ,$21.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.26 ,75,,,$11.92 ,$21.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.03 ,97,,,$11.92 ,$21.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,85,,,$11.92 ,$21.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.51 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.60 ,90,,,$11.92 ,$21.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.92 ,55,,,$11.92 ,$21.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.16 ,93,,,$11.92 ,$21.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90746 Vaccine - Hepatitis B Adult Vaccine,8041242,CDM,636,RC,90746,HCPCS,both,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$81.40 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$81.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.40 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$127.28 ,86,,,$81.40 ,$143.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.40 ,80,,,$81.40 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$81.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$81.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$81.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$81.40 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$81.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$81.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$81.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$81.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$81.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$81.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$81.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$81.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$81.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$81.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$81.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$81.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$81.40 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90748 Hepatitis B and Haemophilus (Hib-HepB),8240932,CDM,636,RC,90748,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90748 VFC Hepatitis B and Haemophilus (Hib-HepB),8240936,CDM,636,RC,90748,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
90750 Zoster (shingles) vaccine (HZV),8180291,CDM,636,RC,90750,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
96372 Therapeutic,8041252,CDM,521,RC,96372,HCPCS,outpatient,,,,,,,,,,$25.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$25.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$25.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$25.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$25.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$25.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$25.00 ,100,,,$25.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$25.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$25.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$25.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$25.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$25.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$25.00 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
96374 Therapeutic,8041253,CDM,521,RC,96374,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
G0008 Admin of influenza virus vaccine,8041269,CDM,521,RC,G0008,HCPCS,outpatient,,,,,,,,,,$24.00 ,$24.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,,Not seperately reimbursible per contract terms,,,,,$24.00 ,$24.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of Influenza case rate,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$24.00 ,$24.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,$24.00 ,100,,,$24.00 ,$24.00 ,case rate,,100% of influenza case rate for outpatient setting,,,,,$24.00 ,$24.00 ,other,,Not Seperately reimbursable per table 3 in the contract
G0009 Admin of pneumococcal vaccine,8041270,CDM,521,RC,G0009,HCPCS,outpatient,,,$51.00 ,$38.25 ,,$46.92 ,92,,,$38.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$38.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$38.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$43.86 ,86,,,$38.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.80 ,80,,,$38.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$38.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,95,,,$38.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.45 ,95,,,$38.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.25 ,75,,,$38.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.35 ,85,,,$38.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.47 ,97,,,$38.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$38.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$45.90 ,90,,,$38.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.47 ,97,,,$38.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$38.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$38.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.35 ,85,,,$38.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.90 ,90,,,$38.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$38.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,90,,,$38.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$38.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
G0010 Administration of hepatitis b vaccine,8041271,CDM,521,RC,G0010,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
J0171 Injection,8041275,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J0696 Injection,8041288,CDM,636,RC,J0696,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J0696 Injection,8408791,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J0735 Injection,8084915,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J1040 Depomedrol x 80 mg,9172903,CDM,636,RC,J1040,HCPCS,both,80,mg,$110.00 ,$82.50 ,,$101.20 ,92,,,$60.50 ,$106.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.50 ,$106.70 ,other,,Not applicable. No negotiated rates per contract,$94.60 ,86,,,$60.50 ,$106.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.00 ,80,,,$60.50 ,$106.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.50 ,75,,,$60.50 ,$106.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.30 ,93,,,$60.50 ,$106.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J1050 Injection,8041306,CDM,636,RC,521J1,HCPCS,both,,,$2.00 ,$1.50 ,,$1.84 ,92,,,$1.10 ,$1.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$1.10 ,55,,,$1.10 ,$1.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.10 ,$1.94 ,other,,Not applicable. No negotiated rates per contract,$1.72 ,86,,,$1.10 ,$1.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$1.60 ,80,,,$1.10 ,$1.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$1.10 ,55,,,$1.10 ,$1.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$1.90 ,95,,,$1.10 ,$1.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$1.90 ,95,,,$1.10 ,$1.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$1.50 ,75,,,$1.10 ,$1.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$1.70 ,85,,,$1.10 ,$1.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$1.94 ,97,,,$1.10 ,$1.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$1.10 ,55,,,$1.10 ,$1.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$1.80 ,90,,,$1.10 ,$1.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$1.94 ,97,,,$1.10 ,$1.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$1.94 ,97,,,$1.10 ,$1.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$1.94 ,97,,,$1.10 ,$1.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$1.70 ,85,,,$1.10 ,$1.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$1.80 ,90,,,$1.10 ,$1.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$1.10 ,55,,,$1.10 ,$1.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$1.90 ,90,,,$1.10 ,$1.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$1.10 ,55,,,$1.10 ,$1.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$1.86 ,93,,,$1.10 ,$1.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J1100 Injection,8041308,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J1200 Injection,8041311,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J1885 Injection,8041333,CDM,636,RC,521J1,HCPCS,both,,,$12.00 ,$9.00 ,,$11.04 ,92,,,$6.60 ,$11.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$11.64 ,other,,Not applicable. No negotiated rates per contract,$10.32 ,86,,,$6.60 ,$11.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$9.60 ,80,,,$6.60 ,$11.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$9.00 ,75,,,$6.60 ,$11.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.16 ,93,,,$6.60 ,$11.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J2405 Injection,8041345,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J2550 Injection,8041350,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J2930 Injection,8041361,CDM,636,RC,,HCPCS,both,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$50.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J3030 Injection,8041363,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J3301 Injection,8041368,CDM,636,RC,J3301,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J3301 Injection,8869515,CDM,636,RC,J3301,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J3411 Injection; Thiamine HCL 100mg,8041374,CDM,636,RC,J3411,HCPCS,both,100,mg,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$44.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$44.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.30 ,$44.62 ,other,,Not applicable. No negotiated rates per contract,$39.56 ,86,,,$25.30 ,$44.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$44.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$44.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$44.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$44.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$44.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$44.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$44.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$44.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.40 ,90,,,$25.30 ,$44.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$44.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$44.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$44.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$44.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$44.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$44.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$44.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$44.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$44.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J3420 Injection,8041375,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J3490 Unclassified drugs,8084917,CDM,636,RC,J3490,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J7296 Levonorgestrel Release Intrauterine Contraceptive System (Kyleena),8255080,CDM,521,RC,J7296,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
J7298 Levonorgestrel-releasing intrauterine contraceptive system,8041387,CDM,636,RC,J7298,HCPCS,both,,,"$1,985.00 ","$1,488.75 ",,"$1,826.20 ",92,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,091.75 ",55,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,091.75 ","$1,925.45 ",other,,Not applicable. No negotiated rates per contract,"$1,707.10 ",86,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,588.00 ",80,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,091.75 ",55,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,885.75 ",95,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,885.75 ",95,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,488.75 ",75,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,687.25 ",85,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,925.45 ",97,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,091.75 ",55,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,786.50 ",90,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,925.45 ",97,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,925.45 ",97,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,925.45 ",97,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,687.25 ",85,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,786.50 ",90,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,091.75 ",55,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,885.75 ",90,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,091.75 ",55,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,846.05 ",93,,,"$1,091.75 ","$1,925.45 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7298 Liletta Levonorgestrel 52mg IUD,9222653,CDM,636,RC,J7298,HCPCS,both,52,mg,"$1,768.00 ","$1,326.00 ",,"$1,626.56 ",92,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$972.40 ,55,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$972.40 ,"$1,714.96 ",other,,Not applicable. No negotiated rates per contract,"$1,520.48 ",86,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,414.40 ",80,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$972.40 ,55,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,679.60 ",95,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,679.60 ",95,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,326.00 ",75,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,502.80 ",85,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,714.96 ",97,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$972.40 ,55,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,591.20 ",90,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,714.96 ",97,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,714.96 ",97,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,714.96 ",97,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,502.80 ",85,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,591.20 ",90,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$972.40 ,55,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,679.60 ",90,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$972.40 ,55,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,644.24 ",93,,,$972.40 ,"$1,714.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7300 HCPCS Intrauterine copper contraceptive,9042938,CDM,636,RC,J7300,HCPCS,both,,,"$2,419.00 ","$1,814.25 ",,"$2,225.48 ",92,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,330.45 ",55,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,330.45 ","$2,346.43 ",other,,Not applicable. No negotiated rates per contract,"$2,080.34 ",86,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,935.20 ",80,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,330.45 ",55,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,298.05 ",95,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,298.05 ",95,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,814.25 ",75,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,056.15 ",85,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,346.43 ",97,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,330.45 ",55,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,177.10 ",90,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,346.43 ",97,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,346.43 ",97,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,346.43 ",97,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,056.15 ",85,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,177.10 ",90,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,330.45 ",55,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,298.05 ",90,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,330.45 ",55,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,249.67 ",93,,,"$1,330.45 ","$2,346.43 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7300 Intrauterine copper contraceptive,8041388,CDM,636,RC,J7300,HCPCS,both,,,"$2,787.00 ","$2,090.25 ",,"$2,564.04 ",92,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,532.85 ",55,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,532.85 ","$2,703.39 ",other,,Not applicable. No negotiated rates per contract,"$2,396.82 ",86,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,229.60 ",80,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,532.85 ",55,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.65 ",95,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,647.65 ",95,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,090.25 ",75,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,368.95 ",85,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,703.39 ",97,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,532.85 ",55,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.30 ",90,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,703.39 ",97,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,703.39 ",97,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,703.39 ",97,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,368.95 ",85,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,508.30 ",90,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.85 ",55,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.65 ",90,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.85 ",55,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,591.91 ",93,,,"$1,532.85 ","$2,703.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7301 Levonorgestrel-releasing intrauterine contraceptive system,8041389,CDM,636,RC,J7301,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J7307 Etonogestrel (contraceptive) implant system,8041390,CDM,636,RC,521J7,HCPCS,both,,,"$1,877.00 ","$1,407.75 ",,"$1,726.84 ",92,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,032.35 ",55,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,032.35 ","$1,820.69 ",other,,Not applicable. No negotiated rates per contract,"$1,614.22 ",86,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,501.60 ",80,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,032.35 ",55,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,783.15 ",95,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,783.15 ",95,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,407.75 ",75,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,595.45 ",85,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,820.69 ",97,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,032.35 ",55,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,689.30 ",90,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,820.69 ",97,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,820.69 ",97,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,820.69 ",97,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,595.45 ",85,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,689.30 ",90,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,032.35 ",55,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,783.15 ",90,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,032.35 ",55,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,745.61 ",93,,,"$1,032.35 ","$1,820.69 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7324 Hyaluronan Or Derivative Orthovisc,8046252,CDM,636,RC,J7324,HCPCS,both,,,"$2,107.00 ","$1,580.25 ",,"$1,938.44 ",92,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,158.85 ",55,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,158.85 ","$2,043.79 ",other,,Not applicable. No negotiated rates per contract,"$1,812.02 ",86,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,685.60 ",80,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,158.85 ",55,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,001.65 ",95,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,001.65 ",95,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,580.25 ",75,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,790.95 ",85,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,043.79 ",97,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.85 ",55,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,896.30 ",90,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,043.79 ",97,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,043.79 ",97,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,043.79 ",97,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,790.95 ",85,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,896.30 ",90,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.85 ",55,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,001.65 ",90,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.85 ",55,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,959.51 ",93,,,"$1,158.85 ","$2,043.79 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J7325 Hyaluronan or derivative,8041399,CDM,636,RC,J7325,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J7325 Hyaluronan or derivative,9009013,CDM,636,RC,J7325,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
J7328 Sodium Hyaluronate 8.4mg/ml inj. 2ml,9383762,CDM,636,RC,J7328,HCPCS,both,8.4,mg,"$1,522.00 ","$1,141.50 ",,"$1,400.24 ",92,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$837.10 ,55,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$837.10 ,"$1,476.34 ",other,,Not applicable. No negotiated rates per contract,"$1,308.92 ",86,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,217.60 ",80,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$837.10 ,55,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,445.90 ",95,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,445.90 ",95,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,141.50 ",75,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,293.70 ",85,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,476.34 ",97,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$837.10 ,55,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,369.80 ",90,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,476.34 ",97,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,476.34 ",97,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,476.34 ",97,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,293.70 ",85,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,369.80 ",90,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$837.10 ,55,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,445.90 ",90,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$837.10 ,55,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,415.46 ",93,,,$837.10 ,"$1,476.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
81002 Urinalysis Dipstick,8418619,CDM,300,RC,81002,HCPCS,outpatient,,,,,,,,,,$1.53 ,$1.53 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.53 ,$1.53 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.53 ,$1.53 ,other,,Not applicable. No negotiated rates per contract,$1.53 ,44,,,$1.53 ,$1.53 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.53 ,$1.53 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.53 ,$1.53 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.53 ,$1.53 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.53 ,$1.53 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.53 ,$1.53 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.53 ,$1.53 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.53 ,$1.53 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
81003 Urinalysis Dipstick POC,8680649,CDM,300,RC,81003,HCPCS,outpatient,,,,,,,,,,$0.99 ,$0.99 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$0.99 ,$0.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$0.99 ,$0.99 ,other,,Not applicable. No negotiated rates per contract,$0.99 ,44,,,$0.99 ,$0.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$0.99 ,$0.99 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$0.99 ,$0.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$0.99 ,$0.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$0.99 ,$0.99 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$0.99 ,$0.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$0.99 ,$0.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$0.99 ,$0.99 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Alcohol Breath (EBT) Test POC,8041480,CDM,300,RC,82075,HCPCS,outpatient,,,$57.00 ,$42.75 ,,$52.44 ,92,,,$13.20 ,$55.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.35 ,55,,,$13.20 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.20 ,$55.29 ,other,,Not applicable. No negotiated rates per contract,$13.20 ,44,,,$13.20 ,$55.29 ,fee schedule,,44% of CMS Medicare lab fee schedule,$45.60 ,80,,,$13.20 ,$55.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.35 ,55,,,$13.20 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,95,,,$13.20 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.15 ,95,,,$13.20 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,75,,,$13.20 ,$55.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.45 ,85,,,$13.20 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.29 ,97,,,$13.20 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.35 ,55,,,$13.20 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$13.20 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.29 ,97,,,$13.20 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$13.20 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$13.20 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.45 ,85,,,$13.20 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.30 ,90,,,$13.20 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$13.20 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,90,,,$13.20 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$13.20 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.01 ,93,,,$13.20 ,$55.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Allergy Injection POC - Multi,8106382,CDM,521,RC,95117,HCPCS,outpatient,,,$34.00 ,$25.50 ,,$31.28 ,92,,,$25.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$25.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$25.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$29.24 ,86,,,$25.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.20 ,80,,,$25.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$25.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,95,,,$25.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.30 ,95,,,$25.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.50 ,75,,,$25.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.90 ,85,,,$25.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.98 ,97,,,$25.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$25.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$30.60 ,90,,,$25.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.98 ,97,,,$25.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$25.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$25.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.90 ,85,,,$25.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.60 ,90,,,$25.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$25.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,90,,,$25.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$25.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
Allergy Injection POC - Single,8106379,CDM,521,RC,95115,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$21.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$21.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$21.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$21.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$21.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$21.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$21.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$21.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$25.20 ,90,,,$21.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$21.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$21.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$21.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$21.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$21.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$21.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
Blood Glucose Monitoring POC,8518509,CDM,300,RC,82962,HCPCS,outpatient,,,,,,,,,,$1.44 ,$1.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.44 ,$1.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.44 ,$1.44 ,other,,Not applicable. No negotiated rates per contract,$1.44 ,44,,,$1.44 ,$1.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.44 ,$1.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.44 ,$1.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.44 ,$1.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.44 ,$1.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.44 ,$1.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.44 ,$1.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.44 ,$1.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hematocrit POC,1019800,CDM,300,RC,85014,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.04 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.04 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.04 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.04 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hemoglobin POC,3352320,CDM,300,RC,85018,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.04 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.04 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.04 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.04 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Influenza A/B POC.,8041486,CDM,300,RC,87502,HCPCS,outpatient,,,$224.00 ,$168.00 ,,$206.08 ,92,,,$42.15 ,$217.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$123.20 ,55,,,$42.15 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.15 ,$217.28 ,other,,Not applicable. No negotiated rates per contract,$42.15 ,44,,,$42.15 ,$217.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,$179.20 ,80,,,$42.15 ,$217.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$123.20 ,55,,,$42.15 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.80 ,95,,,$42.15 ,$217.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.80 ,95,,,$42.15 ,$217.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.00 ,75,,,$42.15 ,$217.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$190.40 ,85,,,$42.15 ,$217.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$217.28 ,97,,,$42.15 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.20 ,55,,,$42.15 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.60 ,90,,,$42.15 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.28 ,97,,,$42.15 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.28 ,97,,,$42.15 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.28 ,97,,,$42.15 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.40 ,85,,,$42.15 ,$217.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$201.60 ,90,,,$42.15 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.20 ,55,,,$42.15 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.80 ,90,,,$42.15 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.20 ,55,,,$42.15 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.32 ,93,,,$42.15 ,$217.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KOH POC,1019770,CDM,300,RC,87220,HCPCS,outpatient,,,,,,,,,,$1.88 ,$1.88 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.88 ,$1.88 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.88 ,$1.88 ,other,,Not applicable. No negotiated rates per contract,$1.88 ,44,,,$1.88 ,$1.88 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.88 ,$1.88 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.88 ,$1.88 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.88 ,$1.88 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.88 ,$1.88 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.88 ,$1.88 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.88 ,$1.88 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.88 ,$1.88 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
PPD Administration (TB Screen) POC,1019775,CDM,300,RC,86580,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$31.90 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.90 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$49.88 ,86,,,$31.90 ,$56.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$31.90 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$31.90 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$31.90 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$31.90 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$31.90 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT/INR POC,8041488,CDM,300,RC,85610,HCPCS,outpatient,,,$56.00 ,$42.00 ,,$51.52 ,92,,,$1.89 ,$54.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.80 ,55,,,$1.89 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.89 ,$54.32 ,other,,Not applicable. No negotiated rates per contract,$1.89 ,44,,,$1.89 ,$54.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,$44.80 ,80,,,$1.89 ,$54.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.80 ,55,,,$1.89 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,95,,,$1.89 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.20 ,95,,,$1.89 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.00 ,75,,,$1.89 ,$54.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.60 ,85,,,$1.89 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.32 ,97,,,$1.89 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.80 ,55,,,$1.89 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.40 ,90,,,$1.89 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.32 ,97,,,$1.89 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$1.89 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$1.89 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.60 ,85,,,$1.89 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.40 ,90,,,$1.89 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$1.89 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,90,,,$1.89 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$1.89 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.08 ,93,,,$1.89 ,$54.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RSV POC,1019808,CDM,300,RC,87801,HCPCS,outpatient,,,$224.00 ,$168.00 ,,$206.08 ,92,,,$30.89 ,$217.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$123.20 ,55,,,$30.89 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.89 ,$217.28 ,other,,Not applicable. No negotiated rates per contract,$30.89 ,44,,,$30.89 ,$217.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,$179.20 ,80,,,$30.89 ,$217.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$123.20 ,55,,,$30.89 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.80 ,95,,,$30.89 ,$217.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.80 ,95,,,$30.89 ,$217.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.00 ,75,,,$30.89 ,$217.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$190.40 ,85,,,$30.89 ,$217.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$217.28 ,97,,,$30.89 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.20 ,55,,,$30.89 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.60 ,90,,,$30.89 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.28 ,97,,,$30.89 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.28 ,97,,,$30.89 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.28 ,97,,,$30.89 ,$217.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.40 ,85,,,$30.89 ,$217.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$201.60 ,90,,,$30.89 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.20 ,55,,,$30.89 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.80 ,90,,,$30.89 ,$217.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.20 ,55,,,$30.89 ,$217.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.32 ,93,,,$30.89 ,$217.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rapid Strep POC,1019780,CDM,300,RC,87880,HCPCS,outpatient,,,$79.00 ,$59.25 ,,$72.68 ,92,,,$7.27 ,$76.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.45 ,55,,,$7.27 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.27 ,$76.63 ,other,,Not applicable. No negotiated rates per contract,$7.27 ,44,,,$7.27 ,$76.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$63.20 ,80,,,$7.27 ,$76.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.45 ,55,,,$7.27 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,95,,,$7.27 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.05 ,95,,,$7.27 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.25 ,75,,,$7.27 ,$76.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.15 ,85,,,$7.27 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.63 ,97,,,$7.27 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.45 ,55,,,$7.27 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.10 ,90,,,$7.27 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.63 ,97,,,$7.27 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$7.27 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$7.27 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.15 ,85,,,$7.27 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.10 ,90,,,$7.27 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$7.27 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,90,,,$7.27 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$7.27 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.47 ,93,,,$7.27 ,$76.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Stool for Occult Blood POC,607615,CDM,300,RC,82270,HCPCS,outpatient,,,$34.00 ,$25.50 ,,$31.28 ,92,,,$1.93 ,$32.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.70 ,55,,,$1.93 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.93 ,$32.98 ,other,,Not applicable. No negotiated rates per contract,$1.93 ,44,,,$1.93 ,$32.98 ,fee schedule,,44% of CMS Medicare lab fee schedule,$27.20 ,80,,,$1.93 ,$32.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.70 ,55,,,$1.93 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,95,,,$1.93 ,$32.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.30 ,95,,,$1.93 ,$32.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.50 ,75,,,$1.93 ,$32.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.90 ,85,,,$1.93 ,$32.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.98 ,97,,,$1.93 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.70 ,55,,,$1.93 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.60 ,90,,,$1.93 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.98 ,97,,,$1.93 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$1.93 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$1.93 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.90 ,85,,,$1.93 ,$32.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.60 ,90,,,$1.93 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.70 ,55,,,$1.93 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,90,,,$1.93 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.70 ,55,,,$1.93 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.62 ,93,,,$1.93 ,$32.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urinalysis Dipstick POC Auto w/ Micro,1025836,CDM,300,RC,81000,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$1.77 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$1.77 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.77 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$1.77 ,44,,,$1.77 ,$56.26 ,fee schedule,,44% of CMS Medicare lab fee schedule,$46.40 ,80,,,$1.77 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$1.77 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$1.77 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$1.77 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$1.77 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$1.77 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$1.77 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$1.77 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$1.77 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$1.77 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.77 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.77 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$1.77 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$1.77 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.77 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$1.77 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.77 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$1.77 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urine Pregnancy Test POC,8080540,CDM,300,RC,81025,HCPCS,outpatient,,,,,,,,,,$3.79 ,$3.79 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$3.79 ,$3.79 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.79 ,$3.79 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$3.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$3.79 ,$3.79 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$3.79 ,$3.79 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.79 ,$3.79 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.79 ,$3.79 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.79 ,$3.79 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.79 ,$3.79 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.79 ,$3.79 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Wet Mount POC,7750609,CDM,300,RC,87210,HCPCS,outpatient,,,,,,,,,,$2.56 ,$2.56 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.56 ,$2.56 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.56 ,$2.56 ,other,,Not applicable. No negotiated rates per contract,$2.56 ,44,,,$2.56 ,$2.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.56 ,$2.56 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.56 ,$2.56 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.56 ,$2.56 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.56 ,$2.56 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.56 ,$2.56 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.56 ,$2.56 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.56 ,$2.56 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11102 Tangential biopsy of skin (eg,8271319,CDM,521,RC,11102,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
10060 Incision and drainage of abscess; simple or single,8037065,CDM,521,RC,10060,HCPCS,outpatient,,,$426.00 ,$319.50 ,,$391.92 ,92,,,$197.64 ,$413.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$413.22 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$413.22 ,other,,Not applicable. No negotiated rates per contract,$366.36 ,86,,,$197.64 ,$413.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$340.80 ,80,,,$197.64 ,$413.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.70 ,95,,,$197.64 ,$413.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$404.70 ,95,,,$197.64 ,$413.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$319.50 ,75,,,$197.64 ,$413.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$362.10 ,85,,,$197.64 ,$413.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$413.22 ,97,,,$197.64 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$413.22 ,case rate,,100% of clinic case rate per visit,$383.40 ,90,,,$197.64 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$413.22 ,97,,,$197.64 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.22 ,97,,,$197.64 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.22 ,97,,,$197.64 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.10 ,85,,,$197.64 ,$413.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$383.40 ,90,,,$197.64 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.70 ,90,,,$197.64 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$413.22 ,other,,Not separately reimbursable per table 3 referenced in contract
10061 Incision and drainage of abscess; complicated or multiple,8037066,CDM,521,RC,10061,HCPCS,outpatient,,,$594.00 ,$445.50 ,,$546.48 ,92,,,$197.64 ,$576.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$576.18 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$576.18 ,other,,Not applicable. No negotiated rates per contract,$510.84 ,86,,,$197.64 ,$576.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$475.20 ,80,,,$197.64 ,$576.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$576.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$564.30 ,95,,,$197.64 ,$576.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$564.30 ,95,,,$197.64 ,$576.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$445.50 ,75,,,$197.64 ,$576.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$504.90 ,85,,,$197.64 ,$576.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$576.18 ,97,,,$197.64 ,$576.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$576.18 ,case rate,,100% of clinic case rate per visit,$534.60 ,90,,,$197.64 ,$576.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$576.18 ,97,,,$197.64 ,$576.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$576.18 ,97,,,$197.64 ,$576.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$576.18 ,97,,,$197.64 ,$576.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.90 ,85,,,$197.64 ,$576.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$534.60 ,90,,,$197.64 ,$576.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$576.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$564.30 ,90,,,$197.64 ,$576.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$576.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$576.18 ,other,,Not separately reimbursable per table 3 referenced in contract
10080 Incision and drainage of pilonidal cyst; simple,8037067,CDM,521,RC,10080,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
10120 Incision and removal of foreign body,8037069,CDM,521,RC,10120,HCPCS,outpatient,,,$454.00 ,$340.50 ,,$417.68 ,92,,,$197.64 ,$440.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$440.38 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$440.38 ,other,,Not applicable. No negotiated rates per contract,$390.44 ,86,,,$197.64 ,$440.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$363.20 ,80,,,$197.64 ,$440.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,95,,,$197.64 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.30 ,95,,,$197.64 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$340.50 ,75,,,$197.64 ,$440.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$385.90 ,85,,,$197.64 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$440.38 ,97,,,$197.64 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$440.38 ,case rate,,100% of clinic case rate per visit,$408.60 ,90,,,$197.64 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$440.38 ,97,,,$197.64 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$197.64 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$197.64 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.90 ,85,,,$197.64 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$408.60 ,90,,,$197.64 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,90,,,$197.64 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$440.38 ,other,,Not separately reimbursable per table 3 referenced in contract
10140 Incision and drainage of hematoma,8037071,CDM,521,RC,10140,HCPCS,outpatient,,,$446.00 ,$334.50 ,,$410.32 ,92,,,$197.64 ,$432.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$432.62 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$432.62 ,other,,Not applicable. No negotiated rates per contract,$383.56 ,86,,,$197.64 ,$432.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$356.80 ,80,,,$197.64 ,$432.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$432.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$423.70 ,95,,,$197.64 ,$432.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$423.70 ,95,,,$197.64 ,$432.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$334.50 ,75,,,$197.64 ,$432.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$379.10 ,85,,,$197.64 ,$432.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$432.62 ,97,,,$197.64 ,$432.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$432.62 ,case rate,,100% of clinic case rate per visit,$401.40 ,90,,,$197.64 ,$432.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.62 ,97,,,$197.64 ,$432.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$432.62 ,97,,,$197.64 ,$432.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$432.62 ,97,,,$197.64 ,$432.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.10 ,85,,,$197.64 ,$432.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.40 ,90,,,$197.64 ,$432.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$432.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$423.70 ,90,,,$197.64 ,$432.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$432.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$432.62 ,other,,Not separately reimbursable per table 3 referenced in contract
10160 Puncture aspiration of abscess,8037072,CDM,521,RC,10160,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface,8037074,CDM,521,RC,11000,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11004 Debride of skin,8037076,CDM,521,RC,11004,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11055 Paring or cutting of benign hyperkeratotic lesion; single lesion,8037089,CDM,521,RC,11055,HCPCS,outpatient,,,$182.00 ,$136.50 ,,$167.44 ,92,,,$136.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$136.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$136.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$156.52 ,86,,,$136.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$145.60 ,80,,,$136.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,95,,,$136.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.90 ,95,,,$136.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.50 ,75,,,$136.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$154.70 ,85,,,$136.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$136.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$163.80 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.70 ,85,,,$136.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$163.80 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
11056 Paring or cutting of benign hyperkeratotic lesion; 2 to 4 lesions,8037090,CDM,521,RC,11056,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11104 Biopsy of skin,8037092,CDM,521,RC,11104,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11104 Punch biopsy of skin (including simple closure,8271323,CDM,521,RC,11104,HCPCS,outpatient,,,$295.00 ,$221.25 ,,$271.40 ,92,,,$197.64 ,$286.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$286.15 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$286.15 ,other,,Not applicable. No negotiated rates per contract,$253.70 ,86,,,$197.64 ,$286.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$236.00 ,80,,,$197.64 ,$286.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$286.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.25 ,95,,,$197.64 ,$286.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$280.25 ,95,,,$197.64 ,$286.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.25 ,75,,,$197.64 ,$286.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$250.75 ,85,,,$197.64 ,$286.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.15 ,97,,,$197.64 ,$286.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$286.15 ,case rate,,100% of clinic case rate per visit,$265.50 ,90,,,$197.64 ,$286.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.15 ,97,,,$197.64 ,$286.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.15 ,97,,,$197.64 ,$286.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.15 ,97,,,$197.64 ,$286.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.75 ,85,,,$197.64 ,$286.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$265.50 ,90,,,$197.64 ,$286.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$286.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.25 ,90,,,$197.64 ,$286.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$286.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$286.15 ,other,,Not separately reimbursable per table 3 referenced in contract
11105 Punch biopsy of skin (including simple closure,8271324,CDM,521,RC,11105,HCPCS,outpatient,,,$152.00 ,$114.00 ,,$139.84 ,92,,,$114.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$114.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$114.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$130.72 ,86,,,$114.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.60 ,80,,,$114.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.40 ,95,,,$114.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.40 ,95,,,$114.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.00 ,75,,,$114.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.20 ,85,,,$114.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$114.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$136.80 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.20 ,85,,,$114.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.80 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.40 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$114.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
11106  Incisional biopsy of skin (eg,8271325,CDM,521,RC,11106,HCPCS,outpatient,,,$714.00 ,$535.50 ,,$656.88 ,92,,,$197.64 ,$692.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$692.58 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$692.58 ,other,,Not applicable. No negotiated rates per contract,$614.04 ,86,,,$197.64 ,$692.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$571.20 ,80,,,$197.64 ,$692.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$678.30 ,95,,,$197.64 ,$692.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$678.30 ,95,,,$197.64 ,$692.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.50 ,75,,,$197.64 ,$692.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$606.90 ,85,,,$197.64 ,$692.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$692.58 ,97,,,$197.64 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$692.58 ,case rate,,100% of clinic case rate per visit,$642.60 ,90,,,$197.64 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$692.58 ,97,,,$197.64 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.58 ,97,,,$197.64 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.58 ,97,,,$197.64 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$606.90 ,85,,,$197.64 ,$692.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$642.60 ,90,,,$197.64 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$678.30 ,90,,,$197.64 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$692.58 ,other,,Not separately reimbursable per table 3 referenced in contract
11107 Incisional biopsy of skin (eg,8271326,CDM,521,RC,11107,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11200 Removal of skin tags,8037094,CDM,521,RC,11200,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11201 Removal of skin tags,8037095,CDM,521,RC,11201,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11300 Shaving of epidermal or dermal lesion,8037096,CDM,521,RC,11300,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11301 Shaving of epidermal or dermal lesion,8037097,CDM,521,RC,11301,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11302 Shaving of epidermal or dermal lesion,8037098,CDM,521,RC,11302,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11303 Shaving of epidermal or dermal lesion,8037099,CDM,521,RC,11303,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11305 Shaving of epidermal or dermal lesion; scalp,8037100,CDM,521,RC,11305,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11306 Shaving of epidermal or dermal lesion; scalp,8037101,CDM,521,RC,11306,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11307 Shaving of epidermal or dermal lesion; scalp,8037102,CDM,521,RC,11307,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11308 Shaving of epidermal or dermal lesion; scalp,8037103,CDM,521,RC,11308,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11400 Excision,8037108,CDM,521,RC,11400,HCPCS,outpatient,,,$380.00 ,$285.00 ,,$349.60 ,92,,,$197.64 ,$368.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$368.60 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$368.60 ,other,,Not applicable. No negotiated rates per contract,$326.80 ,86,,,$197.64 ,$368.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$304.00 ,80,,,$197.64 ,$368.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$368.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$361.00 ,95,,,$197.64 ,$368.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$361.00 ,95,,,$197.64 ,$368.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$285.00 ,75,,,$197.64 ,$368.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$323.00 ,85,,,$197.64 ,$368.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$368.60 ,97,,,$197.64 ,$368.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$368.60 ,case rate,,100% of clinic case rate per visit,$342.00 ,90,,,$197.64 ,$368.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$368.60 ,97,,,$197.64 ,$368.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$368.60 ,97,,,$197.64 ,$368.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$368.60 ,97,,,$197.64 ,$368.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$323.00 ,85,,,$197.64 ,$368.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$342.00 ,90,,,$197.64 ,$368.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$368.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$361.00 ,90,,,$197.64 ,$368.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$368.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$368.60 ,other,,Not separately reimbursable per table 3 referenced in contract
11401 Excision,8037109,CDM,521,RC,11401,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11403 Excision,9216971,CDM,521,RC,11403,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11404 Excision,8037112,CDM,975,RC,11404,HCPCS,outpatient,,,,,,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursible per contract terms,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursible. Not contracted for physician rates,$276.17 ,100,,,$237.44 ,$276.17 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursable per contract terms,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$237.44 ,100,,,$237.44 ,$276.17 ,fee schedule,,100% Humana physician fee schedule,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursable per contract terms,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursable per contract terms,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursable per contract terms,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursable per contract terms,,,,,$237.44 ,$276.17 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$237.44 ,$276.17 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11420 Excision,8037114,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11421 Excision,8037115,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11470 Exc skin/subq tissue for hidradenitis,8037129,CDM,975,RC,11470,HCPCS,outpatient,,,$964.00 ,$723.00 ,,$370.59 ,135,cms physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$295.19 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$539.88 ,100,,,$295.19 ,$915.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$567.70 ,100,physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$428.03 ,145,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$915.80 ,95,,,$295.19 ,$915.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$295.19 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$412.33 ,100,,,$295.19 ,$915.80 ,fee schedule,,100% Humana physician fee schedule,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$295.19 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.19 ,$915.80 ,other,,Not separately reimbursable per contract terms,$578.40 ,60,,,$295.19 ,$915.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$578.40 ,60,,,$295.19 ,$915.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$413.27 ,140,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$295.19 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$915.80 ,95,,,$295.19 ,$915.80 ,percent of total billed charges,,95% of total billed charges,$295.19 ,100,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$368.26 ,124.753,CMS physician fee schedule,,$295.19 ,$915.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11603 Excision,8037134,CDM,521,RC,11603,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11719 Trimming of nondystrophic nails,8037149,CDM,521,RC,11719,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$36.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$36.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$36.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$41.28 ,86,,,$36.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.40 ,80,,,$36.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$36.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$36.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$36.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$36.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$36.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$36.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$36.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$43.20 ,90,,,$36.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$36.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$36.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$36.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$36.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$36.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$36.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
11720 Debridement of nail(s) by any method(s); 1 to 5,8037150,CDM,521,RC,11720,HCPCS,outpatient,,,$91.00 ,$68.25 ,,$83.72 ,92,,,$68.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$68.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$68.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$78.26 ,86,,,$68.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.80 ,80,,,$68.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$68.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,95,,,$68.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.45 ,95,,,$68.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.25 ,75,,,$68.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.35 ,85,,,$68.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.27 ,97,,,$68.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$68.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$81.90 ,90,,,$68.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.27 ,97,,,$68.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$68.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$68.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.35 ,85,,,$68.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.90 ,90,,,$68.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$68.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,90,,,$68.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$68.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
11721 Debridement of nail(s) by any method(s); 6 or more,8037151,CDM,450,RC,11721,HCPCS,outpatient,,,$91.00 ,$68.25 ,,$83.72 ,92,,,$50.05 ,$88.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.05 ,55,,,$50.05 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.05 ,$88.27 ,other,,Not applicable. No negotiated rates per contract,$78.26 ,86,,,$50.05 ,$88.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.80 ,80,,,$50.05 ,$88.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.05 ,55,,,$50.05 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,95,,,$50.05 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.45 ,95,,,$50.05 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.25 ,75,,,$50.05 ,$88.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.35 ,85,,,$50.05 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.27 ,97,,,$50.05 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.05 ,55,,,$50.05 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.90 ,90,,,$50.05 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.27 ,97,,,$50.05 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$50.05 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$50.05 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.35 ,85,,,$50.05 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.90 ,90,,,$50.05 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$50.05 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,90,,,$50.05 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$50.05 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.63 ,93,,,$50.05 ,$88.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11730 Avulsion of nail plate,8037152,CDM,521,RC,11730,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11732 Clinic Avulsion of nail plate,8037153,CDM,521,RC,11732,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11740 Evacuation of subungual hematoma,8037154,CDM,521,RC,11740,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11750 Excision of nail and nail matrix,8037155,CDM,521,RC,11750,HCPCS,outpatient,,,$624.00 ,$468.00 ,,$574.08 ,92,,,$197.64 ,$605.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$605.28 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$605.28 ,other,,Not applicable. No negotiated rates per contract,$536.64 ,86,,,$197.64 ,$605.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$499.20 ,80,,,$197.64 ,$605.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$605.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$592.80 ,95,,,$197.64 ,$605.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$592.80 ,95,,,$197.64 ,$605.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$468.00 ,75,,,$197.64 ,$605.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$530.40 ,85,,,$197.64 ,$605.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$605.28 ,97,,,$197.64 ,$605.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$605.28 ,case rate,,100% of clinic case rate per visit,$561.60 ,90,,,$197.64 ,$605.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$605.28 ,97,,,$197.64 ,$605.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$605.28 ,97,,,$197.64 ,$605.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$605.28 ,97,,,$197.64 ,$605.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.40 ,85,,,$197.64 ,$605.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$561.60 ,90,,,$197.64 ,$605.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$605.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$592.80 ,90,,,$197.64 ,$605.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$605.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$605.28 ,other,,Not separately reimbursable per table 3 referenced in contract
11765 Wedge excision of skin of nail fold,8037160,CDM,521,RC,11765,HCPCS,outpatient,,,$375.00 ,$281.25 ,,$345.00 ,92,,,$197.64 ,$363.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$363.75 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$363.75 ,other,,Not applicable. No negotiated rates per contract,$322.50 ,86,,,$197.64 ,$363.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$300.00 ,80,,,$197.64 ,$363.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.25 ,95,,,$197.64 ,$363.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.25 ,95,,,$197.64 ,$363.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$281.25 ,75,,,$197.64 ,$363.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$318.75 ,85,,,$197.64 ,$363.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$363.75 ,97,,,$197.64 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$363.75 ,case rate,,100% of clinic case rate per visit,$337.50 ,90,,,$197.64 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$363.75 ,97,,,$197.64 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.75 ,97,,,$197.64 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.75 ,97,,,$197.64 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.75 ,85,,,$197.64 ,$363.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.50 ,90,,,$197.64 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.25 ,90,,,$197.64 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$363.75 ,other,,Not separately reimbursable per table 3 referenced in contract
11976 Removal,8037174,CDM,521,RC,11976,HCPCS,outpatient,,,$443.00 ,$332.25 ,,$407.56 ,92,,,$197.64 ,$429.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$429.71 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$429.71 ,other,,Not applicable. No negotiated rates per contract,$380.98 ,86,,,$197.64 ,$429.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$354.40 ,80,,,$197.64 ,$429.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$429.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$420.85 ,95,,,$197.64 ,$429.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.85 ,95,,,$197.64 ,$429.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$332.25 ,75,,,$197.64 ,$429.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$376.55 ,85,,,$197.64 ,$429.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$429.71 ,97,,,$197.64 ,$429.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$429.71 ,case rate,,100% of clinic case rate per visit,$398.70 ,90,,,$197.64 ,$429.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$429.71 ,97,,,$197.64 ,$429.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$429.71 ,97,,,$197.64 ,$429.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$429.71 ,97,,,$197.64 ,$429.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$376.55 ,85,,,$197.64 ,$429.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$398.70 ,90,,,$197.64 ,$429.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$429.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$420.85 ,90,,,$197.64 ,$429.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$429.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$429.71 ,other,,Not separately reimbursable per table 3 referenced in contract
11980 Female Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone,8680644,CDM,521,RC,11980,HCPCS,outpatient,,,$365.00 ,$273.75 ,,$335.80 ,92,,,$197.64 ,$354.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$354.05 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$354.05 ,other,,Not applicable. No negotiated rates per contract,$313.90 ,86,,,$197.64 ,$354.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$292.00 ,80,,,$197.64 ,$354.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$354.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.75 ,95,,,$197.64 ,$354.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$346.75 ,95,,,$197.64 ,$354.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$273.75 ,75,,,$197.64 ,$354.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$310.25 ,85,,,$197.64 ,$354.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.05 ,97,,,$197.64 ,$354.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$354.05 ,case rate,,100% of clinic case rate per visit,$328.50 ,90,,,$197.64 ,$354.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.05 ,97,,,$197.64 ,$354.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.05 ,97,,,$197.64 ,$354.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.05 ,97,,,$197.64 ,$354.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.25 ,85,,,$197.64 ,$354.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$328.50 ,90,,,$197.64 ,$354.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$354.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.75 ,90,,,$197.64 ,$354.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$354.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$354.05 ,other,,Not separately reimbursable per table 3 referenced in contract
11980 Male Modified Subcutaneous hormone pellet implantation,9494329,CDM,521,RC,11980,HCPCS,outpatient,,,$550.00 ,$412.50 ,,$506.00 ,92,,,$197.64 ,$533.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$533.50 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$533.50 ,other,,Not applicable. No negotiated rates per contract,$473.00 ,86,,,$197.64 ,$533.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$440.00 ,80,,,$197.64 ,$533.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$533.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$522.50 ,95,,,$197.64 ,$533.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$522.50 ,95,,,$197.64 ,$533.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$412.50 ,75,,,$197.64 ,$533.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$467.50 ,85,,,$197.64 ,$533.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$533.50 ,97,,,$197.64 ,$533.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$533.50 ,case rate,,100% of clinic case rate per visit,$495.00 ,90,,,$197.64 ,$533.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$533.50 ,97,,,$197.64 ,$533.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$533.50 ,97,,,$197.64 ,$533.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$533.50 ,97,,,$197.64 ,$533.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.50 ,85,,,$197.64 ,$533.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$495.00 ,90,,,$197.64 ,$533.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$533.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$522.50 ,90,,,$197.64 ,$533.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$533.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$533.50 ,other,,Not separately reimbursable per table 3 referenced in contract
11980 Male Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone p,8680645,CDM,521,RC,11980,HCPCS,outpatient,,,$674.00 ,$505.50 ,,$620.08 ,92,,,$197.64 ,$653.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$653.78 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$653.78 ,other,,Not applicable. No negotiated rates per contract,$579.64 ,86,,,$197.64 ,$653.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$539.20 ,80,,,$197.64 ,$653.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$653.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$640.30 ,95,,,$197.64 ,$653.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$640.30 ,95,,,$197.64 ,$653.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$505.50 ,75,,,$197.64 ,$653.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$572.90 ,85,,,$197.64 ,$653.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$653.78 ,97,,,$197.64 ,$653.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$653.78 ,case rate,,100% of clinic case rate per visit,$606.60 ,90,,,$197.64 ,$653.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$653.78 ,97,,,$197.64 ,$653.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$653.78 ,97,,,$197.64 ,$653.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$653.78 ,97,,,$197.64 ,$653.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$572.90 ,85,,,$197.64 ,$653.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$606.60 ,90,,,$197.64 ,$653.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$653.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$640.30 ,90,,,$197.64 ,$653.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$653.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$653.78 ,other,,Not separately reimbursable per table 3 referenced in contract
11980 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellet,8680646,CDM,521,RC,11980,HCPCS,outpatient,,,$700.00 ,$525.00 ,,$644.00 ,92,,,$197.64 ,$679.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$679.00 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$679.00 ,other,,Not applicable. No negotiated rates per contract,$602.00 ,86,,,$197.64 ,$679.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$560.00 ,80,,,$197.64 ,$679.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$679.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$665.00 ,95,,,$197.64 ,$679.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$665.00 ,95,,,$197.64 ,$679.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$525.00 ,75,,,$197.64 ,$679.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$595.00 ,85,,,$197.64 ,$679.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$679.00 ,97,,,$197.64 ,$679.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$679.00 ,case rate,,100% of clinic case rate per visit,$630.00 ,90,,,$197.64 ,$679.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$679.00 ,97,,,$197.64 ,$679.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$679.00 ,97,,,$197.64 ,$679.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$679.00 ,97,,,$197.64 ,$679.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$595.00 ,85,,,$197.64 ,$679.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$630.00 ,90,,,$197.64 ,$679.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$679.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$665.00 ,90,,,$197.64 ,$679.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$679.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$679.00 ,other,,Not separately reimbursable per table 3 referenced in contract
11981 Insertion,8037175,CDM,521,RC,11981,HCPCS,outpatient,,,$391.00 ,$293.25 ,,$359.72 ,92,,,$197.64 ,$379.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$379.27 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$379.27 ,other,,Not applicable. No negotiated rates per contract,$336.26 ,86,,,$197.64 ,$379.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$312.80 ,80,,,$197.64 ,$379.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$379.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.45 ,95,,,$197.64 ,$379.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.45 ,95,,,$197.64 ,$379.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$293.25 ,75,,,$197.64 ,$379.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$332.35 ,85,,,$197.64 ,$379.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$379.27 ,97,,,$197.64 ,$379.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$379.27 ,case rate,,100% of clinic case rate per visit,$351.90 ,90,,,$197.64 ,$379.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$379.27 ,97,,,$197.64 ,$379.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.27 ,97,,,$197.64 ,$379.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.27 ,97,,,$197.64 ,$379.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.35 ,85,,,$197.64 ,$379.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.90 ,90,,,$197.64 ,$379.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$379.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.45 ,90,,,$197.64 ,$379.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$379.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$379.27 ,other,,Not separately reimbursable per table 3 referenced in contract
11982 Removal,8037176,CDM,521,RC,11982,HCPCS,outpatient,,,$342.00 ,$256.50 ,,$314.64 ,92,,,$197.64 ,$331.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$331.74 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$331.74 ,other,,Not applicable. No negotiated rates per contract,$294.12 ,86,,,$197.64 ,$331.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$273.60 ,80,,,$197.64 ,$331.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,95,,,$197.64 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.90 ,95,,,$197.64 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$256.50 ,75,,,$197.64 ,$331.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$290.70 ,85,,,$197.64 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$331.74 ,97,,,$197.64 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$331.74 ,case rate,,100% of clinic case rate per visit,$307.80 ,90,,,$197.64 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$331.74 ,97,,,$197.64 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$197.64 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$197.64 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.70 ,85,,,$197.64 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.80 ,90,,,$197.64 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,90,,,$197.64 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$331.74 ,other,,Not separately reimbursable per table 3 referenced in contract
11983 Removal with reinsertion,8037177,CDM,521,RC,11983,HCPCS,outpatient,,,$609.00 ,$456.75 ,,$560.28 ,92,,,$197.64 ,$590.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$590.73 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$590.73 ,other,,Not applicable. No negotiated rates per contract,$523.74 ,86,,,$197.64 ,$590.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$487.20 ,80,,,$197.64 ,$590.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$590.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$578.55 ,95,,,$197.64 ,$590.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$578.55 ,95,,,$197.64 ,$590.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$456.75 ,75,,,$197.64 ,$590.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$517.65 ,85,,,$197.64 ,$590.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.73 ,97,,,$197.64 ,$590.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$590.73 ,case rate,,100% of clinic case rate per visit,$548.10 ,90,,,$197.64 ,$590.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$590.73 ,97,,,$197.64 ,$590.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$590.73 ,97,,,$197.64 ,$590.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$590.73 ,97,,,$197.64 ,$590.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$517.65 ,85,,,$197.64 ,$590.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$548.10 ,90,,,$197.64 ,$590.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$590.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$578.55 ,90,,,$197.64 ,$590.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$590.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$590.73 ,other,,Not separately reimbursable per table 3 referenced in contract
15275 Application of skin graft to face/neck/genitalia/hands/feet,8037254,CDM,510,RC,15275,HCPCS,outpatient,,,$403.00 ,$302.25 ,,$370.76 ,92,,,$35.00 ,$390.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$390.91 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$390.91 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$390.91 ,other,,Not seperately reimbursible per contract terms,$322.40 ,80,,,$35.00 ,$390.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.85 ,95,,,$35.00 ,$390.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$382.85 ,95,,,$35.00 ,$390.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.25 ,75,,,$35.00 ,$390.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$342.55 ,85,,,$35.00 ,$390.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$390.91 ,97,,,$35.00 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$390.91 ,case rate,,100% of clinic case rate per visit,$362.70 ,90,,,$35.00 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.91 ,97,,,$35.00 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$35.00 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.91 ,97,,,$35.00 ,$390.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$35.00 ,$390.91 ,case rate,,100% case rate for treatment room,$362.70 ,90,,,$35.00 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.85 ,90,,,$35.00 ,$390.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$390.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.79 ,93,,,$35.00 ,$390.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
17000 Clinic Destruct premalg lesion; first lesion,8037316,CDM,521,RC,17000,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$134.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$134.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$134.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$153.94 ,86,,,$134.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$143.20 ,80,,,$134.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$134.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$134.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$134.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$134.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$134.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$134.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$134.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$161.10 ,90,,,$134.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$134.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$134.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$134.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$134.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$134.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$134.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$134.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$134.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$134.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
17003 Clinic Destruction,8037317,CDM,521,RC,17003,HCPCS,outpatient,,,$41.00 ,$30.75 ,,$37.72 ,92,,,$30.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$30.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$30.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$35.26 ,86,,,$30.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.80 ,80,,,$30.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$30.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.95 ,95,,,$30.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.95 ,95,,,$30.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.75 ,75,,,$30.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.85 ,85,,,$30.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.77 ,97,,,$30.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$30.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$36.90 ,90,,,$30.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.77 ,97,,,$30.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.77 ,97,,,$30.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.77 ,97,,,$30.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.85 ,85,,,$30.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.90 ,90,,,$30.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$30.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.95 ,90,,,$30.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$30.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
17004 Destruction,8037318,CDM,521,RC,17004,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
17110 Destruction of benign lesions; 1-14 lesions,8037321,CDM,521,RC,17110,HCPCS,outpatient,,,$234.00 ,$175.50 ,,$215.28 ,92,,,$175.50 ,$226.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$175.50 ,$226.98 ,case rate,,100% of clinic case rate per visit,,,,,$175.50 ,$226.98 ,other,,Not applicable. No negotiated rates per contract,$201.24 ,86,,,$175.50 ,$226.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$187.20 ,80,,,$175.50 ,$226.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$175.50 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,95,,,$175.50 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.30 ,95,,,$175.50 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.50 ,75,,,$175.50 ,$226.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.90 ,85,,,$175.50 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.98 ,97,,,$175.50 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$175.50 ,$226.98 ,case rate,,100% of clinic case rate per visit,$210.60 ,90,,,$175.50 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.98 ,97,,,$175.50 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$175.50 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$175.50 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.90 ,85,,,$175.50 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.60 ,90,,,$175.50 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$175.50 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,90,,,$175.50 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$175.50 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$175.50 ,$226.98 ,other,,Not separately reimbursable per table 3 referenced in contract
17250 Chemical cauterization of granulation tissue (proud flesh,8037323,CDM,521,RC,17250,HCPCS,outpatient,,,$299.00 ,$224.25 ,,$275.08 ,92,,,$197.64 ,$290.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$290.03 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$290.03 ,other,,Not applicable. No negotiated rates per contract,$257.14 ,86,,,$197.64 ,$290.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$239.20 ,80,,,$197.64 ,$290.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,95,,,$197.64 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.05 ,95,,,$197.64 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.25 ,75,,,$197.64 ,$290.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$254.15 ,85,,,$197.64 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$290.03 ,97,,,$197.64 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$290.03 ,case rate,,100% of clinic case rate per visit,$269.10 ,90,,,$197.64 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.03 ,97,,,$197.64 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$197.64 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$197.64 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.15 ,85,,,$197.64 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.10 ,90,,,$197.64 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,90,,,$197.64 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$290.03 ,other,,Not separately reimbursable per table 3 referenced in contract
20526 Injection,8037394,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
20550 Injection(s); single tendon sheath,8037396,CDM,521,RC,20550,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
20552 Injection(s); single or multiple trigger point(s),8037398,CDM,521,RC,20552,HCPCS,outpatient,,,$165.00 ,$123.75 ,,$151.80 ,92,,,$123.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$123.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$123.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$141.90 ,86,,,$123.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.00 ,80,,,$123.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$123.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,95,,,$123.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.75 ,95,,,$123.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.75 ,75,,,$123.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.25 ,85,,,$123.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.05 ,97,,,$123.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$123.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$148.50 ,90,,,$123.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,97,,,$123.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$123.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$123.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,85,,,$123.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.50 ,90,,,$123.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$123.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,90,,,$123.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$123.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$123.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
20553 Injection(s); single or multiple trigger point(s),8037399,CDM,521,RC,20553,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$144.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$144.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$144.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$165.98 ,86,,,$144.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.40 ,80,,,$144.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$144.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$144.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$144.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$144.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$144.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$173.70 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$144.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$144.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
20600 Arthrocentesis,8037400,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
20605 Arthrocentesis,8037401,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
20610 Arthrocentesis,8037402,CDM,521,RC,20610,HCPCS,outpatient,,,$510.00 ,$382.50 ,,$469.20 ,92,,,$197.64 ,$494.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$494.70 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$494.70 ,other,,Not applicable. No negotiated rates per contract,$438.60 ,86,,,$197.64 ,$494.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$408.00 ,80,,,$197.64 ,$494.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$484.50 ,95,,,$197.64 ,$494.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$484.50 ,95,,,$197.64 ,$494.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$382.50 ,75,,,$197.64 ,$494.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$433.50 ,85,,,$197.64 ,$494.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$494.70 ,97,,,$197.64 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$494.70 ,case rate,,100% of clinic case rate per visit,$459.00 ,90,,,$197.64 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$494.70 ,97,,,$197.64 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$494.70 ,97,,,$197.64 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$494.70 ,97,,,$197.64 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.50 ,85,,,$197.64 ,$494.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$459.00 ,90,,,$197.64 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$484.50 ,90,,,$197.64 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$494.70 ,other,,Not separately reimbursable per table 3 referenced in contract
20612 Aspiration and/or injection of ganglion cyst(s) any location,8037403,CDM,521,RC,20612,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$174.75 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$174.75 ,$226.01 ,case rate,,100% of clinic case rate per visit,,,,,$174.75 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$200.38 ,86,,,$174.75 ,$226.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.40 ,80,,,$174.75 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$174.75 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$174.75 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$174.75 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$174.75 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$174.75 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$174.75 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$174.75 ,$226.01 ,case rate,,100% of clinic case rate per visit,$209.70 ,90,,,$174.75 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$174.75 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$174.75 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$174.75 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$174.75 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$174.75 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$174.75 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$174.75 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$174.75 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.75 ,$226.01 ,other,,Not separately reimbursable per table 3 referenced in contract
23500 Closed treatment of clavicular fracture; without manipulation,8037662,CDM,521,RC,23500,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
24530 Closed tx supra/transcondylar humeral fx,8037734,CDM,521,RC,24530,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
24560 Closed treatment of humeral epicondylar fracture,8037739,CDM,521,RC,24560,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
24650 Closed treatment of radial head or neck fracture; without manipulation,8037753,CDM,983,RC,24650,HCPCS,outpatient,,,$838.00 ,$628.50 ,,$309.26 ,135,cms physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,135% of 2011 CMS physician fee schedule,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$258.92 ,$796.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$327.71 ,100,,,$258.92 ,$796.10 ,fee schedule,,100% of the Blue Cross physician fee schedule,$487.20 ,100,physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$375.43 ,145,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,145% CMS Medicare physician fee schedule ,$796.10 ,95,,,$258.92 ,$796.10 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$258.92 ,$796.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$356.57 ,100,,,$258.92 ,$796.10 ,fee schedule,,100% Humana physician fee schedule,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$258.92 ,$796.10 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$258.92 ,$796.10 ,other,,Not separately reimbursable per contract terms,$502.80 ,60,,,$258.92 ,$796.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$502.80 ,60,,,$258.92 ,$796.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$362.49 ,140,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$258.92 ,$796.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$796.10 ,95,,,$258.92 ,$796.10 ,percent of total billed charges,,95% of total billed charges,$258.92 ,100,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$323.01 ,124.753,CMS physician fee schedule,,$258.92 ,$796.10 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
25560 Closed treatment of radial and ulnar shaft fractures; without manipulation,8037846,CDM,521,RC,25560,HCPCS,outpatient,,,"$1,016.00 ",$762.00 ,,$934.72 ,92,,,$197.64 ,$985.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$985.52 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$985.52 ,other,,Not applicable. No negotiated rates per contract,$873.76 ,86,,,$197.64 ,$985.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$812.80 ,80,,,$197.64 ,$985.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$985.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$965.20 ,95,,,$197.64 ,$985.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$965.20 ,95,,,$197.64 ,$985.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$762.00 ,75,,,$197.64 ,$985.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$863.60 ,85,,,$197.64 ,$985.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$985.52 ,97,,,$197.64 ,$985.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$985.52 ,case rate,,100% of clinic case rate per visit,$914.40 ,90,,,$197.64 ,$985.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$985.52 ,97,,,$197.64 ,$985.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$985.52 ,97,,,$197.64 ,$985.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$985.52 ,97,,,$197.64 ,$985.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$863.60 ,85,,,$197.64 ,$985.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$914.40 ,90,,,$197.64 ,$985.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$985.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$965.20 ,90,,,$197.64 ,$985.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$985.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$985.52 ,other,,Not separately reimbursable per table 3 referenced in contract
25565 Closed treatment of radial and ulnar shaft fractures; with manipulation,8037847,CDM,521,RC,25565,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
25600 Closed treatment of distal radial fracture; without manipulation,8037850,CDM,521,RC,25600,HCPCS,outpatient,,,"$1,059.00 ",$794.25 ,,$974.28 ,92,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,"$1,027.23 ",case rate,,100% of clinic case rate per visit,,,,,$197.64 ,"$1,027.23 ",other,,Not applicable. No negotiated rates per contract,$910.74 ,86,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$847.20 ,80,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,006.05 ",95,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,006.05 ",95,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$794.25 ,75,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$900.15 ,85,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,027.23 ",97,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,"$1,027.23 ",case rate,,100% of clinic case rate per visit,$953.10 ,90,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,027.23 ",97,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,027.23 ",97,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,027.23 ",97,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$900.15 ,85,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$953.10 ,90,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,006.05 ",90,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,027.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,"$1,027.23 ",other,,Not separately reimbursable per table 3 referenced in contract
25605 Closed treatment of distal radial fracture; with manipulation,8037851,CDM,521,RC,25605,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
25630 Closed treatment of carpal bone fracture; without manipulation,8037859,CDM,521,RC,25630,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
25650 Closed treatment of ulnar styloid fracture,8037862,CDM,521,RC,25650,HCPCS,outpatient,,,"$1,047.00 ",$785.25 ,,$963.24 ,92,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,"$1,015.59 ",case rate,,100% of clinic case rate per visit,,,,,$197.64 ,"$1,015.59 ",other,,Not applicable. No negotiated rates per contract,$900.42 ,86,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$837.60 ,80,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$994.65 ,95,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$994.65 ,95,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$785.25 ,75,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$889.95 ,85,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,015.59 ",97,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,"$1,015.59 ",case rate,,100% of clinic case rate per visit,$942.30 ,90,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,015.59 ",97,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,015.59 ",97,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,015.59 ",97,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$889.95 ,85,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$942.30 ,90,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$994.65 ,90,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,"$1,015.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,"$1,015.59 ",other,,Not separately reimbursable per table 3 referenced in contract
26600 Closed treatment of metacarpal fracture,8037982,CDM,521,RC,26600,HCPCS,outpatient,,,$915.00 ,$686.25 ,,$841.80 ,92,,,$197.64 ,$887.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$887.55 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$887.55 ,other,,Not applicable. No negotiated rates per contract,$786.90 ,86,,,$197.64 ,$887.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$732.00 ,80,,,$197.64 ,$887.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$887.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$869.25 ,95,,,$197.64 ,$887.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$869.25 ,95,,,$197.64 ,$887.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$686.25 ,75,,,$197.64 ,$887.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$777.75 ,85,,,$197.64 ,$887.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$887.55 ,97,,,$197.64 ,$887.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$887.55 ,case rate,,100% of clinic case rate per visit,$823.50 ,90,,,$197.64 ,$887.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$887.55 ,97,,,$197.64 ,$887.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$887.55 ,97,,,$197.64 ,$887.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$887.55 ,97,,,$197.64 ,$887.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$777.75 ,85,,,$197.64 ,$887.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$823.50 ,90,,,$197.64 ,$887.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$887.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$869.25 ,90,,,$197.64 ,$887.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$887.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$887.55 ,other,,Not separately reimbursable per table 3 referenced in contract
26750 Closed treatment of distal phalangeal fracture,8038006,CDM,521,RC,26750,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
27487 Revision of total knee arthroplasty; femoral and entire tibial component,8038158,CDM,360,RC,27487,HCPCS,outpatient,,,"$6,016.00 ","$4,512.00 ",,"$5,534.72 ",92,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,308.80 ",55,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,308.80 ","$5,835.52 ",other,,Not applicable. No negotiated rates per contract,"$5,173.76 ",86,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,812.80 ",80,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,308.80 ",55,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,715.20 ",95,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,715.20 ",95,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,512.00 ",75,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,113.60 ",85,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,835.52 ",97,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,308.80 ",55,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,414.40 ",90,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,835.52 ",97,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,835.52 ",97,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,835.52 ",97,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,113.60 ",85,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,414.40 ",90,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,308.80 ",55,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,715.20 ",90,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,308.80 ",55,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,594.88 ",93,,,"$3,308.80 ","$5,835.52 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27570 Manipulation of knee joint under general anesthesia,8038192,CDM,975,RC,27570,HCPCS,outpatient,,,$507.00 ,$380.25 ,,$197.17 ,135,cms physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$158.61 ,$481.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$188.12 ,100,,,$158.61 ,$481.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$303.80 ,100,physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.98 ,145,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$481.65 ,95,,,$158.61 ,$481.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$158.61 ,$481.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$221.27 ,100,,,$158.61 ,$481.65 ,fee schedule,,100% Humana physician fee schedule,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$158.61 ,$481.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$158.61 ,$481.65 ,other,,Not separately reimbursable per contract terms,$304.20 ,60,,,$158.61 ,$481.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$304.20 ,60,,,$158.61 ,$481.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.05 ,140,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$158.61 ,$481.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$481.65 ,95,,,$158.61 ,$481.65 ,percent of total billed charges,,95% of total billed charges,$158.61 ,100,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$197.87 ,124.753,CMS physician fee schedule,,$158.61 ,$481.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27780 Closed treatment of proximal fibula or shaft fracture; without manipulation,8038260,CDM,521,RC,27780,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation,8038263,CDM,521,RC,27786,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
27810 Closed treatment of bimalleolar ankle fracture; with manipulation,8038267,CDM,521,RC,27810,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
28190 Removal of foreign body,8038342,CDM,521,RC,28190,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
28232 Tenotomy,9091736,CDM,975,RC,28232,HCPCS,outpatient,,,,,,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursible per contract terms,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursible. Not contracted for physician rates,$485.76 ,100,,,$354.82 ,$485.76 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursable per contract terms,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$354.82 ,100,,,$354.82 ,$485.76 ,fee schedule,,100% Humana physician fee schedule,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursable per contract terms,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursable per contract terms,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursable per contract terms,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursable per contract terms,,,,,$354.82 ,$485.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$354.82 ,$485.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
28430 Closed treatment of talus fracture; without manipulation,8038383,CDM,521,RC,28430,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29065 Application,8038436,CDM,521,RC,29065,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29075 Short Arm Cast,9080413,CDM,521,RC,29075,HCPCS,outpatient,,,$237.00 ,$177.75 ,,$218.04 ,92,,,$177.75 ,$229.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$177.75 ,$229.89 ,case rate,,100% of clinic case rate per visit,,,,,$177.75 ,$229.89 ,other,,Not applicable. No negotiated rates per contract,$203.82 ,86,,,$177.75 ,$229.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$189.60 ,80,,,$177.75 ,$229.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$177.75 ,$229.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.15 ,95,,,$177.75 ,$229.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.15 ,95,,,$177.75 ,$229.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.75 ,75,,,$177.75 ,$229.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$201.45 ,85,,,$177.75 ,$229.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$229.89 ,97,,,$177.75 ,$229.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$177.75 ,$229.89 ,case rate,,100% of clinic case rate per visit,$213.30 ,90,,,$177.75 ,$229.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$229.89 ,97,,,$177.75 ,$229.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.89 ,97,,,$177.75 ,$229.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.89 ,97,,,$177.75 ,$229.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.45 ,85,,,$177.75 ,$229.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$213.30 ,90,,,$177.75 ,$229.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$177.75 ,$229.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.15 ,90,,,$177.75 ,$229.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$177.75 ,$229.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$177.75 ,$229.89 ,other,,Not separately reimbursable per table 3 referenced in contract
29105 Application of long arm splint (shoulder to hand),8038439,CDM,521,RC,29105,HCPCS,outpatient,,,$262.00 ,$196.50 ,,$241.04 ,92,,,$196.50 ,$254.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$196.50 ,$254.14 ,case rate,,100% of clinic case rate per visit,,,,,$196.50 ,$254.14 ,other,,Not applicable. No negotiated rates per contract,$225.32 ,86,,,$196.50 ,$254.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$209.60 ,80,,,$196.50 ,$254.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$196.50 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.90 ,95,,,$196.50 ,$254.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.90 ,95,,,$196.50 ,$254.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$196.50 ,75,,,$196.50 ,$254.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$222.70 ,85,,,$196.50 ,$254.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.14 ,97,,,$196.50 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$196.50 ,$254.14 ,case rate,,100% of clinic case rate per visit,$235.80 ,90,,,$196.50 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.14 ,97,,,$196.50 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.14 ,97,,,$196.50 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.14 ,97,,,$196.50 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.70 ,85,,,$196.50 ,$254.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.80 ,90,,,$196.50 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$196.50 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.90 ,90,,,$196.50 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$196.50 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$196.50 ,$254.14 ,other,,Not separately reimbursable per table 3 referenced in contract
29125 CLINIC Application of short arm splint (forearm to hand); static,8038440,CDM,521,RC,29125,HCPCS,outpatient,,,$199.00 ,$149.25 ,,$183.08 ,92,,,$149.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$149.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$149.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$171.14 ,86,,,$149.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$159.20 ,80,,,$149.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$149.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,95,,,$149.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.05 ,95,,,$149.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.25 ,75,,,$149.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$169.15 ,85,,,$149.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.03 ,97,,,$149.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$149.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$179.10 ,90,,,$149.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.03 ,97,,,$149.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$149.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$149.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.15 ,85,,,$149.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.10 ,90,,,$149.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$149.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,90,,,$149.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$149.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
29130 – Application of Finger Splint ,9252476,CDM,521,RC,29130,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29131 Application of finger splint; dynamic,8038443,CDM,521,RC,29131,HCPCS,outpatient,,,$152.00 ,$114.00 ,,$139.84 ,92,,,$114.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$114.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$114.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$130.72 ,86,,,$114.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.60 ,80,,,$114.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.40 ,95,,,$114.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.40 ,95,,,$114.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.00 ,75,,,$114.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.20 ,85,,,$114.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$114.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$136.80 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.44 ,97,,,$114.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.20 ,85,,,$114.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.80 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.40 ,90,,,$114.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$114.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$114.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
29240 Strapping,8038445,CDM,521,RC,29240,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29405 Application of short leg cast (below knee to toes);,8038452,CDM,521,RC,29405,HCPCS,outpatient,,,$278.00 ,$208.50 ,,$255.76 ,92,,,$197.64 ,$269.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$269.66 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$269.66 ,other,,Not applicable. No negotiated rates per contract,$239.08 ,86,,,$197.64 ,$269.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$222.40 ,80,,,$197.64 ,$269.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.10 ,95,,,$197.64 ,$269.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.10 ,95,,,$197.64 ,$269.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.50 ,75,,,$197.64 ,$269.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$236.30 ,85,,,$197.64 ,$269.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.66 ,97,,,$197.64 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$269.66 ,case rate,,100% of clinic case rate per visit,$250.20 ,90,,,$197.64 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.66 ,97,,,$197.64 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.66 ,97,,,$197.64 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.66 ,97,,,$197.64 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.30 ,85,,,$197.64 ,$269.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.20 ,90,,,$197.64 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.10 ,90,,,$197.64 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$269.66 ,other,,Not separately reimbursable per table 3 referenced in contract
29505 Application of long leg splint (thigh to ankle or toes),8038458,CDM,521,RC,29505,HCPCS,outpatient,,,$301.00 ,$225.75 ,,$276.92 ,92,,,$197.64 ,$291.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$291.97 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$291.97 ,other,,Not applicable. No negotiated rates per contract,$258.86 ,86,,,$197.64 ,$291.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$240.80 ,80,,,$197.64 ,$291.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.95 ,95,,,$197.64 ,$291.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$285.95 ,95,,,$197.64 ,$291.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.75 ,75,,,$197.64 ,$291.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$255.85 ,85,,,$197.64 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.97 ,97,,,$197.64 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$291.97 ,case rate,,100% of clinic case rate per visit,$270.90 ,90,,,$197.64 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.97 ,97,,,$197.64 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$197.64 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$197.64 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.85 ,85,,,$197.64 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.90 ,90,,,$197.64 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.95 ,90,,,$197.64 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$291.97 ,other,,Not separately reimbursable per table 3 referenced in contract
29515 Application of short leg splint (calf to foot),8038459,CDM,521,RC,29515,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$197.64 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$275.48 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$197.64 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$197.64 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$197.64 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$197.64 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$197.64 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$197.64 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$275.48 ,case rate,,100% of clinic case rate per visit,$255.60 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$197.64 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$275.48 ,other,,Not separately reimbursable per table 3 referenced in contract
29530 Strapping; knee,8282285,CDM,521,RC,29530,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29580 Strapping Unna boot,8038462,CDM,521,RC,29580,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$144.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$144.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$144.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$165.98 ,86,,,$144.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.40 ,80,,,$144.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$144.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$144.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$144.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$144.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$144.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$173.70 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$144.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$144.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$144.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$144.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$144.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
29700 Removal or bivalving; gauntlet,8038464,CDM,521,RC,29700,HCPCS,outpatient,,,$182.00 ,$136.50 ,,$167.44 ,92,,,$136.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$136.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$136.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$156.52 ,86,,,$136.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$145.60 ,80,,,$136.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,95,,,$136.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.90 ,95,,,$136.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.50 ,75,,,$136.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$154.70 ,85,,,$136.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$136.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$163.80 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$136.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.70 ,85,,,$136.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$163.80 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,90,,,$136.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$136.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
29705 Removal or bivalving; full arm or full leg cast,8038465,CDM,521,RC,29705,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
29870 Arthroscopy,8038500,CDM,975,RC,,HCPCS,outpatient,,,,,,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30000 Drainage abscess or hematoma,8038525,CDM,450,RC,30000,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
30020 Drainage abscess or hematoma,8038526,CDM,450,RC,30020,HCPCS,outpatient,,,$732.00 ,$549.00 ,,$673.44 ,92,,,$402.60 ,$710.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$402.60 ,$710.04 ,other,,Not applicable. No negotiated rates per contract,$629.52 ,86,,,$402.60 ,$710.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$585.60 ,80,,,$402.60 ,$710.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.40 ,95,,,$402.60 ,$710.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$695.40 ,95,,,$402.60 ,$710.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$549.00 ,75,,,$402.60 ,$710.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$622.20 ,85,,,$402.60 ,$710.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$658.80 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$622.20 ,85,,,$402.60 ,$710.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$658.80 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.40 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.76 ,93,,,$402.60 ,$710.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
30300 Removal foreign body,8038541,CDM,521,RC,30300,HCPCS,outpatient,,,$357.00 ,$267.75 ,,$328.44 ,92,,,$197.64 ,$346.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$346.29 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$346.29 ,other,,Not applicable. No negotiated rates per contract,$307.02 ,86,,,$197.64 ,$346.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$285.60 ,80,,,$197.64 ,$346.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$346.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.15 ,95,,,$197.64 ,$346.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$339.15 ,95,,,$197.64 ,$346.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.75 ,75,,,$197.64 ,$346.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$303.45 ,85,,,$197.64 ,$346.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$346.29 ,97,,,$197.64 ,$346.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$346.29 ,case rate,,100% of clinic case rate per visit,$321.30 ,90,,,$197.64 ,$346.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.29 ,97,,,$197.64 ,$346.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.29 ,97,,,$197.64 ,$346.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.29 ,97,,,$197.64 ,$346.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.45 ,85,,,$197.64 ,$346.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.30 ,90,,,$197.64 ,$346.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$346.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.15 ,90,,,$197.64 ,$346.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$346.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$346.29 ,other,,Not separately reimbursable per table 3 referenced in contract
30801 Ablation,8038555,CDM,521,RC,30801,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
30901 CLINIC Control nasal hemorrhage,8038557,CDM,521,RC,30901,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
30903 Control nasal hemorrhage,8038558,CDM,521,RC,30903,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
30905 Control nasal hemorrhage,8038559,CDM,521,RC,30905,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
31575 Laryngoscopy,8038634,CDM,450,RC,31575,HCPCS,outpatient,,,$259.00 ,$194.25 ,,$238.28 ,92,,,$142.45 ,$251.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.45 ,$251.23 ,other,,Not applicable. No negotiated rates per contract,$222.74 ,86,,,$142.45 ,$251.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.20 ,80,,,$142.45 ,$251.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.25 ,75,,,$142.45 ,$251.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.87 ,93,,,$142.45 ,$251.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
40806 Incision of labial frenum (frenotomy),8039110,CDM,521,RC,40806,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$197.64 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$334.65 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$197.64 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$197.64 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$197.64 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$197.64 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$197.64 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$197.64 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$197.64 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$334.65 ,case rate,,100% of clinic case rate per visit,$310.50 ,90,,,$197.64 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$197.64 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$197.64 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$197.64 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$197.64 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$197.64 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$197.64 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$334.65 ,other,,Not separately reimbursable per table 3 referenced in contract
41010 Incision of labial frenum (frenotomy),9614235,CDM,521,RC,41010,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
41010 Incision of lingual frenum (frenotomy),8039127,CDM,521,RC,41010,HCPCS,outpatient,,,$741.00 ,$555.75 ,,$681.72 ,92,,,$197.64 ,$718.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$718.77 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$718.77 ,other,,Not applicable. No negotiated rates per contract,$637.26 ,86,,,$197.64 ,$718.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$592.80 ,80,,,$197.64 ,$718.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.95 ,95,,,$197.64 ,$718.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$703.95 ,95,,,$197.64 ,$718.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$555.75 ,75,,,$197.64 ,$718.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$629.85 ,85,,,$197.64 ,$718.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$718.77 ,97,,,$197.64 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$718.77 ,case rate,,100% of clinic case rate per visit,$666.90 ,90,,,$197.64 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$718.77 ,97,,,$197.64 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$718.77 ,97,,,$197.64 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$718.77 ,97,,,$197.64 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$629.85 ,85,,,$197.64 ,$718.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.90 ,90,,,$197.64 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.95 ,90,,,$197.64 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$718.77 ,other,,Not separately reimbursable per table 3 referenced in contract
42000 Drainage of abscess of palate,8039157,CDM,450,RC,42000,HCPCS,outpatient,,,$338.00 ,$253.50 ,,$310.96 ,92,,,$185.90 ,$327.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$185.90 ,55,,,$185.90 ,$327.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$185.90 ,$327.86 ,other,,Not applicable. No negotiated rates per contract,$290.68 ,86,,,$185.90 ,$327.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$270.40 ,80,,,$185.90 ,$327.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$185.90 ,55,,,$185.90 ,$327.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.10 ,95,,,$185.90 ,$327.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$321.10 ,95,,,$185.90 ,$327.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$253.50 ,75,,,$185.90 ,$327.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$287.30 ,85,,,$185.90 ,$327.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$327.86 ,97,,,$185.90 ,$327.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.90 ,55,,,$185.90 ,$327.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.20 ,90,,,$185.90 ,$327.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$327.86 ,97,,,$185.90 ,$327.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$327.86 ,97,,,$185.90 ,$327.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$327.86 ,97,,,$185.90 ,$327.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.30 ,85,,,$185.90 ,$327.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$304.20 ,90,,,$185.90 ,$327.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.90 ,55,,,$185.90 ,$327.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.10 ,90,,,$185.90 ,$327.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.90 ,55,,,$185.90 ,$327.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.34 ,93,,,$185.90 ,$327.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
43247 Esophagogastroduodenoscopy,8039262,CDM,450,RC,43247,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45915 Removal of fecal impaction or foreign body (separate procedure) under anesthesia,8039455,CDM,450,RC,45915,HCPCS,outpatient,,,"$1,665.00 ","$1,248.75 ",,"$1,531.80 ",92,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$915.75 ,55,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$915.75 ,"$1,615.05 ",other,,Not applicable. No negotiated rates per contract,"$1,431.90 ",86,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,332.00 ",80,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$915.75 ,55,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,581.75 ",95,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",95,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,248.75 ",75,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,415.25 ",85,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,615.05 ",97,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$915.75 ,55,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,498.50 ",90,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,615.05 ",97,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,615.05 ",97,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,615.05 ",97,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,415.25 ",85,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,498.50 ",90,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$915.75 ,55,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,581.75 ",90,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$915.75 ,55,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,548.45 ",93,,,$915.75 ,"$1,615.05 ",percent of total billed charges,,93% of total billed charges for outpatient setting
51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound,8039690,CDM,521,RC,51798,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
52000 Cystourethroscopy (separate procedure),8039699,CDM,761,RC,52000,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
53620 Dilation of urethral stricture by passage of filiform and follower,8039758,CDM,450,RC,53620,HCPCS,outpatient,,,$922.00 ,$691.50 ,,$848.24 ,92,,,$507.10 ,$894.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$507.10 ,55,,,$507.10 ,$894.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$507.10 ,$894.34 ,other,,Not applicable. No negotiated rates per contract,$792.92 ,86,,,$507.10 ,$894.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$737.60 ,80,,,$507.10 ,$894.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$507.10 ,55,,,$507.10 ,$894.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$875.90 ,95,,,$507.10 ,$894.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$875.90 ,95,,,$507.10 ,$894.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$691.50 ,75,,,$507.10 ,$894.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$783.70 ,85,,,$507.10 ,$894.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$894.34 ,97,,,$507.10 ,$894.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$507.10 ,55,,,$507.10 ,$894.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$829.80 ,90,,,$507.10 ,$894.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$894.34 ,97,,,$507.10 ,$894.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$894.34 ,97,,,$507.10 ,$894.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$894.34 ,97,,,$507.10 ,$894.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$783.70 ,85,,,$507.10 ,$894.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$829.80 ,90,,,$507.10 ,$894.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$507.10 ,55,,,$507.10 ,$894.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$875.90 ,90,,,$507.10 ,$894.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$507.10 ,55,,,$507.10 ,$894.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$857.46 ,93,,,$507.10 ,$894.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
54150 Circumcision,8039775,CDM,521,RC,54150,HCPCS,outpatient,,,$459.00 ,$344.25 ,,$422.28 ,92,,,$197.64 ,$445.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$445.23 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$445.23 ,other,,Not applicable. No negotiated rates per contract,$394.74 ,86,,,$197.64 ,$445.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$367.20 ,80,,,$197.64 ,$445.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$436.05 ,95,,,$197.64 ,$445.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$436.05 ,95,,,$197.64 ,$445.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$344.25 ,75,,,$197.64 ,$445.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$390.15 ,85,,,$197.64 ,$445.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$445.23 ,case rate,,100% of clinic case rate per visit,$413.10 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.15 ,85,,,$197.64 ,$445.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$413.10 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$436.05 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$445.23 ,other,,Not separately reimbursable per table 3 referenced in contract
54162 Lysis or excision of penile post-circumicision adhesions,8273487,CDM,521,RC,54162,HCPCS,outpatient,,,$843.00 ,$632.25 ,,$775.56 ,92,,,$197.64 ,$817.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$817.71 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$817.71 ,other,,Not applicable. No negotiated rates per contract,$724.98 ,86,,,$197.64 ,$817.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$674.40 ,80,,,$197.64 ,$817.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$817.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$800.85 ,95,,,$197.64 ,$817.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$800.85 ,95,,,$197.64 ,$817.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$632.25 ,75,,,$197.64 ,$817.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$716.55 ,85,,,$197.64 ,$817.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$817.71 ,97,,,$197.64 ,$817.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$817.71 ,case rate,,100% of clinic case rate per visit,$758.70 ,90,,,$197.64 ,$817.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$817.71 ,97,,,$197.64 ,$817.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$817.71 ,97,,,$197.64 ,$817.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$817.71 ,97,,,$197.64 ,$817.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$716.55 ,85,,,$197.64 ,$817.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$758.70 ,90,,,$197.64 ,$817.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$817.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$800.85 ,90,,,$197.64 ,$817.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$817.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$817.71 ,other,,Not separately reimbursable per table 3 referenced in contract
54220 Irrigation of corpora cavernosa for priapism,8039781,CDM,450,RC,54220,HCPCS,outpatient,,,$399.00 ,$299.25 ,,$367.08 ,92,,,$219.45 ,$387.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.45 ,$387.03 ,other,,Not applicable. No negotiated rates per contract,$343.14 ,86,,,$219.45 ,$387.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$319.20 ,80,,,$219.45 ,$387.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.05 ,95,,,$219.45 ,$387.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$379.05 ,95,,,$219.45 ,$387.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.25 ,75,,,$219.45 ,$387.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$339.15 ,85,,,$219.45 ,$387.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.15 ,85,,,$219.45 ,$387.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$359.10 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.05 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.07 ,93,,,$219.45 ,$387.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
54235 INJECTION OF CORPORA CAVERN-ER PROC,8051068,CDM,450,RC,54235,HCPCS,outpatient,,,$399.00 ,$299.25 ,,$367.08 ,92,,,$219.45 ,$387.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.45 ,$387.03 ,other,,Not applicable. No negotiated rates per contract,$343.14 ,86,,,$219.45 ,$387.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$319.20 ,80,,,$219.45 ,$387.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.05 ,95,,,$219.45 ,$387.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$379.05 ,95,,,$219.45 ,$387.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.25 ,75,,,$219.45 ,$387.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$339.15 ,85,,,$219.45 ,$387.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.03 ,97,,,$219.45 ,$387.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.15 ,85,,,$219.45 ,$387.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$359.10 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.05 ,90,,,$219.45 ,$387.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.45 ,55,,,$219.45 ,$387.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.07 ,93,,,$219.45 ,$387.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
54450 Foreskin manipulation including lysis of preputial adhesions and stretching,8039796,CDM,521,RC,54450,HCPCS,outpatient,,,$218.00 ,$163.50 ,,$200.56 ,92,,,$163.50 ,$211.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$163.50 ,$211.46 ,case rate,,100% of clinic case rate per visit,,,,,$163.50 ,$211.46 ,other,,Not applicable. No negotiated rates per contract,$187.48 ,86,,,$163.50 ,$211.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$174.40 ,80,,,$163.50 ,$211.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$163.50 ,$211.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.10 ,95,,,$163.50 ,$211.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$207.10 ,95,,,$163.50 ,$211.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.50 ,75,,,$163.50 ,$211.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$185.30 ,85,,,$163.50 ,$211.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$211.46 ,97,,,$163.50 ,$211.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$163.50 ,$211.46 ,case rate,,100% of clinic case rate per visit,$196.20 ,90,,,$163.50 ,$211.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$211.46 ,97,,,$163.50 ,$211.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.46 ,97,,,$163.50 ,$211.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.46 ,97,,,$163.50 ,$211.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.30 ,85,,,$163.50 ,$211.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.20 ,90,,,$163.50 ,$211.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$163.50 ,$211.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.10 ,90,,,$163.50 ,$211.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$163.50 ,$211.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.50 ,$211.46 ,other,,Not separately reimbursable per table 3 referenced in contract
55100 Drainage of scrotal wall abscess,8039817,CDM,450,RC,55100,HCPCS,outpatient,,,"$2,274.00 ","$1,705.50 ",,"$2,092.08 ",92,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,250.70 ",55,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,250.70 ","$2,205.78 ",other,,Not applicable. No negotiated rates per contract,"$1,955.64 ",86,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,819.20 ",80,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,250.70 ",55,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,160.30 ",95,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,160.30 ",95,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,705.50 ",75,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,932.90 ",85,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,205.78 ",97,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,250.70 ",55,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,046.60 ",90,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,205.78 ",97,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,205.78 ",97,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,205.78 ",97,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,932.90 ",85,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,046.60 ",90,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,250.70 ",55,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,160.30 ",90,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,250.70 ",55,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.82 ",93,,,"$1,250.70 ","$2,205.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
55120 Removal of foreign body in scrotum,8039819,CDM,450,RC,55120,HCPCS,outpatient,,,"$2,935.00 ","$2,201.25 ",,"$2,700.20 ",92,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,614.25 ",55,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,614.25 ","$2,846.95 ",other,,Not applicable. No negotiated rates per contract,"$2,524.10 ",86,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,348.00 ",80,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,614.25 ",55,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,788.25 ",95,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,788.25 ",95,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,201.25 ",75,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,494.75 ",85,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,846.95 ",97,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,614.25 ",55,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,641.50 ",90,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,846.95 ",97,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.95 ",97,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.95 ",97,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,494.75 ",85,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,641.50 ",90,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,614.25 ",55,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,788.25 ",90,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,614.25 ",55,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,729.55 ",93,,,"$1,614.25 ","$2,846.95 ",percent of total billed charges,,93% of total billed charges for outpatient setting
57160 Fitting and insertion of pessary or other intravaginal support device,8039866,CDM,521,RC,57160,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
57415 Removal of impacted vaginal foreign body under anesthesia (other than local),8039888,CDM,521,RC,57415,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
57455 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix,8039894,CDM,983,RC,57455,HCPCS,outpatient,,,$720.00 ,$540.00 ,,$148.49 ,135,cms physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$111.06 ,$684.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$192.42 ,100,,,$111.06 ,$684.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$223.30 ,100,physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$161.04 ,145,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$684.00 ,95,,,$111.06 ,$684.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$111.06 ,$684.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$161.17 ,100,,,$111.06 ,$684.00 ,fee schedule,,100% Humana physician fee schedule,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$111.06 ,$684.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$221.26 ,100,,,$111.06 ,$684.00 ,fee schedule,,100% Midlands Choice physician fee schedule,$432.00 ,60,,,$111.06 ,$684.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$432.00 ,60,,,$111.06 ,$684.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$155.48 ,140,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$111.06 ,$684.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$684.00 ,95,,,$111.06 ,$684.00 ,percent of total billed charges,,95% of total billed charges,$111.06 ,100,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$138.55 ,124.753,CMS physician fee schedule,,$111.06 ,$684.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
58100 Endometrial biopsy with or w/o endocer biopsy,8039911,CDM,983,RC,58100,HCPCS,outpatient,,,$352.00 ,$264.00 ,,$117.56 ,135,cms physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,135% of 2011 CMS physician fee schedule,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$64.93 ,$334.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$121.55 ,100,,,$64.93 ,$334.40 ,fee schedule,,100% of the Blue Cross physician fee schedule,$130.19 ,100,physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$94.15 ,145,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,145% CMS Medicare physician fee schedule ,$334.40 ,95,,,$64.93 ,$334.40 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$64.93 ,$334.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$93.83 ,100,,,$64.93 ,$334.40 ,fee schedule,,100% Humana physician fee schedule,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$64.93 ,$334.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$142.54 ,100,,,$64.93 ,$334.40 ,fee schedule,,100% Midlands Choice physician fee schedule,$211.20 ,60,,,$64.93 ,$334.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$211.20 ,60,,,$64.93 ,$334.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.90 ,140,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$64.93 ,$334.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$334.40 ,95,,,$64.93 ,$334.40 ,percent of total billed charges,,95% of total billed charges,$64.93 ,100,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$81.00 ,124.753,CMS physician fee schedule,,$64.93 ,$334.40 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
58110 Peak Flow Clinic POC (RE),8039912,CDM,983,RC,58110,HCPCS,outpatient,,,,,,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursible per contract terms,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$63.14 ,100,,,$60.05 ,$63.14 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursable per contract terms,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$60.05 ,100,,,$60.05 ,$63.14 ,fee schedule,,100% Humana physician fee schedule,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursable per contract terms,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursable per contract terms,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursable per contract terms,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursable per contract terms,,,,,$60.05 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$60.05 ,$63.14 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
58300 Insertion of intrauterine device (IUD),8039933,CDM,521,RC,58300,HCPCS,outpatient,,,$310.00 ,$232.50 ,,$285.20 ,92,,,$197.64 ,$300.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$300.70 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$300.70 ,other,,Not applicable. No negotiated rates per contract,$266.60 ,86,,,$197.64 ,$300.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$248.00 ,80,,,$197.64 ,$300.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$300.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$294.50 ,95,,,$197.64 ,$300.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$294.50 ,95,,,$197.64 ,$300.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$232.50 ,75,,,$197.64 ,$300.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$263.50 ,85,,,$197.64 ,$300.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.70 ,97,,,$197.64 ,$300.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$300.70 ,case rate,,100% of clinic case rate per visit,$279.00 ,90,,,$197.64 ,$300.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.70 ,97,,,$197.64 ,$300.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.70 ,97,,,$197.64 ,$300.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.70 ,97,,,$197.64 ,$300.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.50 ,85,,,$197.64 ,$300.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$279.00 ,90,,,$197.64 ,$300.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$300.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$294.50 ,90,,,$197.64 ,$300.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$300.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$300.70 ,other,,Not separately reimbursable per table 3 referenced in contract
58301 Removal of intrauterine device (IUD),8039934,CDM,521,RC,58301,HCPCS,outpatient,,,$328.00 ,$246.00 ,,$301.76 ,92,,,$197.64 ,$318.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$318.16 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$318.16 ,other,,Not applicable. No negotiated rates per contract,$282.08 ,86,,,$197.64 ,$318.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$262.40 ,80,,,$197.64 ,$318.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,95,,,$197.64 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$311.60 ,95,,,$197.64 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.00 ,75,,,$197.64 ,$318.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$278.80 ,85,,,$197.64 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$318.16 ,97,,,$197.64 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$318.16 ,case rate,,100% of clinic case rate per visit,$295.20 ,90,,,$197.64 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$318.16 ,97,,,$197.64 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$197.64 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$197.64 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.80 ,85,,,$197.64 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.20 ,90,,,$197.64 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,90,,,$197.64 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$318.16 ,other,,Not separately reimbursable per table 3 referenced in contract
59414 Deliver Placenta,9049178,CDM,450,RC,59414,HCPCS,outpatient,,,"$5,156.00 ","$3,867.00 ",,"$4,743.52 ",92,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,835.80 ",55,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,835.80 ","$5,001.32 ",other,,Not applicable. No negotiated rates per contract,"$4,434.16 ",86,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,124.80 ",80,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,835.80 ",55,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,898.20 ",95,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,898.20 ",95,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,867.00 ",75,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,382.60 ",85,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,001.32 ",97,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,835.80 ",55,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,640.40 ",90,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,001.32 ",97,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,001.32 ",97,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,001.32 ",97,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,382.60 ",85,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,640.40 ",90,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,835.80 ",55,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,898.20 ",90,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,835.80 ",55,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,795.08 ",93,,,"$2,835.80 ","$5,001.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
59425 Antepartum care only; 4-6 visits,8040019,CDM,521,RC,59425,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
59426 Antepartum care only; 7 or more visits,8040020,CDM,521,RC,59426,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
60100 Biopsy thyroid,8040042,CDM,983,RC,60100,HCPCS,outpatient,,,$410.00 ,$307.50 ,,$104.13 ,135,cms physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.67 ,$389.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$138.30 ,100,,,$77.67 ,$389.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$157.50 ,100,physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$112.62 ,145,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$389.50 ,95,,,$77.67 ,$389.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$77.67 ,$389.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$113.99 ,100,,,$77.67 ,$389.50 ,fee schedule,,100% Humana physician fee schedule,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.67 ,$389.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$77.67 ,$389.50 ,other,,Not separately reimbursable per contract terms,$246.00 ,60,,,$77.67 ,$389.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$246.00 ,60,,,$77.67 ,$389.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$108.74 ,140,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$77.67 ,$389.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$389.50 ,95,,,$77.67 ,$389.50 ,percent of total billed charges,,95% of total billed charges,$77.67 ,100,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$96.90 ,124.753,CMS physician fee schedule,,$77.67 ,$389.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64405 Injection,8891019,CDM,521,RC,64405,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
64450 Injection,8040179,CDM,521,RC,64450,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
64630 Destruction by neurolytic agent,8680647,CDM,983,RC,64630,HCPCS,outpatient,,,,,,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursible per contract terms,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursible. Not contracted for physician rates,$301.51 ,100,,,$276.19 ,$301.51 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursable per contract terms,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$276.19 ,100,,,$276.19 ,$301.51 ,fee schedule,,100% Humana physician fee schedule,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursable per contract terms,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursable per contract terms,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursable per contract terms,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursable per contract terms,,,,,$276.19 ,$301.51 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$276.19 ,$301.51 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
64721 Neuroplasty and/or transposition; median nerve at carpal tunnel,8040227,CDM,983,RC,64721,HCPCS,outpatient,,,,,,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursible per contract terms,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$544.18 ,100,,,$544.18 ,$853.13 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursable per contract terms,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$631.13 ,100,,,$544.18 ,$853.13 ,fee schedule,,100% Humana physician fee schedule,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$853.13 ,100,,,$544.18 ,$853.13 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursable per contract terms,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursable per contract terms,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursable per contract terms,,,,,$544.18 ,$853.13 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$544.18 ,$853.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
65205 Removal of foreign body,8040274,CDM,521,RC,65205,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
65210 Removal of foreign body,8040275,CDM,521,RC,65210,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
65220 Removal of foreign body,8040276,CDM,521,RC,65220,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
65222 Removal of foreign body,8040277,CDM,521,RC,65222,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
69020 Drainage external auditory canal,8040480,CDM,450,RC,69020,HCPCS,outpatient,,,"$1,011.00 ",$758.25 ,,$930.12 ,92,,,$556.05 ,$980.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$556.05 ,55,,,$556.05 ,$980.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$556.05 ,$980.67 ,other,,Not applicable. No negotiated rates per contract,$869.46 ,86,,,$556.05 ,$980.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$808.80 ,80,,,$556.05 ,$980.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$556.05 ,55,,,$556.05 ,$980.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$960.45 ,95,,,$556.05 ,$980.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$960.45 ,95,,,$556.05 ,$980.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$758.25 ,75,,,$556.05 ,$980.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$859.35 ,85,,,$556.05 ,$980.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$980.67 ,97,,,$556.05 ,$980.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$556.05 ,55,,,$556.05 ,$980.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$909.90 ,90,,,$556.05 ,$980.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$980.67 ,97,,,$556.05 ,$980.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$980.67 ,97,,,$556.05 ,$980.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$980.67 ,97,,,$556.05 ,$980.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$859.35 ,85,,,$556.05 ,$980.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$909.90 ,90,,,$556.05 ,$980.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$556.05 ,55,,,$556.05 ,$980.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$960.45 ,90,,,$556.05 ,$980.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$556.05 ,55,,,$556.05 ,$980.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$940.23 ,93,,,$556.05 ,$980.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
69200 Removal foreign body from external auditory canal; without general anesthesia,8040489,CDM,521,RC,69200,HCPCS,outpatient,,,$157.00 ,$117.75 ,,$144.44 ,92,,,$117.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$117.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$117.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$135.02 ,86,,,$117.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$125.60 ,80,,,$117.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$117.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,95,,,$117.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.15 ,95,,,$117.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.75 ,75,,,$117.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$133.45 ,85,,,$117.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.29 ,97,,,$117.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$117.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$141.30 ,90,,,$117.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.29 ,97,,,$117.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$117.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$117.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.45 ,85,,,$117.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.30 ,90,,,$117.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$117.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,90,,,$117.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$117.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
69209 Ear Irrigation POC,8040491,CDM,521,RC,69209,HCPCS,outpatient,,,$64.00 ,$48.00 ,,$58.88 ,92,,,$48.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$48.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$48.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$55.04 ,86,,,$48.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$51.20 ,80,,,$48.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$48.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.80 ,95,,,$48.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.80 ,95,,,$48.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.00 ,75,,,$48.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$54.40 ,85,,,$48.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.08 ,97,,,$48.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$48.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$57.60 ,90,,,$48.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.08 ,97,,,$48.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.08 ,97,,,$48.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.08 ,97,,,$48.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.40 ,85,,,$48.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.60 ,90,,,$48.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$48.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.80 ,90,,,$48.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$48.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
69210 Clinic Removal impacted cerumen requiring instrumentation,8040492,CDM,521,RC,69210,HCPCS,outpatient,,,$115.00 ,$86.25 ,,$105.80 ,92,,,$86.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$86.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$86.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$98.90 ,86,,,$86.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.00 ,80,,,$86.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$86.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,95,,,$86.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.25 ,95,,,$86.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.25 ,75,,,$86.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.75 ,85,,,$86.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.55 ,97,,,$86.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$86.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$103.50 ,90,,,$86.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.55 ,97,,,$86.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$86.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$86.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.75 ,85,,,$86.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.50 ,90,,,$86.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$86.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,90,,,$86.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$86.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$86.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
86382 Neutralization test,8040568,CDM,302,RC,86382,HCPCS,outpatient,,,,,,,,,,$7.44 ,$7.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.44 ,$7.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.44 ,$7.44 ,other,,Not applicable. No negotiated rates per contract,$7.44 ,44,,,$7.44 ,$7.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.44 ,$7.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.44 ,$7.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.44 ,$7.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.44 ,$7.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.44 ,$7.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.44 ,$7.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.44 ,$7.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
89060 Crystal identification by light microscopy with or without polarizing lens analysis,8040571,CDM,300,RC,89060,HCPCS,outpatient,,,$210.00 ,$157.50 ,,$193.20 ,92,,,$3.23 ,$203.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.23 ,$203.70 ,other,,Not applicable. No negotiated rates per contract,$3.23 ,44,,,$3.23 ,$203.70 ,fee schedule,,44% of CMS Medicare lab fee schedule,$168.00 ,80,,,$3.23 ,$203.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,95,,,$3.23 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.50 ,95,,,$3.23 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.50 ,75,,,$3.23 ,$203.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.50 ,85,,,$3.23 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.00 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.50 ,85,,,$3.23 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.00 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.30 ,93,,,$3.23 ,$203.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
92977 Thrombolysis,8040639,CDM,450,RC,92977,HCPCS,outpatient,,,"$1,026.00 ",$769.50 ,,$943.92 ,92,,,$564.30 ,$995.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$564.30 ,55,,,$564.30 ,$995.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$564.30 ,$995.22 ,other,,Not applicable. No negotiated rates per contract,$882.36 ,86,,,$564.30 ,$995.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$820.80 ,80,,,$564.30 ,$995.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$564.30 ,55,,,$564.30 ,$995.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$974.70 ,95,,,$564.30 ,$995.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$974.70 ,95,,,$564.30 ,$995.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$769.50 ,75,,,$564.30 ,$995.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$872.10 ,85,,,$564.30 ,$995.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$995.22 ,97,,,$564.30 ,$995.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$564.30 ,55,,,$564.30 ,$995.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$923.40 ,90,,,$564.30 ,$995.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$995.22 ,97,,,$564.30 ,$995.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$995.22 ,97,,,$564.30 ,$995.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$995.22 ,97,,,$564.30 ,$995.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$872.10 ,85,,,$564.30 ,$995.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$923.40 ,90,,,$564.30 ,$995.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.30 ,55,,,$564.30 ,$995.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$974.70 ,90,,,$564.30 ,$995.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.30 ,55,,,$564.30 ,$995.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$954.18 ,93,,,$564.30 ,$995.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93005 Clinic EKG w/ 12+ leads; Tracing Only,8040643,CDM,521,RC,93005,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
93010 EKG w/ 12+ leads; Interp/Report Only,8040644,CDM,521,RC,93010,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
94200 Lung Function Test,9091219,CDM,460,RC,94200,HCPCS,outpatient,,,$117.00 ,$87.75 ,,$107.64 ,92,,,$64.35 ,$113.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.35 ,55,,,$64.35 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.35 ,$113.49 ,other,,Not applicable. No negotiated rates per contract,$100.62 ,86,,,$64.35 ,$113.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$93.60 ,80,,,$64.35 ,$113.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.35 ,55,,,$64.35 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.15 ,95,,,$64.35 ,$113.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.15 ,95,,,$64.35 ,$113.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.75 ,75,,,$64.35 ,$113.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$99.45 ,85,,,$64.35 ,$113.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.49 ,97,,,$64.35 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.35 ,55,,,$64.35 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.30 ,90,,,$64.35 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.49 ,97,,,$64.35 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.49 ,97,,,$64.35 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.49 ,97,,,$64.35 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.45 ,85,,,$64.35 ,$113.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.30 ,90,,,$64.35 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.35 ,55,,,$64.35 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.15 ,90,,,$64.35 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.35 ,55,,,$64.35 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.81 ,93,,,$64.35 ,$113.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94618 Pulmonary stress testing,8988969,CDM,521,RC,94618,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction,8040758,CDM,521,RC,94640,HCPCS,outpatient,,,$63.00 ,$47.25 ,,$57.96 ,92,,,$47.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$47.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$47.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$54.18 ,86,,,$47.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$50.40 ,80,,,$47.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$47.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.85 ,95,,,$47.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.85 ,95,,,$47.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.25 ,75,,,$47.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$53.55 ,85,,,$47.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.11 ,97,,,$47.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$47.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$56.70 ,90,,,$47.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.11 ,97,,,$47.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.11 ,97,,,$47.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.11 ,97,,,$47.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.55 ,85,,,$47.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.70 ,90,,,$47.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$47.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.85 ,90,,,$47.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$47.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
94660 Continuous positive airway pressure ventilation (CPAP),8040759,CDM,521,RC,94660,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
95992 Canalith repositioning procedure(s),8040857,CDM,521,RC,95992,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
96160 Pt Focused Hlth Risk Assmt,9025442,CDM,521,RC,96160,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$18.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$18.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$18.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$18.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$18.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$18.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$18.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$18.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$18.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$18.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$22.50 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$18.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
96161 Caregiver-Focused Hlth Risk Assmt,11187243,CDM,521,RC,96161,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$18.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$18.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$18.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$18.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$18.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$18.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$18.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$18.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$18.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$18.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$22.50 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$18.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$18.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$18.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$18.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
97597 DEBRIDEMENT CHARGE.,8669080,CDM,521,RC,97597,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
97810 Acupuncture,8680675,CDM,374,RC,97810,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$55.00 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.00 ,$97.00 ,other,,Not applicable. No negotiated rates per contract,$86.00 ,86,,,$55.00 ,$97.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.00 ,80,,,$55.00 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$55.00 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$55.00 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
98925 Osteopathic manipulative treatment (OMT); 1-2 body regions involved,8040907,CDM,521,RC,98925,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$78.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$78.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$78.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$90.30 ,86,,,$78.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$84.00 ,80,,,$78.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$78.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$78.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$78.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$78.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$78.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$78.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$78.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$94.50 ,90,,,$78.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$78.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$78.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$78.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$78.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$78.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$78.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$78.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$78.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$78.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
98926 Osteopathic manipulative treatment (OMT); 3-4 body regions involved,8040908,CDM,521,RC,98926,HCPCS,outpatient,,,$131.00 ,$98.25 ,,$120.52 ,92,,,$98.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$98.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$98.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$112.66 ,86,,,$98.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$104.80 ,80,,,$98.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$98.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,95,,,$98.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.45 ,95,,,$98.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.25 ,75,,,$98.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$111.35 ,85,,,$98.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.07 ,97,,,$98.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$98.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$117.90 ,90,,,$98.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.07 ,97,,,$98.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$98.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$98.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.35 ,85,,,$98.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.90 ,90,,,$98.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$98.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,90,,,$98.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$98.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$98.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
98927 Osteopathic manipulative treatment (OMT); 5-6 body regions involved,8040909,CDM,521,RC,98927,HCPCS,outpatient,,,$190.00 ,$142.50 ,,$174.80 ,92,,,$142.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$142.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$142.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$163.40 ,86,,,$142.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$152.00 ,80,,,$142.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$142.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,95,,,$142.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.50 ,95,,,$142.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,75,,,$142.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$161.50 ,85,,,$142.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$184.30 ,97,,,$142.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$142.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$171.00 ,90,,,$142.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.30 ,97,,,$142.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$142.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$142.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.50 ,85,,,$142.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.00 ,90,,,$142.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$142.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,90,,,$142.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$142.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
98928 Osteopathic manipulative treatment (OMT); 7-8 body regions involved,8040910,CDM,521,RC,98928,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
98966 Telephone assessment/management; est pt/parent/guardian; 5-10 minutes,8040917,CDM,521,RC,98966,HCPCS,outpatient,,,$109.00 ,$81.75 ,,$100.28 ,92,,,$81.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$81.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$81.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$93.74 ,86,,,$81.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$87.20 ,80,,,$81.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$81.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.55 ,95,,,$81.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.55 ,95,,,$81.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.75 ,75,,,$81.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$92.65 ,85,,,$81.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.73 ,97,,,$81.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$81.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$98.10 ,90,,,$81.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.73 ,97,,,$81.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.73 ,97,,,$81.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.73 ,97,,,$81.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.65 ,85,,,$81.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.10 ,90,,,$81.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$81.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.55 ,90,,,$81.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$81.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
98967 Telephone Assessment 11-20 mins,8870256,CDM,521,RC,98967,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
98968 Telephone Assessment 21-30 mins,8870257,CDM,521,RC,98968,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99001 Handling and/or conveyance of specimen for transfer from the patient in other than an office t,8680676,CDM,521,RC,99001,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99441 Telephone Evaluation and Management 5-10 min,8870303,CDM,960,RC,99441,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$16.78 ,135,cms physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,135% of 2011 CMS physician fee schedule,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.78 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$17.18 ,100,,,$16.78 ,$106.40 ,fee schedule,,100% of the Blue Cross physician fee schedule,$40.88 ,100,physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$52.42 ,145,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,145% CMS Medicare physician fee schedule ,$106.40 ,95,,,$16.78 ,$106.40 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$16.78 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.97 ,100,,,$16.78 ,$106.40 ,fee schedule,,100% Humana physician fee schedule,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.78 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.72 ,100,,,$16.78 ,$106.40 ,fee schedule,,100% Midlands Choice physician fee schedule,$67.20 ,60,,,$16.78 ,$106.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$67.20 ,60,,,$16.78 ,$106.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$50.61 ,140,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$16.78 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$106.40 ,95,,,$16.78 ,$106.40 ,percent of total billed charges,,95% of total billed charges,$36.15 ,100,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$45.10 ,124.753,CMS physician fee schedule,,$16.78 ,$106.40 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99442 Telephone Evaluation and Management 11-20 min,8870304,CDM,960,RC,99442,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$33.86 ,135,cms physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$33.50 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$33.50 ,100,,,$33.50 ,$116.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$81.20 ,100,physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$97.82 ,145,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$116.85 ,95,,,$33.50 ,$116.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$33.50 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$73.54 ,100,,,$33.50 ,$116.85 ,fee schedule,,100% Humana physician fee schedule,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$33.50 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.08 ,100,,,$33.50 ,$116.85 ,fee schedule,,100% Midlands Choice physician fee schedule,$73.80 ,60,,,$33.50 ,$116.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.80 ,60,,,$33.50 ,$116.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$94.44 ,140,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$33.50 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$116.85 ,95,,,$33.50 ,$116.85 ,percent of total billed charges,,95% of total billed charges,$67.46 ,100,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$84.16 ,124.753,CMS physician fee schedule,,$33.50 ,$116.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
G0439 Annual Wellness visit subsequent visit (each exam thereafter) CCMC,9573232,CDM,521,RC,G0439,HCPCS,outpatient,,,$247.00 ,$185.25 ,,$227.24 ,92,,,$185.25 ,$239.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$185.25 ,$239.59 ,case rate,,100% of clinic case rate per visit,,,,,$185.25 ,$239.59 ,other,,Not applicable. No negotiated rates per contract,$212.42 ,86,,,$185.25 ,$239.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$197.60 ,80,,,$185.25 ,$239.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$185.25 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.65 ,95,,,$185.25 ,$239.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.65 ,95,,,$185.25 ,$239.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$185.25 ,75,,,$185.25 ,$239.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$209.95 ,85,,,$185.25 ,$239.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$239.59 ,97,,,$185.25 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$185.25 ,$239.59 ,case rate,,100% of clinic case rate per visit,$222.30 ,90,,,$185.25 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.59 ,97,,,$185.25 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.59 ,97,,,$185.25 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.59 ,97,,,$185.25 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.95 ,85,,,$185.25 ,$239.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$222.30 ,90,,,$185.25 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$185.25 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.65 ,90,,,$185.25 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$185.25 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$185.25 ,$239.59 ,other,,Not separately reimbursable per table 3 referenced in contract
G0511 CCM RHC 20 Minutes,8118446,CDM,521,RC,G0511,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$39.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$39.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$39.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$39.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$39.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$39.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$39.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$39.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$39.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$39.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$46.80 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$39.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$39.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$39.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$39.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
J1030 depomedrol x 40 mg,8952548,CDM,636,RC,J1030,HCPCS,both,40,mg,$82.00 ,$61.50 ,,$75.44 ,92,,,$45.10 ,$79.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.10 ,$79.54 ,other,,Not applicable. No negotiated rates per contract,$70.52 ,86,,,$45.10 ,$79.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.60 ,80,,,$45.10 ,$79.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.50 ,75,,,$45.10 ,$79.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.26 ,93,,,$45.10 ,$79.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Q3014 Telemedicine Site Fee,8314313,CDM,510,RC,Q3014,HCPCS,outpatient,,,$60.00 ,$45.00 ,,$55.20 ,92,,,$35.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$35.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$48.00 ,80,,,$35.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,95,,,$35.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.00 ,95,,,$35.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.00 ,75,,,$35.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.00 ,85,,,$35.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.20 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$35.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$54.00 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.20 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.20 ,97,,,$35.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$35.00 ,$197.64 ,case rate,,100% case rate for treatment room,$54.00 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.00 ,90,,,$35.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$35.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,93,,,$35.00 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
S0119 Ondansetron,8122167,CDM,636,RC,S0119,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
27096 INJECTION FOR SACROILIAC JOINT,9362522,CDM,964,RC,27096,HCPCS,outpatient,,,$964.00 ,$723.00 ,,$98.81 ,135,cms physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.93 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$201.87 ,100,,,$83.93 ,$915.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$167.30 ,100,physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.70 ,145,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$915.80 ,95,,,$83.93 ,$915.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$83.93 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.44 ,100,,,$83.93 ,$915.80 ,fee schedule,,100% Humana physician fee schedule,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.93 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$171.74 ,100,,,$83.93 ,$915.80 ,fee schedule,,100% Midlands Choice physician fee schedule,$578.40 ,60,,,$83.93 ,$915.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$578.40 ,60,,,$83.93 ,$915.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$117.50 ,140,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$83.93 ,$915.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$915.80 ,95,,,$83.93 ,$915.80 ,percent of total billed charges,,95% of total billed charges,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$104.71 ,124.753,CMS physician fee schedule,,$83.93 ,$915.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
62323 ANESTHES. STEROID EPIDURAL,8759949,CDM,964,RC,62323,HCPCS,outpatient,,,$330.00 ,$247.50 ,,,,,,$101.13 ,$319.98 ,other,,Not seperately reimbursible per contract terms,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$101.13 ,$319.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$319.98 ,100,,,$101.13 ,$319.98 ,fee schedule,,100% of the Blue Cross physician fee schedule,$200.20 ,100,physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$146.64 ,145,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,145% CMS Medicare physician fee schedule ,$313.50 ,95,,,$101.13 ,$319.98 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$101.13 ,$319.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$145.11 ,100,,,$101.13 ,$319.98 ,fee schedule,,100% Humana physician fee schedule,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$101.13 ,$319.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$204.42 ,100,,,$101.13 ,$319.98 ,fee schedule,,100% Midlands Choice physician fee schedule,$198.00 ,60,,,$101.13 ,$319.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$198.00 ,60,,,$101.13 ,$319.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$141.58 ,140,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$101.13 ,$319.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$313.50 ,95,,,$101.13 ,$319.98 ,percent of total billed charges,,95% of total billed charges,$101.13 ,100,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$126.16 ,124.753,CMS physician fee schedule,,$101.13 ,$319.98 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64447 FEMORAL NERVE BLOCK TECH FEE,8986982,CDM,964,RC,64447,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$88.48 ,135,cms physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$110.38 ,100,,,$53.39 ,$217.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$107.10 ,100,physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.42 ,145,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$53.39 ,$217.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.43 ,100,,,$53.39 ,$217.55 ,fee schedule,,100% Humana physician fee schedule,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$53.39 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$53.39 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$74.75 ,140,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$53.39 ,$217.55 ,percent of total billed charges,,95% of total billed charges,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$66.61 ,124.753,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
76942 Ultrasound Guidance with images,8977529,CDM,402,RC,76942,HCPCS,outpatient,,,$745.00 ,$558.75 ,,$685.40 ,92,,,$409.75 ,$722.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$409.75 ,$722.65 ,other,,Not applicable. No negotiated rates per contract,$640.70 ,86,,,$409.75 ,$722.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.00 ,80,,,$409.75 ,$722.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$558.75 ,75,,,$409.75 ,$722.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.85 ,93,,,$409.75 ,$722.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Anesthesia Time - 667195,1379881,CDM,964,RC,,HCPCS,outpatient,,,,,,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
Nasogastric (NG) Tube Insertion,607675,CDM,450,RC,,HCPCS,outpatient,,,$156.00 ,$117.00 ,,$143.52 ,92,,,$85.80 ,$151.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.80 ,55,,,$85.80 ,$151.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.80 ,$151.32 ,other,,Not seperately reimbursible per contract terms,$134.16 ,86,,,$85.80 ,$151.32 ,percent of total billed charges,,86% of total billed charges for ER visit,$124.80 ,80,,,$85.80 ,$151.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.80 ,55,,,$85.80 ,$151.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.20 ,95,,,$85.80 ,$151.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.20 ,95,,,$85.80 ,$151.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.00 ,75,,,$85.80 ,$151.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.60 ,85,,,$85.80 ,$151.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.32 ,97,,,$85.80 ,$151.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.80 ,55,,,$85.80 ,$151.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.40 ,90,,,$85.80 ,$151.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.32 ,97,,,$85.80 ,$151.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$85.80 ,$151.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$85.80 ,$151.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.60 ,85,,,$85.80 ,$151.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.40 ,90,,,$85.80 ,$151.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.80 ,55,,,$85.80 ,$151.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.20 ,90,,,$85.80 ,$151.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.80 ,55,,,$85.80 ,$151.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.08 ,93,,,$85.80 ,$151.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tympanoplasty,2727169,CDM,360,RC,69436,HCPCS,outpatient,,,$520.00 ,$390.00 ,,$478.40 ,92,,,$286.00 ,$504.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$286.00 ,$504.40 ,other,,Not applicable. No negotiated rates per contract,$447.20 ,86,,,$286.00 ,$504.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$416.00 ,80,,,$286.00 ,$504.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.00 ,75,,,$286.00 ,$504.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$483.60 ,93,,,$286.00 ,$504.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ABO Only,8143030,CDM,390,RC,86900,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$1.32 ,$101.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$101.85 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$101.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.00 ,80,,,$1.32 ,$101.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$1.32 ,$101.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.65 ,93,,,$1.32 ,$101.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ABO/Rh,634326,CDM,390,RC,86900,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$1.32 ,$101.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$101.85 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$101.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.00 ,80,,,$1.32 ,$101.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$1.32 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$1.32 ,$101.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$1.32 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$1.32 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$1.32 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$1.32 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.65 ,93,,,$1.32 ,$101.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Antibody Screen Gel,7032166,CDM,300,RC,86850,HCPCS,outpatient,,,$164.00 ,$123.00 ,,$150.88 ,92,,,$4.30 ,$159.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.30 ,$159.08 ,other,,Not applicable. No negotiated rates per contract,$4.30 ,44,,,$4.30 ,$159.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$131.20 ,80,,,$4.30 ,$159.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,95,,,$4.30 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$155.80 ,95,,,$4.30 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.00 ,75,,,$4.30 ,$159.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.40 ,85,,,$4.30 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.60 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.40 ,85,,,$4.30 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.60 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.52 ,93,,,$4.30 ,$159.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Antibody Screen Gel,8405295,CDM,302,RC,86850,HCPCS,outpatient,,,$164.00 ,$123.00 ,,$150.88 ,92,,,$4.30 ,$159.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.30 ,$159.08 ,other,,Not applicable. No negotiated rates per contract,$4.30 ,44,,,$4.30 ,$159.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$131.20 ,80,,,$4.30 ,$159.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,95,,,$4.30 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$155.80 ,95,,,$4.30 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.00 ,75,,,$4.30 ,$159.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.40 ,85,,,$4.30 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.60 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$4.30 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.40 ,85,,,$4.30 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.60 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,90,,,$4.30 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$4.30 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.52 ,93,,,$4.30 ,$159.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only ABID Panel,8042096,CDM,390,RC,86870,HCPCS,outpatient,,,$881.00 ,$660.75 ,,$810.52 ,92,,,$484.55 ,$854.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$484.55 ,$854.57 ,other,,Not applicable. No negotiated rates per contract,$757.66 ,86,,,$484.55 ,$854.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$704.80 ,80,,,$484.55 ,$854.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$660.75 ,75,,,$484.55 ,$854.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.33 ,93,,,$484.55 ,$854.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only DAT,8036624,CDM,390,RC,86880,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$2.37 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.37 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$2.37 ,44,,,$2.37 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$2.37 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$2.37 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$2.37 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only Miscellaneous,8036625,CDM,390,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Computer Crossmatch Interp -> Computer XM OK,8044225,CDM,390,RC,86922,HCPCS,outpatient,,,$464.00 ,$348.00 ,,$426.88 ,92,,,$255.20 ,$450.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$255.20 ,$450.08 ,other,,Not applicable. No negotiated rates per contract,$399.04 ,86,,,$255.20 ,$450.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$371.20 ,80,,,$255.20 ,$450.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.00 ,75,,,$255.20 ,$450.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.52 ,93,,,$255.20 ,$450.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DAT IgG Gel.,8246323,CDM,390,RC,86880,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$2.37 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.37 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$2.37 ,44,,,$2.37 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$2.37 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$2.37 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$2.37 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REF Antibody ID,7032173,CDM,390,RC,86870,HCPCS,outpatient,,,$881.00 ,$660.75 ,,$810.52 ,92,,,$484.55 ,$854.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$484.55 ,$854.57 ,other,,Not applicable. No negotiated rates per contract,$757.66 ,86,,,$484.55 ,$854.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$704.80 ,80,,,$484.55 ,$854.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$660.75 ,75,,,$484.55 ,$854.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.33 ,93,,,$484.55 ,$854.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REF Antibody Titer,8036628,CDM,390,RC,86886,HCPCS,outpatient,,,$479.00 ,$359.25 ,,$440.68 ,92,,,$2.28 ,$464.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$263.45 ,55,,,$2.28 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$464.63 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$464.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$383.20 ,80,,,$2.28 ,$464.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$263.45 ,55,,,$2.28 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$455.05 ,95,,,$2.28 ,$464.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$455.05 ,95,,,$2.28 ,$464.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$359.25 ,75,,,$2.28 ,$464.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$407.15 ,85,,,$2.28 ,$464.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$464.63 ,97,,,$2.28 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.45 ,55,,,$2.28 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.10 ,90,,,$2.28 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$464.63 ,97,,,$2.28 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.63 ,97,,,$2.28 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.63 ,97,,,$2.28 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.15 ,85,,,$2.28 ,$464.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$431.10 ,90,,,$2.28 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.45 ,55,,,$2.28 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$455.05 ,90,,,$2.28 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.45 ,55,,,$2.28 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.47 ,93,,,$2.28 ,$464.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REF DAT C3,8042229,CDM,390,RC,86880,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$2.37 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.37 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$2.37 ,44,,,$2.37 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$2.37 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$2.37 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$2.37 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REF DAT IgG,8042230,CDM,390,RC,86880,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$2.37 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.37 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$2.37 ,44,,,$2.37 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$2.37 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$2.37 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$2.37 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$2.37 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$2.37 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$2.37 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$2.37 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$2.37 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rh Only,8143031,CDM,390,RC,86901,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$1.32 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$1.32 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$1.32 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$1.32 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$1.32 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$1.32 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$1.32 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$1.32 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$1.32 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$1.32 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$1.32 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$1.32 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$1.32 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$1.32 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$1.32 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$1.32 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$1.32 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$1.32 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$1.32 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$1.32 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XM Gel Only Interp -> Compatible,8681467,CDM,390,RC,86922,HCPCS,outpatient,,,$464.00 ,$348.00 ,,$426.88 ,92,,,$255.20 ,$450.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$255.20 ,$450.08 ,other,,Not applicable. No negotiated rates per contract,$399.04 ,86,,,$255.20 ,$450.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$371.20 ,80,,,$255.20 ,$450.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.00 ,75,,,$255.20 ,$450.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.52 ,93,,,$255.20 ,$450.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XM Gel Only Interp -> Incompatible,8681466,CDM,390,RC,86922,HCPCS,outpatient,,,$464.00 ,$348.00 ,,$426.88 ,92,,,$255.20 ,$450.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$255.20 ,$450.08 ,other,,Not applicable. No negotiated rates per contract,$399.04 ,86,,,$255.20 ,$450.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$371.20 ,80,,,$255.20 ,$450.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.80 ,95,,,$255.20 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.00 ,75,,,$255.20 ,$450.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$255.20 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.40 ,85,,,$255.20 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.60 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,90,,,$255.20 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$255.20 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.52 ,93,,,$255.20 ,$450.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E0379 RBC CP2D AS3 500 LR Irr,7266658,CDM,390,RC,P9040,HCPCS,outpatient,,,$846.00 ,$634.50 ,,$778.32 ,92,,,$465.30 ,$820.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$465.30 ,55,,,$465.30 ,$820.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$465.30 ,$820.62 ,other,,Not applicable. No negotiated rates per contract,$727.56 ,86,,,$465.30 ,$820.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$676.80 ,80,,,$465.30 ,$820.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$465.30 ,55,,,$465.30 ,$820.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$803.70 ,95,,,$465.30 ,$820.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$803.70 ,95,,,$465.30 ,$820.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$634.50 ,75,,,$465.30 ,$820.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$719.10 ,85,,,$465.30 ,$820.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$820.62 ,97,,,$465.30 ,$820.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$465.30 ,55,,,$465.30 ,$820.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$761.40 ,90,,,$465.30 ,$820.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$820.62 ,97,,,$465.30 ,$820.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$820.62 ,97,,,$465.30 ,$820.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$820.62 ,97,,,$465.30 ,$820.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$719.10 ,85,,,$465.30 ,$820.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$761.40 ,90,,,$465.30 ,$820.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$465.30 ,55,,,$465.30 ,$820.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$803.70 ,90,,,$465.30 ,$820.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$465.30 ,55,,,$465.30 ,$820.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$786.78 ,93,,,$465.30 ,$820.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E0382 RBC CP2D AS3 500 LR,7266659,CDM,390,RC,P9016,HCPCS,outpatient,,,$645.00 ,$483.75 ,,$593.40 ,92,,,$354.75 ,$625.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$354.75 ,$625.65 ,other,,Not applicable. No negotiated rates per contract,$554.70 ,86,,,$354.75 ,$625.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.00 ,80,,,$354.75 ,$625.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$483.75 ,75,,,$354.75 ,$625.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.85 ,93,,,$354.75 ,$625.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E3088 Aph Plt ACDA LR 2,7266781,CDM,390,RC,,HCPCS,outpatient,,,"$1,611.00 ","$1,208.25 ",,"$1,482.12 ",92,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$886.05 ,55,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$886.05 ,"$1,562.67 ",other,,Not applicable. No negotiated rates per contract,"$1,385.46 ",86,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,288.80 ",80,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$886.05 ,55,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,530.45 ",95,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,530.45 ",95,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,208.25 ",75,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,369.35 ",85,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,562.67 ",97,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$886.05 ,55,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,449.90 ",90,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,562.67 ",97,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,562.67 ",97,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,562.67 ",97,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,369.35 ",85,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,449.90 ",90,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$886.05 ,55,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,530.45 ",90,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$886.05 ,55,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,498.23 ",93,,,$886.05 ,"$1,562.67 ",percent of total billed charges,,93% of total billed charges for outpatient setting
E4532 Aph RBC ACDA AS1 LR 1,7266602,CDM,390,RC,P9016,HCPCS,outpatient,,,$645.00 ,$483.75 ,,$593.40 ,92,,,$354.75 ,$625.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$354.75 ,$625.65 ,other,,Not applicable. No negotiated rates per contract,$554.70 ,86,,,$354.75 ,$625.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.00 ,80,,,$354.75 ,$625.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$483.75 ,75,,,$354.75 ,$625.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.85 ,93,,,$354.75 ,$625.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E4533 Aph RBC ACDA AS1 LR 2,7266603,CDM,390,RC,P9016,HCPCS,outpatient,,,$645.00 ,$483.75 ,,$593.40 ,92,,,$354.75 ,$625.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$354.75 ,$625.65 ,other,,Not applicable. No negotiated rates per contract,$554.70 ,86,,,$354.75 ,$625.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.00 ,80,,,$354.75 ,$625.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$483.75 ,75,,,$354.75 ,$625.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.85 ,93,,,$354.75 ,$625.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E4544 Aph RBC ACDA AS3 LR 1,7266614,CDM,390,RC,P9016,HCPCS,outpatient,,,$645.00 ,$483.75 ,,$593.40 ,92,,,$354.75 ,$625.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$354.75 ,$625.65 ,other,,Not applicable. No negotiated rates per contract,$554.70 ,86,,,$354.75 ,$625.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.00 ,80,,,$354.75 ,$625.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$483.75 ,75,,,$354.75 ,$625.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.85 ,93,,,$354.75 ,$625.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E4545 Aph RBC ACDA AS3 LR 2,7266615,CDM,390,RC,P9016,HCPCS,outpatient,,,$645.00 ,$483.75 ,,$593.40 ,92,,,$354.75 ,$625.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$354.75 ,$625.65 ,other,,Not applicable. No negotiated rates per contract,$554.70 ,86,,,$354.75 ,$625.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.00 ,80,,,$354.75 ,$625.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$612.75 ,95,,,$354.75 ,$625.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$483.75 ,75,,,$354.75 ,$625.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$625.65 ,97,,,$354.75 ,$625.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.25 ,85,,,$354.75 ,$625.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$580.50 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$612.75 ,90,,,$354.75 ,$625.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.75 ,55,,,$354.75 ,$625.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.85 ,93,,,$354.75 ,$625.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E7731  Thawed Aph Plasma ACDA RT<24Fr<24,8044671,CDM,390,RC,E7731,HCPCS,outpatient,,,$254.00 ,$190.50 ,,$233.68 ,92,,,$139.70 ,$246.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.70 ,$246.38 ,other,,Not applicable. No negotiated rates per contract,$218.44 ,86,,,$139.70 ,$246.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.20 ,80,,,$139.70 ,$246.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.30 ,95,,,$139.70 ,$246.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.30 ,95,,,$139.70 ,$246.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.50 ,75,,,$139.70 ,$246.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.90 ,85,,,$139.70 ,$246.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.60 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.90 ,85,,,$139.70 ,$246.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.60 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.30 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.22 ,93,,,$139.70 ,$246.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
E7731 Thawed Aph Plas ACDA RT<24Fr<24 Dv,8044670,CDM,390,RC,E7731,HCPCS,outpatient,,,$254.00 ,$190.50 ,,$233.68 ,92,,,$139.70 ,$246.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.70 ,$246.38 ,other,,Not applicable. No negotiated rates per contract,$218.44 ,86,,,$139.70 ,$246.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.20 ,80,,,$139.70 ,$246.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.30 ,95,,,$139.70 ,$246.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.30 ,95,,,$139.70 ,$246.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.50 ,75,,,$139.70 ,$246.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.90 ,85,,,$139.70 ,$246.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.60 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.38 ,97,,,$139.70 ,$246.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.90 ,85,,,$139.70 ,$246.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.60 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.30 ,90,,,$139.70 ,$246.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.70 ,55,,,$139.70 ,$246.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.22 ,93,,,$139.70 ,$246.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Anes Supplies Charge,8854594,CDM,272,RC,,HCPCS,outpatient,,,$436.00 ,$327.00 ,,$401.12 ,92,,,$239.80 ,$422.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.80 ,55,,,$239.80 ,$422.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.80 ,$422.92 ,other,,Not applicable. No negotiated rates per contract,$374.96 ,86,,,$239.80 ,$422.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.80 ,80,,,$239.80 ,$422.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.80 ,55,,,$239.80 ,$422.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$414.20 ,95,,,$239.80 ,$422.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$414.20 ,95,,,$239.80 ,$422.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.00 ,75,,,$239.80 ,$422.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$370.60 ,85,,,$239.80 ,$422.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$422.92 ,97,,,$239.80 ,$422.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.80 ,55,,,$239.80 ,$422.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$392.40 ,90,,,$239.80 ,$422.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$422.92 ,97,,,$239.80 ,$422.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.92 ,97,,,$239.80 ,$422.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.92 ,97,,,$239.80 ,$422.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$370.60 ,85,,,$239.80 ,$422.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.40 ,90,,,$239.80 ,$422.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.80 ,55,,,$239.80 ,$422.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$414.20 ,90,,,$239.80 ,$422.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.80 ,55,,,$239.80 ,$422.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$405.48 ,93,,,$239.80 ,$422.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93010 EKG INTERPRETATION CHARGE,8180736,CDM,730,RC,93010,HCPCS,outpatient,,,$45.00 ,$33.75 ,,$41.40 ,92,,,$24.75 ,$43.65 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.75 ,$43.65 ,other,,Not applicable. No negotiated rates per contract,$38.70 ,86,,,$24.75 ,$43.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.00 ,80,,,$24.75 ,$43.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,95,,,$24.75 ,$43.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,95,,,$24.75 ,$43.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,75,,,$24.75 ,$43.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$43.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.50 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$43.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.85 ,93,,,$24.75 ,$43.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93015 TREADMILL MONITOR OR DRUG INDUCED CHARGE,8584494,CDM,482,RC,93015,HCPCS,outpatient,,,$238.00 ,$178.50 ,,$218.96 ,92,,,$130.90 ,$230.86 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$130.90 ,55,,,$130.90 ,$230.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$130.90 ,$230.86 ,other,,Not applicable. No negotiated rates per contract,$204.68 ,86,,,$130.90 ,$230.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$190.40 ,80,,,$130.90 ,$230.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$130.90 ,55,,,$130.90 ,$230.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.10 ,95,,,$130.90 ,$230.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$226.10 ,95,,,$130.90 ,$230.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.50 ,75,,,$130.90 ,$230.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$202.30 ,85,,,$130.90 ,$230.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$230.86 ,97,,,$130.90 ,$230.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.90 ,55,,,$130.90 ,$230.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.20 ,90,,,$130.90 ,$230.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.86 ,97,,,$130.90 ,$230.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.86 ,97,,,$130.90 ,$230.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.86 ,97,,,$130.90 ,$230.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$202.30 ,85,,,$130.90 ,$230.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.20 ,90,,,$130.90 ,$230.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$130.90 ,55,,,$130.90 ,$230.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.10 ,90,,,$130.90 ,$230.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$130.90 ,55,,,$130.90 ,$230.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.34 ,93,,,$130.90 ,$230.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93017 Cardiac Stress Test Charge,8853973,CDM,482,RC,93017,HCPCS,outpatient,,,"$1,150.00 ",$862.50 ,,"$1,058.00 ",92,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$632.50 ,"$1,115.50 ",other,,Not applicable. No negotiated rates per contract,$989.00 ,86,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$920.00 ,80,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$862.50 ,75,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,069.50 ",93,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
93225 Holter Monitor Charge,8853974,CDM,731,RC,93225,HCPCS,outpatient,,,$348.00 ,$261.00 ,,$320.16 ,92,,,$191.40 ,$337.56 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$191.40 ,$337.56 ,other,,Not applicable. No negotiated rates per contract,$299.28 ,86,,,$191.40 ,$337.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$278.40 ,80,,,$191.40 ,$337.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$261.00 ,75,,,$191.40 ,$337.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.64 ,93,,,$191.40 ,$337.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93350 Echo Stress Test Charge,8220519,CDM,480,RC,93350,HCPCS,outpatient,,,"$1,654.00 ","$1,240.50 ",,"$1,521.68 ",92,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$909.70 ,55,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$909.70 ,"$1,604.38 ",other,,Not applicable. No negotiated rates per contract,"$1,422.44 ",86,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,323.20 ",80,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$909.70 ,55,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,571.30 ",95,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,571.30 ",95,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,240.50 ",75,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,405.90 ",85,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,604.38 ",97,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$909.70 ,55,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,488.60 ",90,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,604.38 ",97,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,604.38 ",97,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,604.38 ",97,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,405.90 ",85,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,488.60 ",90,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$909.70 ,55,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,571.30 ",90,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$909.70 ,55,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,538.22 ",93,,,$909.70 ,"$1,604.38 ",percent of total billed charges,,93% of total billed charges for outpatient setting
93797 CARD REHAB W/O MONITOR CHARGE,8265076,CDM,943,RC,93797,HCPCS,outpatient,,,$398.00 ,$298.50 ,,$366.16 ,92,,,$218.90 ,$386.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$218.90 ,$386.06 ,other,,Not applicable. No negotiated rates per contract,$342.28 ,86,,,$218.90 ,$386.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.40 ,80,,,$218.90 ,$386.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,95,,,$218.90 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.10 ,95,,,$218.90 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.50 ,75,,,$218.90 ,$386.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.30 ,85,,,$218.90 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.20 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.30 ,85,,,$218.90 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.20 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.14 ,93,,,$218.90 ,$386.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93798 CARD REHAB/MONITOR CHARGE,8265077,CDM,943,RC,93798,HCPCS,outpatient,,,$398.00 ,$298.50 ,,$366.16 ,92,,,$218.90 ,$386.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$218.90 ,$386.06 ,other,,Not applicable. No negotiated rates per contract,$342.28 ,86,,,$218.90 ,$386.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.40 ,80,,,$218.90 ,$386.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,95,,,$218.90 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.10 ,95,,,$218.90 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.50 ,75,,,$218.90 ,$386.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.30 ,85,,,$218.90 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.20 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$218.90 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.30 ,85,,,$218.90 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.20 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,90,,,$218.90 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$218.90 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.14 ,93,,,$218.90 ,$386.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94010 Pulmonary Function Test Charge,8853972,CDM,460,RC,94010,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94010 Pulmonary Function Test Charge,8853980,CDM,943,RC,94010,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94060 Pre & Post Pulmonary Function Test Charge,8853970,CDM,460,RC,94060,HCPCS,outpatient,,,$537.00 ,$402.75 ,,$494.04 ,92,,,$295.35 ,$520.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$295.35 ,55,,,$295.35 ,$520.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$295.35 ,$520.89 ,other,,Not applicable. No negotiated rates per contract,$461.82 ,86,,,$295.35 ,$520.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$429.60 ,80,,,$295.35 ,$520.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$295.35 ,55,,,$295.35 ,$520.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$510.15 ,95,,,$295.35 ,$520.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$510.15 ,95,,,$295.35 ,$520.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$402.75 ,75,,,$295.35 ,$520.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$456.45 ,85,,,$295.35 ,$520.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$520.89 ,97,,,$295.35 ,$520.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.35 ,55,,,$295.35 ,$520.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$483.30 ,90,,,$295.35 ,$520.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$520.89 ,97,,,$295.35 ,$520.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$520.89 ,97,,,$295.35 ,$520.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$520.89 ,97,,,$295.35 ,$520.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$456.45 ,85,,,$295.35 ,$520.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$483.30 ,90,,,$295.35 ,$520.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.35 ,55,,,$295.35 ,$520.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$510.15 ,90,,,$295.35 ,$520.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.35 ,55,,,$295.35 ,$520.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$499.41 ,93,,,$295.35 ,$520.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93005 EKG TRACING ONLY CHARGE,8180725,CDM,730,RC,93005,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$156.20 ,$275.48 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.20 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$156.20 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$156.20 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$156.20 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.12 ,93,,,$156.20 ,$275.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93270 EVENT MONITOR SETUP CHARGE,8223639,CDM,731,RC,93270,HCPCS,outpatient,,,$348.00 ,$261.00 ,,$320.16 ,92,,,$191.40 ,$337.56 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$191.40 ,$337.56 ,other,,Not applicable. No negotiated rates per contract,$299.28 ,86,,,$191.40 ,$337.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$278.40 ,80,,,$191.40 ,$337.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$261.00 ,75,,,$191.40 ,$337.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.64 ,93,,,$191.40 ,$337.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94644 CONTINUOUS INHALATION TREATMENT - 1ST HOUR,8730596,CDM,410,RC,94644,HCPCS,outpatient,,,$341.00 ,$255.75 ,,$313.72 ,92,,,$187.55 ,$330.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$187.55 ,$330.77 ,other,,Not applicable. No negotiated rates per contract,$293.26 ,86,,,$187.55 ,$330.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$272.80 ,80,,,$187.55 ,$330.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.75 ,75,,,$187.55 ,$330.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.13 ,93,,,$187.55 ,$330.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94645 CONTINUOUS INHALATION TREATMENT - EA ADD'L HOUR,8730597,CDM,410,RC,94645,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.57 ,93,,,$26.95 ,$47.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0403 EKG (IPPE) WITH INTERPRETATION,8730599,CDM,730,RC,G0403,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$156.20 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.20 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$156.20 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$156.20 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$156.20 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.12 ,93,,,$156.20 ,$275.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0404 EKG (IPPE),8730600,CDM,730,RC,G0404,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$156.20 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.20 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$156.20 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$156.20 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$156.20 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.12 ,93,,,$156.20 ,$275.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0424 PULM REHAB W EXER 1 HR PER SESSION CHARGE,8712881,CDM,948,RC,G0424,HCPCS,outpatient,,,$240.00 ,$180.00 ,,$220.80 ,92,,,$132.00 ,$232.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.00 ,$232.80 ,other,,Not applicable. No negotiated rates per contract,$206.40 ,86,,,$132.00 ,$232.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.00 ,80,,,$132.00 ,$232.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.00 ,95,,,$132.00 ,$232.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.00 ,95,,,$132.00 ,$232.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.00 ,75,,,$132.00 ,$232.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.00 ,85,,,$132.00 ,$232.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.00 ,85,,,$132.00 ,$232.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.20 ,93,,,$132.00 ,$232.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OXYGEN INITIAL SET UP CHARGE,8177486,CDM,270,RC,,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$55.00 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.00 ,$97.00 ,other,,Not applicable. No negotiated rates per contract,$86.00 ,86,,,$55.00 ,$97.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.00 ,80,,,$55.00 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$55.00 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$55.00 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96360 - ED Hydration,1928297,CDM,260,RC,96360,HCPCS,outpatient,,,$305.00 ,$228.75 ,,$280.60 ,92,,,$167.75 ,$295.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$167.75 ,$295.85 ,other,,Not applicable. No negotiated rates per contract,$262.30 ,86,,,$167.75 ,$295.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$244.00 ,80,,,$167.75 ,$295.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.75 ,75,,,$167.75 ,$295.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.65 ,93,,,$167.75 ,$295.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96361- ED Hydration,1928298,CDM,260,RC,96361,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$69.30 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.30 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$108.36 ,86,,,$69.30 ,$122.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.80 ,80,,,$69.30 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$69.30 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$69.30 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96365- ED IV tx,1928299,CDM,260,RC,96365,HCPCS,outpatient,,,$652.00 ,$489.00 ,,$599.84 ,92,,,$358.60 ,$632.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$358.60 ,55,,,$358.60 ,$632.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$358.60 ,$632.44 ,other,,Not applicable. No negotiated rates per contract,$560.72 ,86,,,$358.60 ,$632.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$521.60 ,80,,,$358.60 ,$632.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$358.60 ,55,,,$358.60 ,$632.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$619.40 ,95,,,$358.60 ,$632.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$619.40 ,95,,,$358.60 ,$632.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$489.00 ,75,,,$358.60 ,$632.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$554.20 ,85,,,$358.60 ,$632.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$632.44 ,97,,,$358.60 ,$632.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.60 ,55,,,$358.60 ,$632.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$586.80 ,90,,,$358.60 ,$632.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$632.44 ,97,,,$358.60 ,$632.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$632.44 ,97,,,$358.60 ,$632.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$632.44 ,97,,,$358.60 ,$632.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$554.20 ,85,,,$358.60 ,$632.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$586.80 ,90,,,$358.60 ,$632.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.60 ,55,,,$358.60 ,$632.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$619.40 ,90,,,$358.60 ,$632.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.60 ,55,,,$358.60 ,$632.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$606.36 ,93,,,$358.60 ,$632.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96366- ED IV tx,1928300,CDM,260,RC,96366,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$69.30 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.30 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$108.36 ,86,,,$69.30 ,$122.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.80 ,80,,,$69.30 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$69.30 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$69.30 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96367- ED IV tx,1928301,CDM,260,RC,96367,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$108.90 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$108.90 ,$192.06 ,other,,Not applicable. No negotiated rates per contract,$170.28 ,86,,,$108.90 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$108.90 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$108.90 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$108.90 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96372- ED Subq/IM Injection,1928303,CDM,260,RC,96372,HCPCS,outpatient,,,$199.00 ,$149.25 ,,$183.08 ,92,,,$25.00 ,$193.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$109.45 ,55,,,$25.00 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.00 ,$193.03 ,other,,Not applicable. No negotiated rates per contract,$171.14 ,86,,,$25.00 ,$193.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$159.20 ,80,,,$25.00 ,$193.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$109.45 ,55,,,$25.00 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.00 ,100,,,$25.00 ,$193.03 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$189.05 ,95,,,$25.00 ,$193.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.25 ,75,,,$25.00 ,$193.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$169.15 ,85,,,$25.00 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.03 ,97,,,$25.00 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.45 ,55,,,$25.00 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.10 ,90,,,$25.00 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.03 ,97,,,$25.00 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$25.00 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$25.00 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.15 ,85,,,$25.00 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.10 ,90,,,$25.00 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$25.00 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,90,,,$25.00 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$25.00 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.07 ,93,,,$25.00 ,$193.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96374-Injection,1928305,CDM,260,RC,96374,HCPCS,outpatient,,,$305.00 ,$228.75 ,,$280.60 ,92,,,$167.75 ,$295.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$167.75 ,$295.85 ,other,,Not applicable. No negotiated rates per contract,$262.30 ,86,,,$167.75 ,$295.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$244.00 ,80,,,$167.75 ,$295.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.75 ,75,,,$167.75 ,$295.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.65 ,93,,,$167.75 ,$295.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96375-IV Injection,1928306,CDM,260,RC,96375,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$69.30 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.30 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$108.36 ,86,,,$69.30 ,$122.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.80 ,80,,,$69.30 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$69.30 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$69.30 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$69.30 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$69.30 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$69.30 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$69.30 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$69.30 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96376- ED IV Injection,1928307,CDM,260,RC,96376,HCPCS,outpatient,,,$54.00 ,$40.50 ,,$49.68 ,92,,,$29.70 ,$52.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.70 ,55,,,$29.70 ,$52.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.70 ,$52.38 ,other,,Not applicable. No negotiated rates per contract,$46.44 ,86,,,$29.70 ,$52.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$43.20 ,80,,,$29.70 ,$52.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.70 ,55,,,$29.70 ,$52.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,95,,,$29.70 ,$52.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.30 ,95,,,$29.70 ,$52.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.50 ,75,,,$29.70 ,$52.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.90 ,85,,,$29.70 ,$52.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.38 ,97,,,$29.70 ,$52.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.70 ,55,,,$29.70 ,$52.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.60 ,90,,,$29.70 ,$52.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.38 ,97,,,$29.70 ,$52.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.38 ,97,,,$29.70 ,$52.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.38 ,97,,,$29.70 ,$52.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.90 ,85,,,$29.70 ,$52.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.60 ,90,,,$29.70 ,$52.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.70 ,55,,,$29.70 ,$52.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$29.70 ,$52.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.70 ,55,,,$29.70 ,$52.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.22 ,93,,,$29.70 ,$52.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99291 - Facility Level Critical Care Ill/Injured Patient Init 30-74 Min,2389455,CDM,450,RC,99291,HCPCS,outpatient,,,"$1,783.00 ","$1,337.25 ",,"$1,640.36 ",92,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$980.65 ,"$1,729.51 ",other,,Not seperately reimbursible per contract terms,"$1,000.00 ",86,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,86% of total billed charges for ER visit,"$1,426.40 ",80,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,693.85 ",95,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,693.85 ",95,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,337.25 ",75,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,515.55 ",85,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,604.70 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,515.55 ",85,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,604.70 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,693.85 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,658.19 ",93,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Critical Care Ill/Injured Patient Addl 30 Min 99292,2389456,CDM,450,RC,99292,HCPCS,outpatient,,,$390.00 ,$292.50 ,,$358.80 ,92,,,$214.50 ,$378.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$214.50 ,55,,,$214.50 ,$378.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$214.50 ,$378.30 ,other,,Not seperately reimbursible per contract terms,$335.40 ,86,,,$214.50 ,$378.30 ,percent of total billed charges,,86% of total billed charges for ER visit,$312.00 ,80,,,$214.50 ,$378.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$214.50 ,55,,,$214.50 ,$378.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.50 ,95,,,$214.50 ,$378.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$370.50 ,95,,,$214.50 ,$378.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$292.50 ,75,,,$214.50 ,$378.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$331.50 ,85,,,$214.50 ,$378.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$378.30 ,97,,,$214.50 ,$378.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.50 ,55,,,$214.50 ,$378.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.00 ,90,,,$214.50 ,$378.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$378.30 ,97,,,$214.50 ,$378.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$378.30 ,97,,,$214.50 ,$378.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$378.30 ,97,,,$214.50 ,$378.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.50 ,85,,,$214.50 ,$378.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.00 ,90,,,$214.50 ,$378.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.50 ,55,,,$214.50 ,$378.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.50 ,90,,,$214.50 ,$378.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.50 ,55,,,$214.50 ,$378.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$362.70 ,93,,,$214.50 ,$378.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97803 MEDICAL NUTRITION THERAPY REASSESSMENT 15 MIN CHARGE,8730604,CDM,942,RC,97803,HCPCS,outpatient,,,$45.00 ,$33.75 ,,$41.40 ,92,,,$24.75 ,$43.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.75 ,$43.65 ,other,,Not applicable. No negotiated rates per contract,$38.70 ,86,,,$24.75 ,$43.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.00 ,80,,,$24.75 ,$43.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,95,,,$24.75 ,$43.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,95,,,$24.75 ,$43.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,75,,,$24.75 ,$43.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$43.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.50 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$43.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$43.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,90,,,$24.75 ,$43.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$43.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.85 ,93,,,$24.75 ,$43.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
40810 Excision of lesion of mucosa and submucosa,4615876,CDM,521,RC,40810,HCPCS,outpatient,,,$730.00 ,$547.50 ,,$671.60 ,92,,,$197.64 ,$708.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$708.10 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$708.10 ,other,,Not applicable. No negotiated rates per contract,$627.80 ,86,,,$197.64 ,$708.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$584.00 ,80,,,$197.64 ,$708.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$708.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$693.50 ,95,,,$197.64 ,$708.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$693.50 ,95,,,$197.64 ,$708.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$547.50 ,75,,,$197.64 ,$708.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$620.50 ,85,,,$197.64 ,$708.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$708.10 ,97,,,$197.64 ,$708.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$708.10 ,case rate,,100% of clinic case rate per visit,$657.00 ,90,,,$197.64 ,$708.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$708.10 ,97,,,$197.64 ,$708.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$708.10 ,97,,,$197.64 ,$708.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$708.10 ,97,,,$197.64 ,$708.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$620.50 ,85,,,$197.64 ,$708.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$657.00 ,90,,,$197.64 ,$708.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$708.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$693.50 ,90,,,$197.64 ,$708.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$708.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$708.10 ,other,,Not separately reimbursable per table 3 referenced in contract
40819 Excision of frenum,5205909,CDM,521,RC,40819,HCPCS,outpatient,,,$897.00 ,$672.75 ,,$825.24 ,92,,,$197.64 ,$870.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$870.09 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$870.09 ,other,,Not applicable. No negotiated rates per contract,$771.42 ,86,,,$197.64 ,$870.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$717.60 ,80,,,$197.64 ,$870.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$870.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$852.15 ,95,,,$197.64 ,$870.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$852.15 ,95,,,$197.64 ,$870.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$672.75 ,75,,,$197.64 ,$870.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$762.45 ,85,,,$197.64 ,$870.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$870.09 ,97,,,$197.64 ,$870.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$870.09 ,case rate,,100% of clinic case rate per visit,$807.30 ,90,,,$197.64 ,$870.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$870.09 ,97,,,$197.64 ,$870.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$870.09 ,97,,,$197.64 ,$870.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$870.09 ,97,,,$197.64 ,$870.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$762.45 ,85,,,$197.64 ,$870.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$807.30 ,90,,,$197.64 ,$870.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$870.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$852.15 ,90,,,$197.64 ,$870.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$870.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$870.09 ,other,,Not separately reimbursable per table 3 referenced in contract
41115 Excision of lingual frenum,5205911,CDM,521,RC,41115,HCPCS,outpatient,,,$885.00 ,$663.75 ,,$814.20 ,92,,,$197.64 ,$858.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$858.45 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$858.45 ,other,,Not applicable. No negotiated rates per contract,$761.10 ,86,,,$197.64 ,$858.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$708.00 ,80,,,$197.64 ,$858.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$858.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$840.75 ,95,,,$197.64 ,$858.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$840.75 ,95,,,$197.64 ,$858.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$663.75 ,75,,,$197.64 ,$858.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$752.25 ,85,,,$197.64 ,$858.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$858.45 ,97,,,$197.64 ,$858.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$858.45 ,case rate,,100% of clinic case rate per visit,$796.50 ,90,,,$197.64 ,$858.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$858.45 ,97,,,$197.64 ,$858.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$858.45 ,97,,,$197.64 ,$858.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$858.45 ,97,,,$197.64 ,$858.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$752.25 ,85,,,$197.64 ,$858.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$796.50 ,90,,,$197.64 ,$858.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$858.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$840.75 ,90,,,$197.64 ,$858.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$858.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$858.45 ,other,,Not separately reimbursable per table 3 referenced in contract
Tonsillectomy and adenoidectomy,2726881,CDM,360,RC,42820,HCPCS,outpatient,,,$946.00 ,$709.50 ,,$870.32 ,92,,,$520.30 ,$917.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$520.30 ,55,,,$520.30 ,$917.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$520.30 ,$917.62 ,other,,Not applicable. No negotiated rates per contract,$813.56 ,86,,,$520.30 ,$917.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$756.80 ,80,,,$520.30 ,$917.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$520.30 ,55,,,$520.30 ,$917.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.70 ,95,,,$520.30 ,$917.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$898.70 ,95,,,$520.30 ,$917.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$709.50 ,75,,,$520.30 ,$917.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$804.10 ,85,,,$520.30 ,$917.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$917.62 ,97,,,$520.30 ,$917.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$520.30 ,55,,,$520.30 ,$917.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$851.40 ,90,,,$520.30 ,$917.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$917.62 ,97,,,$520.30 ,$917.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$917.62 ,97,,,$520.30 ,$917.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$917.62 ,97,,,$520.30 ,$917.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$804.10 ,85,,,$520.30 ,$917.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$851.40 ,90,,,$520.30 ,$917.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$520.30 ,55,,,$520.30 ,$917.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.70 ,90,,,$520.30 ,$917.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$520.30 ,55,,,$520.30 ,$917.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.78 ,93,,,$520.30 ,$917.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11104 PUNCH BIOPSY SKIN SINGLE LESION ProFee,8804754,CDM,981,RC,11104,HCPCS,outpatient,,,$295.00 ,$221.25 ,,,,,,$47.62 ,$280.25 ,other,,Not seperately reimbursible per contract terms,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$47.62 ,$280.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$156.77 ,100,,,$47.62 ,$280.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$98.00 ,100,physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$69.05 ,145,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$280.25 ,95,,,$47.62 ,$280.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$47.62 ,$280.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$71.11 ,100,,,$47.62 ,$280.25 ,fee schedule,,100% Humana physician fee schedule,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$47.62 ,$280.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.05 ,100,,,$47.62 ,$280.25 ,fee schedule,,100% Midlands Choice physician fee schedule,$177.00 ,60,,,$47.62 ,$280.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$177.00 ,60,,,$47.62 ,$280.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$66.67 ,140,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$47.62 ,$280.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$280.25 ,95,,,$47.62 ,$280.25 ,percent of total billed charges,,95% of total billed charges,$47.62 ,100,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$59.41 ,124.753,CMS physician fee schedule,,$47.62 ,$280.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11443 Remove Lesion,8023546,CDM,975,RC,11443,HCPCS,outpatient,,,$608.00 ,$456.00 ,,$237.74 ,135,cms physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,135% of 2011 CMS physician fee schedule,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$183.23 ,$577.60 ,other,,Not separately reimbursible. Not contracted for physician rates,$280.89 ,100,,,$183.23 ,$577.60 ,fee schedule,,100% of the Blue Cross physician fee schedule,$355.60 ,100,physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,$265.68 ,145,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,145% CMS Medicare physician fee schedule ,$577.60 ,95,,,$183.23 ,$577.60 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$183.23 ,$577.60 ,other,,Not separately reimbursible. Not contracted for physician rates,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,$259.17 ,100,,,$183.23 ,$577.60 ,fee schedule,,100% Humana physician fee schedule,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$183.23 ,$577.60 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$183.23 ,$577.60 ,other,,Not separately reimbursable per contract terms,$364.80 ,60,,,$183.23 ,$577.60 ,percent of total billed charges,,60% of total billed charges for physician settings,$364.80 ,60,,,$183.23 ,$577.60 ,percent of total billed charges,,60% of total billed charges for physician settings,$256.52 ,140,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$183.23 ,$577.60 ,other,,Not separately reimbursible. Not contracted for physician rates,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,$577.60 ,95,,,$183.23 ,$577.60 ,percent of total billed charges,,95% of total billed charges,$183.23 ,100,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,100% CMS Medicare physician fee schedule ,$228.58 ,124.753,CMS physician fee schedule,,$183.23 ,$577.60 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
17110 DESTRUCT BENIGN LESION OTHER THAN SKIN TAG UP TO 14 LESION ProFee,8023655,CDM,981,RC,17110,HCPCS,outpatient,,,$222.00 ,$166.50 ,,$92.93 ,135,cms physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$68.55 ,$210.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$139.16 ,100,,,$68.55 ,$210.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$133.69 ,100,physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$99.40 ,145,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$210.90 ,95,,,$68.55 ,$210.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$68.55 ,$210.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$98.00 ,100,,,$68.55 ,$210.90 ,fee schedule,,100% Humana physician fee schedule,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$68.55 ,$210.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$138.25 ,100,,,$68.55 ,$210.90 ,fee schedule,,100% Midlands Choice physician fee schedule,$77.97 ,100,,,$68.55 ,$210.90 ,fee schedule,,100% Multiplan physician fee schedule,$77.97 ,100,,,$68.55 ,$210.90 ,fee schedule,,100% Multiplan physician fee schedule,$95.97 ,140,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$68.55 ,$210.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$210.90 ,95,,,$68.55 ,$210.90 ,percent of total billed charges,,95% of total billed charges,$68.55 ,100,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$85.52 ,124.753,CMS physician fee schedule,,$68.55 ,$210.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
20553 INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES ProFee,8023685,CDM,981,RC,20553,HCPCS,outpatient,,,$142.00 ,$106.50 ,,$57.01 ,135,cms physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$43.74 ,$134.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.03 ,100,,,$43.74 ,$134.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$87.50 ,100,physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$63.42 ,145,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$134.90 ,95,,,$43.74 ,$134.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$43.74 ,$134.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$63.41 ,100,,,$43.74 ,$134.90 ,fee schedule,,100% Humana physician fee schedule,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$43.74 ,$134.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$88.54 ,100,,,$43.74 ,$134.90 ,fee schedule,,100% Midlands Choice physician fee schedule,$85.20 ,60,,,$43.74 ,$134.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$85.20 ,60,,,$43.74 ,$134.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$61.24 ,140,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$43.74 ,$134.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$134.90 ,95,,,$43.74 ,$134.90 ,percent of total billed charges,,95% of total billed charges,$43.74 ,100,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$54.57 ,124.753,CMS physician fee schedule,,$43.74 ,$134.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
24560 CLOSED TREAT HUM EPICON FRAC MEDIAL OR LAT; W/OUT MANIP ProFee,8023809,CDM,981,RC,24560,HCPCS,outpatient,,,$981.00 ,$735.75 ,,$370.60 ,135,cms physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,135% of 2011 CMS physician fee schedule,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$311.38 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$411.03 ,100,,,$311.38 ,$931.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,$588.70 ,100,physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$451.50 ,145,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,145% CMS Medicare physician fee schedule ,$931.95 ,95,,,$311.38 ,$931.95 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$311.38 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$430.29 ,100,,,$311.38 ,$931.95 ,fee schedule,,100% Humana physician fee schedule,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$311.38 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$311.38 ,$931.95 ,other,,Not separately reimbursable per contract terms,$588.60 ,60,,,$311.38 ,$931.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$588.60 ,60,,,$311.38 ,$931.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$435.93 ,140,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$311.38 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$931.95 ,95,,,$311.38 ,$931.95 ,percent of total billed charges,,95% of total billed charges,$311.38 ,100,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$388.46 ,124.753,CMS physician fee schedule,,$311.38 ,$931.95 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA ProFee,8023929,CDM,981,RC,26750,HCPCS,outpatient,,,$627.00 ,$470.25 ,,$234.79 ,135,cms physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$199.13 ,$595.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$231.50 ,100,,,$199.13 ,$595.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$374.50 ,100,physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.74 ,145,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$595.65 ,95,,,$199.13 ,$595.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$199.13 ,$595.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$274.04 ,100,,,$199.13 ,$595.65 ,fee schedule,,100% Humana physician fee schedule,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$199.13 ,$595.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$199.13 ,$595.65 ,other,,Not separately reimbursable per contract terms,$376.20 ,60,,,$199.13 ,$595.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$376.20 ,60,,,$199.13 ,$595.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$278.78 ,140,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$199.13 ,$595.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$595.65 ,95,,,$199.13 ,$595.65 ,percent of total billed charges,,95% of total billed charges,$199.13 ,100,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$248.42 ,124.753,CMS physician fee schedule,,$199.13 ,$595.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26785 OPEN TX INTERPHALANGEAL JOINT DISLOCATION ProFee,8023936,CDM,981,RC,26785,HCPCS,outpatient,,,"$1,873.00 ","$1,404.75 ",,$721.14 ,135,cms physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,135% of 2011 CMS physician fee schedule,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$569.30 ,"$1,779.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$681.19 ,100,,,$569.30 ,"$1,779.35 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,099.70 ",100,physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$825.49 ,145,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,779.35 ",95,,,$569.30 ,"$1,779.35 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$569.30 ,"$1,779.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$801.12 ,100,,,$569.30 ,"$1,779.35 ",fee schedule,,100% Humana physician fee schedule,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$569.30 ,"$1,779.35 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$569.30 ,"$1,779.35 ",other,,Not separately reimbursable per contract terms,"$1,123.80 ",60,,,$569.30 ,"$1,779.35 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,123.80 ",60,,,$569.30 ,"$1,779.35 ",percent of total billed charges,,60% of total billed charges for physician settings,$797.02 ,140,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$569.30 ,"$1,779.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,779.35 ",95,,,$569.30 ,"$1,779.35 ",percent of total billed charges,,95% of total billed charges,$569.30 ,100,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$710.22 ,124.753,CMS physician fee schedule,,$569.30 ,"$1,779.35 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27230 TREATMENT CLOSED FEMORAL FRACT-ER SERV ProFee,9557574,CDM,981,RC,27232,HCPCS,outpatient,,,"$2,325.00 ","$1,743.75 ",,"$1,008.03 ",135,cms physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$760.48 ,"$2,208.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$929.87 ,100,,,$760.48 ,"$2,208.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,513.40 ",100,physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,102.70 ",145,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,208.75 ",95,,,$760.48 ,"$2,208.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$760.48 ,"$2,208.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,093.79 ",100,,,$760.48 ,"$2,208.75 ",fee schedule,,100% Humana physician fee schedule,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$760.48 ,"$2,208.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$760.48 ,"$2,208.75 ",other,,Not separately reimbursable per contract terms,"$1,395.00 ",60,,,$760.48 ,"$2,208.75 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,395.00 ",60,,,$760.48 ,"$2,208.75 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,064.67 ",140,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$760.48 ,"$2,208.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,208.75 ",95,,,$760.48 ,"$2,208.75 ",percent of total billed charges,,95% of total billed charges,$760.48 ,100,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$948.72 ,124.753,CMS physician fee schedule,,$760.48 ,"$2,208.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
76937 POCUS Vascular Access ProFee,9280043,CDM,981,RC,76937,HCPCS,outpatient,,,$131.00 ,$98.25 ,,$45.54 ,135,cms physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.77 ,$124.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$45.10 ,100,,,$38.77 ,$124.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$72.09 ,100,physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.02 ,145,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$124.45 ,95,,,$38.77 ,$124.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$38.77 ,$124.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.13 ,100,,,$38.77 ,$124.45 ,fee schedule,,100% Humana physician fee schedule,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.77 ,$124.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.77 ,100,,,$38.77 ,$124.45 ,fee schedule,,100% Midlands Choice physician fee schedule,$78.60 ,60,,,$38.77 ,$124.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$78.60 ,60,,,$38.77 ,$124.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$57.95 ,140,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$38.77 ,$124.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$124.45 ,95,,,$38.77 ,$124.45 ,percent of total billed charges,,95% of total billed charges,$41.39 ,100,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$41.87 ,124.753,CMS physician fee schedule,,$38.77 ,$124.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
81003 URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY ProFee,8804739,CDM,307,RC,81003,HCPCS,outpatient,,,$34.00 ,$25.50 ,,$31.28 ,92,,,$0.99 ,$32.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.70 ,55,,,$0.99 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$0.99 ,$32.98 ,other,,Not applicable. No negotiated rates per contract,$0.99 ,44,,,$0.99 ,$32.98 ,fee schedule,,44% of CMS Medicare lab fee schedule,$27.20 ,80,,,$0.99 ,$32.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.70 ,55,,,$0.99 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,95,,,$0.99 ,$32.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.30 ,95,,,$0.99 ,$32.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.50 ,75,,,$0.99 ,$32.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.90 ,85,,,$0.99 ,$32.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.98 ,97,,,$0.99 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.70 ,55,,,$0.99 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.60 ,90,,,$0.99 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.98 ,97,,,$0.99 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$0.99 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.98 ,97,,,$0.99 ,$32.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.90 ,85,,,$0.99 ,$32.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.60 ,90,,,$0.99 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.70 ,55,,,$0.99 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.30 ,90,,,$0.99 ,$32.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.70 ,55,,,$0.99 ,$32.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.62 ,93,,,$0.99 ,$32.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0168 WOUND CLOSURE BY ADHESIVE ProFee,8024260,CDM,981,RC,G0168,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$35.22 ,135,cms physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,135% of 2011 CMS physician fee schedule,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$15.42 ,$133.57 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.57 ,100,,,$15.42 ,$133.57 ,fee schedule,,100% of the Blue Cross physician fee schedule,$37.79 ,100,physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,$22.36 ,145,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,145% CMS Medicare physician fee schedule ,$89.30 ,95,,,$15.42 ,$133.57 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$15.42 ,$133.57 ,other,,Not separately reimbursible. Not contracted for physician rates,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,$27.29 ,100,,,$15.42 ,$133.57 ,fee schedule,,100% Humana physician fee schedule,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$15.42 ,$133.57 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$15.42 ,$133.57 ,other,,Not separately reimbursable per contract terms,$56.40 ,60,,,$15.42 ,$133.57 ,percent of total billed charges,,60% of total billed charges for physician settings,$56.40 ,60,,,$15.42 ,$133.57 ,percent of total billed charges,,60% of total billed charges for physician settings,$21.59 ,140,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$15.42 ,$133.57 ,other,,Not separately reimbursible. Not contracted for physician rates,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,$89.30 ,95,,,$15.42 ,$133.57 ,percent of total billed charges,,95% of total billed charges,$15.42 ,100,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,100% CMS Medicare physician fee schedule ,$19.24 ,124.753,CMS physician fee schedule,,$15.42 ,$133.57 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE TechFee,8022536,CDM,450,RC,10021,HCPCS,outpatient,,,$337.00 ,$252.75 ,,$310.04 ,92,,,$185.35 ,$326.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$185.35 ,55,,,$185.35 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$185.35 ,$326.89 ,other,,Not applicable. No negotiated rates per contract,$289.82 ,86,,,$185.35 ,$326.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$269.60 ,80,,,$185.35 ,$326.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$185.35 ,55,,,$185.35 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.15 ,95,,,$185.35 ,$326.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$320.15 ,95,,,$185.35 ,$326.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$252.75 ,75,,,$185.35 ,$326.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$286.45 ,85,,,$185.35 ,$326.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$326.89 ,97,,,$185.35 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.35 ,55,,,$185.35 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$303.30 ,90,,,$185.35 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$326.89 ,97,,,$185.35 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.89 ,97,,,$185.35 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.89 ,97,,,$185.35 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.45 ,85,,,$185.35 ,$326.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$303.30 ,90,,,$185.35 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.35 ,55,,,$185.35 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.15 ,90,,,$185.35 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.35 ,55,,,$185.35 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.41 ,93,,,$185.35 ,$326.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10060 INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE TechFee,8022538,CDM,450,RC,10060,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$223.30 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$223.30 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$223.30 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$349.16 ,86,,,$223.30 ,$393.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.80 ,80,,,$223.30 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$223.30 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$223.30 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$223.30 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$223.30 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$223.30 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$223.30 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$223.30 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$223.30 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$223.30 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$223.30 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$223.30 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$223.30 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$223.30 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$223.30 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$223.30 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$223.30 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$223.30 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10061 INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee,8022539,CDM,450,RC,10061,HCPCS,outpatient,,,$693.00 ,$519.75 ,,$637.56 ,92,,,$381.15 ,$672.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$381.15 ,55,,,$381.15 ,$672.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$381.15 ,$672.21 ,other,,Not applicable. No negotiated rates per contract,$595.98 ,86,,,$381.15 ,$672.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$554.40 ,80,,,$381.15 ,$672.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$381.15 ,55,,,$381.15 ,$672.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$658.35 ,95,,,$381.15 ,$672.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$658.35 ,95,,,$381.15 ,$672.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$519.75 ,75,,,$381.15 ,$672.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$589.05 ,85,,,$381.15 ,$672.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$672.21 ,97,,,$381.15 ,$672.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.15 ,55,,,$381.15 ,$672.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.70 ,90,,,$381.15 ,$672.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$672.21 ,97,,,$381.15 ,$672.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$672.21 ,97,,,$381.15 ,$672.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$672.21 ,97,,,$381.15 ,$672.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$589.05 ,85,,,$381.15 ,$672.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$623.70 ,90,,,$381.15 ,$672.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.15 ,55,,,$381.15 ,$672.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$658.35 ,90,,,$381.15 ,$672.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.15 ,55,,,$381.15 ,$672.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$644.49 ,93,,,$381.15 ,$672.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10080 INCISION & DRAINAGE PILONIDAL CYST SIMPLE TechFee,8022540,CDM,450,RC,10080,HCPCS,outpatient,,,$822.00 ,$616.50 ,,$756.24 ,92,,,$452.10 ,$797.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$452.10 ,$797.34 ,other,,Not applicable. No negotiated rates per contract,$706.92 ,86,,,$452.10 ,$797.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$657.60 ,80,,,$452.10 ,$797.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$780.90 ,95,,,$452.10 ,$797.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$780.90 ,95,,,$452.10 ,$797.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$616.50 ,75,,,$452.10 ,$797.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$698.70 ,85,,,$452.10 ,$797.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$739.80 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$698.70 ,85,,,$452.10 ,$797.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$739.80 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$780.90 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$764.46 ,93,,,$452.10 ,$797.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10081 INCISION & DRAINAGE PILONIDAL CYST COMPLICATED TechFee,8022541,CDM,450,RC,10081,HCPCS,outpatient,,,"$1,125.00 ",$843.75 ,,"$1,035.00 ",92,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$618.75 ,55,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$618.75 ,"$1,091.25 ",other,,Not applicable. No negotiated rates per contract,$967.50 ,86,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$900.00 ,80,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$618.75 ,55,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,068.75 ",95,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,068.75 ",95,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$843.75 ,75,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$956.25 ,85,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,091.25 ",97,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$618.75 ,55,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,012.50 ",90,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,091.25 ",97,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,091.25 ",97,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,091.25 ",97,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$956.25 ,85,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,012.50 ",90,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$618.75 ,55,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,068.75 ",90,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$618.75 ,55,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,046.25 ",93,,,$618.75 ,"$1,091.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
10120 INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee,8022542,CDM,450,RC,10120,HCPCS,outpatient,,,$507.00 ,$380.25 ,,$466.44 ,92,,,$278.85 ,$491.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$278.85 ,$491.79 ,other,,Not applicable. No negotiated rates per contract,$436.02 ,86,,,$278.85 ,$491.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$405.60 ,80,,,$278.85 ,$491.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.25 ,75,,,$278.85 ,$491.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.51 ,93,,,$278.85 ,$491.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10121 INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL TechFee,8022543,CDM,450,RC,10121,HCPCS,outpatient,,,$892.00 ,$669.00 ,,$820.64 ,92,,,$490.60 ,$865.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$490.60 ,55,,,$490.60 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$490.60 ,$865.24 ,other,,Not applicable. No negotiated rates per contract,$767.12 ,86,,,$490.60 ,$865.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$713.60 ,80,,,$490.60 ,$865.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$490.60 ,55,,,$490.60 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,95,,,$490.60 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$847.40 ,95,,,$490.60 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$669.00 ,75,,,$490.60 ,$865.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$758.20 ,85,,,$490.60 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$865.24 ,97,,,$490.60 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$490.60 ,55,,,$490.60 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$802.80 ,90,,,$490.60 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$865.24 ,97,,,$490.60 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$490.60 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$490.60 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$758.20 ,85,,,$490.60 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$802.80 ,90,,,$490.60 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$490.60 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,90,,,$490.60 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$490.60 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$829.56 ,93,,,$490.60 ,$865.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10140 I&D HEMATOMA SEROMA/FLUID COLLECTION TechFee,8022544,CDM,450,RC,10140,HCPCS,outpatient,,,$567.00 ,$425.25 ,,$521.64 ,92,,,$311.85 ,$549.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$311.85 ,$549.99 ,other,,Not applicable. No negotiated rates per contract,$487.62 ,86,,,$311.85 ,$549.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$453.60 ,80,,,$311.85 ,$549.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.65 ,95,,,$311.85 ,$549.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$538.65 ,95,,,$311.85 ,$549.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$425.25 ,75,,,$311.85 ,$549.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$481.95 ,85,,,$311.85 ,$549.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$510.30 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.95 ,85,,,$311.85 ,$549.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$510.30 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.65 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.31 ,93,,,$311.85 ,$549.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10160 PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST TechFee,8022545,CDM,450,RC,10160,HCPCS,outpatient,,,$429.00 ,$321.75 ,,$394.68 ,92,,,$235.95 ,$416.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$235.95 ,$416.13 ,other,,Not applicable. No negotiated rates per contract,$368.94 ,86,,,$235.95 ,$416.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$343.20 ,80,,,$235.95 ,$416.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$321.75 ,75,,,$235.95 ,$416.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.97 ,93,,,$235.95 ,$416.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11000 DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee,8022547,CDM,450,RC,11000,HCPCS,outpatient,,,$189.00 ,$141.75 ,,$173.88 ,92,,,$103.95 ,$183.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$103.95 ,$183.33 ,other,,Not applicable. No negotiated rates per contract,$162.54 ,86,,,$103.95 ,$183.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.20 ,80,,,$103.95 ,$183.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.75 ,75,,,$103.95 ,$183.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.77 ,93,,,$103.95 ,$183.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11001 DEBRID EA ADD 10% BOD SUR TechFee,8022548,CDM,450,RC,11001,HCPCS,outpatient,,,$82.00 ,$61.50 ,,$75.44 ,92,,,$45.10 ,$79.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.10 ,$79.54 ,other,,Not applicable. No negotiated rates per contract,$70.52 ,86,,,$45.10 ,$79.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.60 ,80,,,$45.10 ,$79.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.50 ,75,,,$45.10 ,$79.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.26 ,93,,,$45.10 ,$79.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11010 DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS TechFee,8022551,CDM,450,RC,11010,HCPCS,outpatient,,,"$1,556.00 ","$1,167.00 ",,"$1,431.52 ",92,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$855.80 ,"$1,509.32 ",other,,Not applicable. No negotiated rates per contract,"$1,338.16 ",86,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,244.80 ",80,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,167.00 ",75,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,447.08 ",93,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
11042 DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< TechFee,8022554,CDM,450,RC,11042,HCPCS,outpatient,,,$432.00 ,$324.00 ,,$397.44 ,92,,,$237.60 ,$419.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$237.60 ,$419.04 ,other,,Not applicable. No negotiated rates per contract,$371.52 ,86,,,$237.60 ,$419.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$345.60 ,80,,,$237.60 ,$419.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.00 ,75,,,$237.60 ,$419.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$401.76 ,93,,,$237.60 ,$419.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11043 DEBRIDE TISSUE/MUSCLE TechFee,8022555,CDM,450,RC,11043,HCPCS,outpatient,,,$769.00 ,$576.75 ,,$707.48 ,92,,,$422.95 ,$745.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$422.95 ,$745.93 ,other,,Not applicable. No negotiated rates per contract,$661.34 ,86,,,$422.95 ,$745.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$615.20 ,80,,,$422.95 ,$745.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.55 ,95,,,$422.95 ,$745.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$730.55 ,95,,,$422.95 ,$745.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$576.75 ,75,,,$422.95 ,$745.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$653.65 ,85,,,$422.95 ,$745.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.10 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$653.65 ,85,,,$422.95 ,$745.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$692.10 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.55 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$715.17 ,93,,,$422.95 ,$745.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11055 PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 TechFee,8022560,CDM,450,RC,11055,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$128.15 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.15 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$200.38 ,86,,,$128.15 ,$226.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.40 ,80,,,$128.15 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$128.15 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$128.15 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11104 PUNCH BIOPSY SKIN SINGLE LESION TechFee,8939054,CDM,450,RC,11104,HCPCS,outpatient,,,$432.00 ,$324.00 ,,$397.44 ,92,,,$237.60 ,$419.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$237.60 ,$419.04 ,other,,Not applicable. No negotiated rates per contract,$371.52 ,86,,,$237.60 ,$419.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$345.60 ,80,,,$237.60 ,$419.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.00 ,75,,,$237.60 ,$419.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$401.76 ,93,,,$237.60 ,$419.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11200 REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 TechFee,8022565,CDM,450,RC,11200,HCPCS,outpatient,,,$296.00 ,$222.00 ,,$272.32 ,92,,,$162.80 ,$287.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$162.80 ,$287.12 ,other,,Not applicable. No negotiated rates per contract,$254.56 ,86,,,$162.80 ,$287.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$236.80 ,80,,,$162.80 ,$287.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.20 ,95,,,$162.80 ,$287.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$281.20 ,95,,,$162.80 ,$287.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.00 ,75,,,$162.80 ,$287.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$251.60 ,85,,,$162.80 ,$287.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.40 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.60 ,85,,,$162.80 ,$287.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$266.40 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.20 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.28 ,93,,,$162.80 ,$287.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11400 EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/ TechFee,8022572,CDM,450,RC,11400,HCPCS,outpatient,,,$429.00 ,$321.75 ,,$394.68 ,92,,,$235.95 ,$416.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$235.95 ,$416.13 ,other,,Not applicable. No negotiated rates per contract,$368.94 ,86,,,$235.95 ,$416.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$343.20 ,80,,,$235.95 ,$416.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$321.75 ,75,,,$235.95 ,$416.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.97 ,93,,,$235.95 ,$416.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11402 EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM TechFee,8022574,CDM,450,RC,11402,HCPCS,outpatient,,,$573.00 ,$429.75 ,,$527.16 ,92,,,$315.15 ,$555.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$315.15 ,55,,,$315.15 ,$555.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$315.15 ,$555.81 ,other,,Not applicable. No negotiated rates per contract,$492.78 ,86,,,$315.15 ,$555.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$458.40 ,80,,,$315.15 ,$555.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$315.15 ,55,,,$315.15 ,$555.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$544.35 ,95,,,$315.15 ,$555.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$544.35 ,95,,,$315.15 ,$555.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$429.75 ,75,,,$315.15 ,$555.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$487.05 ,85,,,$315.15 ,$555.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$555.81 ,97,,,$315.15 ,$555.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.15 ,55,,,$315.15 ,$555.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$515.70 ,90,,,$315.15 ,$555.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$555.81 ,97,,,$315.15 ,$555.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$555.81 ,97,,,$315.15 ,$555.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$555.81 ,97,,,$315.15 ,$555.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$487.05 ,85,,,$315.15 ,$555.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$515.70 ,90,,,$315.15 ,$555.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.15 ,55,,,$315.15 ,$555.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$544.35 ,90,,,$315.15 ,$555.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.15 ,55,,,$315.15 ,$555.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.89 ,93,,,$315.15 ,$555.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11420 EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< TechFee,8022578,CDM,450,RC,11420,HCPCS,outpatient,,,$429.00 ,$321.75 ,,$394.68 ,92,,,$235.95 ,$416.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$235.95 ,$416.13 ,other,,Not applicable. No negotiated rates per contract,$368.94 ,86,,,$235.95 ,$416.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$343.20 ,80,,,$235.95 ,$416.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$407.55 ,95,,,$235.95 ,$416.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$321.75 ,75,,,$235.95 ,$416.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.13 ,97,,,$235.95 ,$416.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.65 ,85,,,$235.95 ,$416.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.10 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.55 ,90,,,$235.95 ,$416.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.95 ,55,,,$235.95 ,$416.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.97 ,93,,,$235.95 ,$416.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11440 EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< TechFee,8022584,CDM,450,RC,11440,HCPCS,outpatient,,,$479.00 ,$359.25 ,,$440.68 ,92,,,$263.45 ,$464.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$263.45 ,55,,,$263.45 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$263.45 ,$464.63 ,other,,Not applicable. No negotiated rates per contract,$411.94 ,86,,,$263.45 ,$464.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$383.20 ,80,,,$263.45 ,$464.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$263.45 ,55,,,$263.45 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$455.05 ,95,,,$263.45 ,$464.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$455.05 ,95,,,$263.45 ,$464.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$359.25 ,75,,,$263.45 ,$464.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$407.15 ,85,,,$263.45 ,$464.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$464.63 ,97,,,$263.45 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.45 ,55,,,$263.45 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.10 ,90,,,$263.45 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$464.63 ,97,,,$263.45 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.63 ,97,,,$263.45 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.63 ,97,,,$263.45 ,$464.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.15 ,85,,,$263.45 ,$464.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$431.10 ,90,,,$263.45 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.45 ,55,,,$263.45 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$455.05 ,90,,,$263.45 ,$464.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.45 ,55,,,$263.45 ,$464.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.47 ,93,,,$263.45 ,$464.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11719 TRIM NONDYSTROPHIC NAILS ANY # TechFee,8022608,CDM,450,RC,11719,HCPCS,outpatient,,,$47.00 ,$35.25 ,,$43.24 ,92,,,$25.85 ,$45.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.85 ,$45.59 ,other,,Not applicable. No negotiated rates per contract,$40.42 ,86,,,$25.85 ,$45.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.60 ,80,,,$25.85 ,$45.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,95,,,$25.85 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.65 ,95,,,$25.85 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,75,,,$25.85 ,$45.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.30 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.30 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.71 ,93,,,$25.85 ,$45.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11720 DEBRIDEMENT NAIL ANY METHOD 1-5 TechFee,8022609,CDM,450,RC,11720,HCPCS,outpatient,,,$110.00 ,$82.50 ,,$101.20 ,92,,,$60.50 ,$106.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.50 ,$106.70 ,other,,Not applicable. No negotiated rates per contract,$94.60 ,86,,,$60.50 ,$106.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.00 ,80,,,$60.50 ,$106.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.50 ,75,,,$60.50 ,$106.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.30 ,93,,,$60.50 ,$106.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11730 AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee,8022610,CDM,450,RC,11730,HCPCS,outpatient,,,$388.00 ,$291.00 ,,$356.96 ,92,,,$213.40 ,$376.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$213.40 ,$376.36 ,other,,Not applicable. No negotiated rates per contract,$333.68 ,86,,,$213.40 ,$376.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$310.40 ,80,,,$213.40 ,$376.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.60 ,95,,,$213.40 ,$376.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$368.60 ,95,,,$213.40 ,$376.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$291.00 ,75,,,$213.40 ,$376.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$329.80 ,85,,,$213.40 ,$376.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$349.20 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$329.80 ,85,,,$213.40 ,$376.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.60 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.84 ,93,,,$213.40 ,$376.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11732 AVULSION OF NAIL PLATE,8022611,CDM,450,RC,11732,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11740 EVACUATION SUBUNGUAL HEMATOMA TechFee,8022612,CDM,450,RC,11740,HCPCS,outpatient,,,$186.00 ,$139.50 ,,$171.12 ,92,,,$102.30 ,$180.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.30 ,$180.42 ,other,,Not applicable. No negotiated rates per contract,$159.96 ,86,,,$102.30 ,$180.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$148.80 ,80,,,$102.30 ,$180.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.50 ,75,,,$102.30 ,$180.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.98 ,93,,,$102.30 ,$180.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11750 EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee,8022613,CDM,450,RC,11750,HCPCS,outpatient,,,$536.00 ,$402.00 ,,$493.12 ,92,,,$294.80 ,$519.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.80 ,$519.92 ,other,,Not applicable. No negotiated rates per contract,$460.96 ,86,,,$294.80 ,$519.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.80 ,80,,,$294.80 ,$519.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.20 ,95,,,$294.80 ,$519.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$509.20 ,95,,,$294.80 ,$519.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$402.00 ,75,,,$294.80 ,$519.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.60 ,85,,,$294.80 ,$519.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$482.40 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.60 ,85,,,$294.80 ,$519.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.40 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.20 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$498.48 ,93,,,$294.80 ,$519.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11760 REPAIR NAIL BED TechFee,8022615,CDM,450,RC,11760,HCPCS,outpatient,,,$646.00 ,$484.50 ,,$594.32 ,92,,,$355.30 ,$626.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$355.30 ,55,,,$355.30 ,$626.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$355.30 ,$626.62 ,other,,Not applicable. No negotiated rates per contract,$555.56 ,86,,,$355.30 ,$626.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$516.80 ,80,,,$355.30 ,$626.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$355.30 ,55,,,$355.30 ,$626.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$613.70 ,95,,,$355.30 ,$626.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$613.70 ,95,,,$355.30 ,$626.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$484.50 ,75,,,$355.30 ,$626.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$549.10 ,85,,,$355.30 ,$626.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$626.62 ,97,,,$355.30 ,$626.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$355.30 ,55,,,$355.30 ,$626.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$581.40 ,90,,,$355.30 ,$626.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$626.62 ,97,,,$355.30 ,$626.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$626.62 ,97,,,$355.30 ,$626.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$626.62 ,97,,,$355.30 ,$626.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.10 ,85,,,$355.30 ,$626.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$581.40 ,90,,,$355.30 ,$626.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$355.30 ,55,,,$355.30 ,$626.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$613.70 ,90,,,$355.30 ,$626.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$355.30 ,55,,,$355.30 ,$626.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$600.78 ,93,,,$355.30 ,$626.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11765 WEDGE EXCISION SKIN NAIL FOLD TechFee,8022616,CDM,450,RC,11765,HCPCS,outpatient,,,$564.00 ,$423.00 ,,$518.88 ,92,,,$310.20 ,$547.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$310.20 ,$547.08 ,other,,Not applicable. No negotiated rates per contract,$485.04 ,86,,,$310.20 ,$547.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$451.20 ,80,,,$310.20 ,$547.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.80 ,95,,,$310.20 ,$547.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.80 ,95,,,$310.20 ,$547.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$423.00 ,75,,,$310.20 ,$547.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$479.40 ,85,,,$310.20 ,$547.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$507.60 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.40 ,85,,,$310.20 ,$547.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$507.60 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.80 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$524.52 ,93,,,$310.20 ,$547.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
11976 REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES TechFee,8022622,CDM,450,RC,11976,HCPCS,outpatient,,,$476.00 ,$357.00 ,,$437.92 ,92,,,$261.80 ,$461.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.80 ,$461.72 ,other,,Not applicable. No negotiated rates per contract,$409.36 ,86,,,$261.80 ,$461.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$380.80 ,80,,,$261.80 ,$461.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.20 ,95,,,$261.80 ,$461.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.20 ,95,,,$261.80 ,$461.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.00 ,75,,,$261.80 ,$461.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$404.60 ,85,,,$261.80 ,$461.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.40 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.60 ,85,,,$261.80 ,$461.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$428.40 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.20 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.68 ,93,,,$261.80 ,$461.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12001 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee,8022624,CDM,450,RC,12001,HCPCS,outpatient,,,$309.00 ,$231.75 ,,$284.28 ,92,,,$169.95 ,$299.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$169.95 ,55,,,$169.95 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$169.95 ,$299.73 ,other,,Not applicable. No negotiated rates per contract,$265.74 ,86,,,$169.95 ,$299.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$247.20 ,80,,,$169.95 ,$299.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$169.95 ,55,,,$169.95 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.55 ,95,,,$169.95 ,$299.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$293.55 ,95,,,$169.95 ,$299.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.75 ,75,,,$169.95 ,$299.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$262.65 ,85,,,$169.95 ,$299.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$299.73 ,97,,,$169.95 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.95 ,55,,,$169.95 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.10 ,90,,,$169.95 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.73 ,97,,,$169.95 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.73 ,97,,,$169.95 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.73 ,97,,,$169.95 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.65 ,85,,,$169.95 ,$299.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$278.10 ,90,,,$169.95 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.95 ,55,,,$169.95 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.55 ,90,,,$169.95 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.95 ,55,,,$169.95 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$287.37 ,93,,,$169.95 ,$299.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12002 SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee,8022625,CDM,450,RC,12002,HCPCS,outpatient,,,$372.00 ,$279.00 ,,$342.24 ,92,,,$204.60 ,$360.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.60 ,$360.84 ,other,,Not applicable. No negotiated rates per contract,$319.92 ,86,,,$204.60 ,$360.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$297.60 ,80,,,$204.60 ,$360.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.40 ,95,,,$204.60 ,$360.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.40 ,95,,,$204.60 ,$360.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.00 ,75,,,$204.60 ,$360.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$316.20 ,85,,,$204.60 ,$360.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.20 ,85,,,$204.60 ,$360.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.80 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.40 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.96 ,93,,,$204.60 ,$360.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12004 SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee,8022626,CDM,450,RC,12004,HCPCS,outpatient,,,$432.00 ,$324.00 ,,$397.44 ,92,,,$237.60 ,$419.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$237.60 ,$419.04 ,other,,Not applicable. No negotiated rates per contract,$371.52 ,86,,,$237.60 ,$419.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$345.60 ,80,,,$237.60 ,$419.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.40 ,95,,,$237.60 ,$419.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.00 ,75,,,$237.60 ,$419.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.04 ,97,,,$237.60 ,$419.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.20 ,85,,,$237.60 ,$419.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.80 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.40 ,90,,,$237.60 ,$419.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.60 ,55,,,$237.60 ,$419.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$401.76 ,93,,,$237.60 ,$419.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12005 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee,8022627,CDM,450,RC,12005,HCPCS,outpatient,,,$577.00 ,$432.75 ,,$530.84 ,92,,,$317.35 ,$559.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$317.35 ,55,,,$317.35 ,$559.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$317.35 ,$559.69 ,other,,Not applicable. No negotiated rates per contract,$496.22 ,86,,,$317.35 ,$559.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$461.60 ,80,,,$317.35 ,$559.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$317.35 ,55,,,$317.35 ,$559.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$548.15 ,95,,,$317.35 ,$559.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$548.15 ,95,,,$317.35 ,$559.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$432.75 ,75,,,$317.35 ,$559.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$490.45 ,85,,,$317.35 ,$559.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$559.69 ,97,,,$317.35 ,$559.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.35 ,55,,,$317.35 ,$559.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.30 ,90,,,$317.35 ,$559.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$559.69 ,97,,,$317.35 ,$559.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$559.69 ,97,,,$317.35 ,$559.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$559.69 ,97,,,$317.35 ,$559.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$490.45 ,85,,,$317.35 ,$559.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.30 ,90,,,$317.35 ,$559.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$317.35 ,55,,,$317.35 ,$559.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$548.15 ,90,,,$317.35 ,$559.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$317.35 ,55,,,$317.35 ,$559.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$536.61 ,93,,,$317.35 ,$559.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12006 SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee,8022628,CDM,450,RC,12006,HCPCS,outpatient,,,$671.00 ,$503.25 ,,$617.32 ,92,,,$369.05 ,$650.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$369.05 ,$650.87 ,other,,Not applicable. No negotiated rates per contract,$577.06 ,86,,,$369.05 ,$650.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$536.80 ,80,,,$369.05 ,$650.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$637.45 ,95,,,$369.05 ,$650.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$637.45 ,95,,,$369.05 ,$650.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$503.25 ,75,,,$369.05 ,$650.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$570.35 ,85,,,$369.05 ,$650.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$603.90 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$570.35 ,85,,,$369.05 ,$650.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$603.90 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$637.45 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$624.03 ,93,,,$369.05 ,$650.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12007 SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM TechFee,8022629,CDM,450,RC,12007,HCPCS,outpatient,,,$762.00 ,$571.50 ,,$701.04 ,92,,,$419.10 ,$739.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$419.10 ,55,,,$419.10 ,$739.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$419.10 ,$739.14 ,other,,Not applicable. No negotiated rates per contract,$655.32 ,86,,,$419.10 ,$739.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$609.60 ,80,,,$419.10 ,$739.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$419.10 ,55,,,$419.10 ,$739.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$723.90 ,95,,,$419.10 ,$739.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$723.90 ,95,,,$419.10 ,$739.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$571.50 ,75,,,$419.10 ,$739.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$647.70 ,85,,,$419.10 ,$739.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$739.14 ,97,,,$419.10 ,$739.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.10 ,55,,,$419.10 ,$739.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$685.80 ,90,,,$419.10 ,$739.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$739.14 ,97,,,$419.10 ,$739.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$739.14 ,97,,,$419.10 ,$739.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$739.14 ,97,,,$419.10 ,$739.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$647.70 ,85,,,$419.10 ,$739.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$685.80 ,90,,,$419.10 ,$739.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.10 ,55,,,$419.10 ,$739.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$723.90 ,90,,,$419.10 ,$739.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.10 ,55,,,$419.10 ,$739.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.66 ,93,,,$419.10 ,$739.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12011 SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee,8022630,CDM,450,RC,12011,HCPCS,outpatient,,,$372.00 ,$279.00 ,,$342.24 ,92,,,$204.60 ,$360.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.60 ,$360.84 ,other,,Not applicable. No negotiated rates per contract,$319.92 ,86,,,$204.60 ,$360.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$297.60 ,80,,,$204.60 ,$360.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.40 ,95,,,$204.60 ,$360.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.40 ,95,,,$204.60 ,$360.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.00 ,75,,,$204.60 ,$360.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$316.20 ,85,,,$204.60 ,$360.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.84 ,97,,,$204.60 ,$360.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.20 ,85,,,$204.60 ,$360.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.80 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.40 ,90,,,$204.60 ,$360.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.60 ,55,,,$204.60 ,$360.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.96 ,93,,,$204.60 ,$360.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12013 SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee,8022631,CDM,450,RC,12013,HCPCS,outpatient,,,$388.00 ,$291.00 ,,$356.96 ,92,,,$213.40 ,$376.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$213.40 ,$376.36 ,other,,Not applicable. No negotiated rates per contract,$333.68 ,86,,,$213.40 ,$376.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$310.40 ,80,,,$213.40 ,$376.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.60 ,95,,,$213.40 ,$376.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$368.60 ,95,,,$213.40 ,$376.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$291.00 ,75,,,$213.40 ,$376.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$329.80 ,85,,,$213.40 ,$376.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$349.20 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$376.36 ,97,,,$213.40 ,$376.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$329.80 ,85,,,$213.40 ,$376.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.60 ,90,,,$213.40 ,$376.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$213.40 ,55,,,$213.40 ,$376.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.84 ,93,,,$213.40 ,$376.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12014 SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee,8022632,CDM,450,RC,12014,HCPCS,outpatient,,,$469.00 ,$351.75 ,,$431.48 ,92,,,$257.95 ,$454.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$257.95 ,55,,,$257.95 ,$454.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$257.95 ,$454.93 ,other,,Not applicable. No negotiated rates per contract,$403.34 ,86,,,$257.95 ,$454.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$375.20 ,80,,,$257.95 ,$454.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$257.95 ,55,,,$257.95 ,$454.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.55 ,95,,,$257.95 ,$454.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$445.55 ,95,,,$257.95 ,$454.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$351.75 ,75,,,$257.95 ,$454.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$398.65 ,85,,,$257.95 ,$454.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$454.93 ,97,,,$257.95 ,$454.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.95 ,55,,,$257.95 ,$454.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$422.10 ,90,,,$257.95 ,$454.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$454.93 ,97,,,$257.95 ,$454.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$454.93 ,97,,,$257.95 ,$454.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$454.93 ,97,,,$257.95 ,$454.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.65 ,85,,,$257.95 ,$454.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$422.10 ,90,,,$257.95 ,$454.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.95 ,55,,,$257.95 ,$454.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.55 ,90,,,$257.95 ,$454.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.95 ,55,,,$257.95 ,$454.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$436.17 ,93,,,$257.95 ,$454.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12015 SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee,8022633,CDM,450,RC,12015,HCPCS,outpatient,,,$564.00 ,$423.00 ,,$518.88 ,92,,,$310.20 ,$547.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$310.20 ,$547.08 ,other,,Not applicable. No negotiated rates per contract,$485.04 ,86,,,$310.20 ,$547.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$451.20 ,80,,,$310.20 ,$547.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.80 ,95,,,$310.20 ,$547.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.80 ,95,,,$310.20 ,$547.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$423.00 ,75,,,$310.20 ,$547.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$479.40 ,85,,,$310.20 ,$547.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$507.60 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$547.08 ,97,,,$310.20 ,$547.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.40 ,85,,,$310.20 ,$547.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$507.60 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.80 ,90,,,$310.20 ,$547.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.20 ,55,,,$310.20 ,$547.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$524.52 ,93,,,$310.20 ,$547.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12016 SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee,8022634,CDM,450,RC,12016,HCPCS,outpatient,,,$514.00 ,$385.50 ,,$472.88 ,92,,,$282.70 ,$498.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$282.70 ,$498.58 ,other,,Not applicable. No negotiated rates per contract,$442.04 ,86,,,$282.70 ,$498.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$411.20 ,80,,,$282.70 ,$498.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.50 ,75,,,$282.70 ,$498.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.02 ,93,,,$282.70 ,$498.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12017 SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM TechFee,8022635,CDM,450,RC,12017,HCPCS,outpatient,,,$514.00 ,$385.50 ,,$472.88 ,92,,,$282.70 ,$498.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$282.70 ,$498.58 ,other,,Not applicable. No negotiated rates per contract,$442.04 ,86,,,$282.70 ,$498.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$411.20 ,80,,,$282.70 ,$498.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.50 ,75,,,$282.70 ,$498.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.02 ,93,,,$282.70 ,$498.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12018 SIMPLE REPAIR F/E/E/N/L/M >30.0 CM TechFee,8022636,CDM,450,RC,12018,HCPCS,outpatient,,,$545.00 ,$408.75 ,,$501.40 ,92,,,$299.75 ,$528.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$299.75 ,55,,,$299.75 ,$528.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$299.75 ,$528.65 ,other,,Not applicable. No negotiated rates per contract,$468.70 ,86,,,$299.75 ,$528.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$436.00 ,80,,,$299.75 ,$528.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$299.75 ,55,,,$299.75 ,$528.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$517.75 ,95,,,$299.75 ,$528.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$517.75 ,95,,,$299.75 ,$528.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$408.75 ,75,,,$299.75 ,$528.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$463.25 ,85,,,$299.75 ,$528.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$528.65 ,97,,,$299.75 ,$528.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.75 ,55,,,$299.75 ,$528.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$490.50 ,90,,,$299.75 ,$528.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$528.65 ,97,,,$299.75 ,$528.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$528.65 ,97,,,$299.75 ,$528.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$528.65 ,97,,,$299.75 ,$528.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.25 ,85,,,$299.75 ,$528.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$490.50 ,90,,,$299.75 ,$528.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.75 ,55,,,$299.75 ,$528.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$517.75 ,90,,,$299.75 ,$528.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.75 ,55,,,$299.75 ,$528.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$506.85 ,93,,,$299.75 ,$528.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12020 TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE TechFee,8022637,CDM,450,RC,12020,HCPCS,outpatient,,,$999.00 ,$749.25 ,,$919.08 ,92,,,$549.45 ,$969.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$549.45 ,55,,,$549.45 ,$969.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$549.45 ,$969.03 ,other,,Not applicable. No negotiated rates per contract,$859.14 ,86,,,$549.45 ,$969.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$799.20 ,80,,,$549.45 ,$969.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$549.45 ,55,,,$549.45 ,$969.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$949.05 ,95,,,$549.45 ,$969.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$949.05 ,95,,,$549.45 ,$969.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$749.25 ,75,,,$549.45 ,$969.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$849.15 ,85,,,$549.45 ,$969.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$969.03 ,97,,,$549.45 ,$969.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.45 ,55,,,$549.45 ,$969.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$899.10 ,90,,,$549.45 ,$969.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$969.03 ,97,,,$549.45 ,$969.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$969.03 ,97,,,$549.45 ,$969.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$969.03 ,97,,,$549.45 ,$969.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$849.15 ,85,,,$549.45 ,$969.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$899.10 ,90,,,$549.45 ,$969.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$549.45 ,55,,,$549.45 ,$969.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$949.05 ,90,,,$549.45 ,$969.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$549.45 ,55,,,$549.45 ,$969.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$929.07 ,93,,,$549.45 ,$969.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12031 REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee,8022639,CDM,450,RC,12031,HCPCS,outpatient,,,$879.00 ,$659.25 ,,$808.68 ,92,,,$483.45 ,$852.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$483.45 ,55,,,$483.45 ,$852.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$483.45 ,$852.63 ,other,,Not applicable. No negotiated rates per contract,$755.94 ,86,,,$483.45 ,$852.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$703.20 ,80,,,$483.45 ,$852.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$483.45 ,55,,,$483.45 ,$852.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$835.05 ,95,,,$483.45 ,$852.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$835.05 ,95,,,$483.45 ,$852.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$659.25 ,75,,,$483.45 ,$852.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$747.15 ,85,,,$483.45 ,$852.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$852.63 ,97,,,$483.45 ,$852.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.45 ,55,,,$483.45 ,$852.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$791.10 ,90,,,$483.45 ,$852.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$852.63 ,97,,,$483.45 ,$852.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$852.63 ,97,,,$483.45 ,$852.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$852.63 ,97,,,$483.45 ,$852.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$747.15 ,85,,,$483.45 ,$852.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$791.10 ,90,,,$483.45 ,$852.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.45 ,55,,,$483.45 ,$852.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$835.05 ,90,,,$483.45 ,$852.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.45 ,55,,,$483.45 ,$852.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$817.47 ,93,,,$483.45 ,$852.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12032 REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee,8022640,CDM,450,RC,12032,HCPCS,outpatient,,,"$1,021.00 ",$765.75 ,,$939.32 ,92,,,$561.55 ,$990.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$561.55 ,55,,,$561.55 ,$990.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$561.55 ,$990.37 ,other,,Not applicable. No negotiated rates per contract,$878.06 ,86,,,$561.55 ,$990.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$816.80 ,80,,,$561.55 ,$990.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$561.55 ,55,,,$561.55 ,$990.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$969.95 ,95,,,$561.55 ,$990.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$969.95 ,95,,,$561.55 ,$990.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$765.75 ,75,,,$561.55 ,$990.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$867.85 ,85,,,$561.55 ,$990.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$990.37 ,97,,,$561.55 ,$990.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$561.55 ,55,,,$561.55 ,$990.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$918.90 ,90,,,$561.55 ,$990.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$990.37 ,97,,,$561.55 ,$990.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$990.37 ,97,,,$561.55 ,$990.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$990.37 ,97,,,$561.55 ,$990.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$867.85 ,85,,,$561.55 ,$990.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$918.90 ,90,,,$561.55 ,$990.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$561.55 ,55,,,$561.55 ,$990.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$969.95 ,90,,,$561.55 ,$990.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$561.55 ,55,,,$561.55 ,$990.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$949.53 ,93,,,$561.55 ,$990.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12034 REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee,8022641,CDM,450,RC,12034,HCPCS,outpatient,,,"$1,112.00 ",$834.00 ,,"$1,023.04 ",92,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$611.60 ,55,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$611.60 ,"$1,078.64 ",other,,Not applicable. No negotiated rates per contract,$956.32 ,86,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$889.60 ,80,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$611.60 ,55,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,056.40 ",95,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,056.40 ",95,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$834.00 ,75,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$945.20 ,85,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,078.64 ",97,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$611.60 ,55,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,000.80 ",90,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,078.64 ",97,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,078.64 ",97,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,078.64 ",97,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$945.20 ,85,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,000.80 ",90,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$611.60 ,55,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,056.40 ",90,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$611.60 ,55,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,034.16 ",93,,,$611.60 ,"$1,078.64 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12035 REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee,8022642,CDM,450,RC,12035,HCPCS,outpatient,,,"$1,311.00 ",$983.25 ,,"$1,206.12 ",92,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$721.05 ,55,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$721.05 ,"$1,271.67 ",other,,Not applicable. No negotiated rates per contract,"$1,127.46 ",86,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,048.80 ",80,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$721.05 ,55,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,245.45 ",95,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,245.45 ",95,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$983.25 ,75,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,114.35 ",85,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,271.67 ",97,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$721.05 ,55,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,271.67 ",97,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,271.67 ",97,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,271.67 ",97,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,114.35 ",85,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,179.90 ",90,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$721.05 ,55,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,245.45 ",90,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$721.05 ,55,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,219.23 ",93,,,$721.05 ,"$1,271.67 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12036 REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM TechFee,8022643,CDM,450,RC,12036,HCPCS,outpatient,,,"$1,440.00 ","$1,080.00 ",,"$1,324.80 ",92,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$792.00 ,55,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$792.00 ,"$1,396.80 ",other,,Not applicable. No negotiated rates per contract,"$1,238.40 ",86,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,152.00 ",80,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$792.00 ,55,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,368.00 ",95,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,368.00 ",95,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,080.00 ",75,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,224.00 ",85,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,396.80 ",97,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$792.00 ,55,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,296.00 ",90,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,396.80 ",97,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,396.80 ",97,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,396.80 ",97,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,224.00 ",85,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,296.00 ",90,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$792.00 ,55,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,368.00 ",90,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$792.00 ,55,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,339.20 ",93,,,$792.00 ,"$1,396.80 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12037 REPAIR INTERMEDIATE S/A/T/E >30.0 CM TechFee,8022644,CDM,450,RC,12037,HCPCS,outpatient,,,"$1,610.00 ","$1,207.50 ",,"$1,481.20 ",92,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$885.50 ,"$1,561.70 ",other,,Not applicable. No negotiated rates per contract,"$1,384.60 ",86,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,288.00 ",80,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,529.50 ",95,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,529.50 ",95,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,207.50 ",75,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,368.50 ",85,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,449.00 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,368.50 ",85,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,449.00 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,529.50 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,497.30 ",93,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12041 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee,8022645,CDM,450,RC,12041,HCPCS,outpatient,,,$882.00 ,$661.50 ,,$811.44 ,92,,,$485.10 ,$855.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$485.10 ,55,,,$485.10 ,$855.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$485.10 ,$855.54 ,other,,Not applicable. No negotiated rates per contract,$758.52 ,86,,,$485.10 ,$855.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$705.60 ,80,,,$485.10 ,$855.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$485.10 ,55,,,$485.10 ,$855.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.90 ,95,,,$485.10 ,$855.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$837.90 ,95,,,$485.10 ,$855.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$661.50 ,75,,,$485.10 ,$855.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$749.70 ,85,,,$485.10 ,$855.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$855.54 ,97,,,$485.10 ,$855.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$485.10 ,55,,,$485.10 ,$855.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$793.80 ,90,,,$485.10 ,$855.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$855.54 ,97,,,$485.10 ,$855.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$855.54 ,97,,,$485.10 ,$855.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$855.54 ,97,,,$485.10 ,$855.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$749.70 ,85,,,$485.10 ,$855.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$793.80 ,90,,,$485.10 ,$855.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$485.10 ,55,,,$485.10 ,$855.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.90 ,90,,,$485.10 ,$855.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$485.10 ,55,,,$485.10 ,$855.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$820.26 ,93,,,$485.10 ,$855.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12042 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee,8022646,CDM,450,RC,12042,HCPCS,outpatient,,,"$1,030.00 ",$772.50 ,,$947.60 ,92,,,$566.50 ,$999.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$566.50 ,55,,,$566.50 ,$999.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$566.50 ,$999.10 ,other,,Not applicable. No negotiated rates per contract,$885.80 ,86,,,$566.50 ,$999.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$824.00 ,80,,,$566.50 ,$999.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$566.50 ,55,,,$566.50 ,$999.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$978.50 ,95,,,$566.50 ,$999.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$978.50 ,95,,,$566.50 ,$999.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$772.50 ,75,,,$566.50 ,$999.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$875.50 ,85,,,$566.50 ,$999.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$999.10 ,97,,,$566.50 ,$999.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$566.50 ,55,,,$566.50 ,$999.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$927.00 ,90,,,$566.50 ,$999.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$999.10 ,97,,,$566.50 ,$999.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$999.10 ,97,,,$566.50 ,$999.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$999.10 ,97,,,$566.50 ,$999.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$875.50 ,85,,,$566.50 ,$999.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$927.00 ,90,,,$566.50 ,$999.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$566.50 ,55,,,$566.50 ,$999.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$978.50 ,90,,,$566.50 ,$999.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$566.50 ,55,,,$566.50 ,$999.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$957.90 ,93,,,$566.50 ,$999.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12044 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee,8022647,CDM,450,RC,12044,HCPCS,outpatient,,,"$1,273.00 ",$954.75 ,,"$1,171.16 ",92,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$700.15 ,55,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$700.15 ,"$1,234.81 ",other,,Not applicable. No negotiated rates per contract,"$1,094.78 ",86,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,018.40 ",80,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$700.15 ,55,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,209.35 ",95,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,209.35 ",95,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$954.75 ,75,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,082.05 ",85,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,234.81 ",97,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$700.15 ,55,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,145.70 ",90,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,234.81 ",97,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,234.81 ",97,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,234.81 ",97,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,082.05 ",85,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,145.70 ",90,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$700.15 ,55,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,209.35 ",90,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$700.15 ,55,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,183.89 ",93,,,$700.15 ,"$1,234.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12045 REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM TechFee,8022648,CDM,450,RC,12045,HCPCS,outpatient,,,"$1,351.00 ","$1,013.25 ",,"$1,242.92 ",92,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$743.05 ,"$1,310.47 ",other,,Not applicable. No negotiated rates per contract,"$1,161.86 ",86,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,080.80 ",80,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,283.45 ",95,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,283.45 ",95,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,013.25 ",75,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,148.35 ",85,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,215.90 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,148.35 ",85,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,215.90 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,283.45 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,256.43 ",93,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12046 RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM TechFee,8022649,CDM,450,RC,12046,HCPCS,outpatient,,,"$1,673.00 ","$1,254.75 ",,"$1,539.16 ",92,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$920.15 ,55,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$920.15 ,"$1,622.81 ",other,,Not applicable. No negotiated rates per contract,"$1,438.78 ",86,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,338.40 ",80,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$920.15 ,55,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,589.35 ",95,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,589.35 ",95,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,254.75 ",75,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,422.05 ",85,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,622.81 ",97,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$920.15 ,55,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,505.70 ",90,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,622.81 ",97,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,622.81 ",97,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,622.81 ",97,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,422.05 ",85,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,505.70 ",90,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$920.15 ,55,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,589.35 ",90,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$920.15 ,55,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,555.89 ",93,,,$920.15 ,"$1,622.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12047 REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM TechFee,8022650,CDM,450,RC,12047,HCPCS,outpatient,,,"$1,827.00 ","$1,370.25 ",,"$1,680.84 ",92,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,004.85 ",55,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,004.85 ","$1,772.19 ",other,,Not applicable. No negotiated rates per contract,"$1,571.22 ",86,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,461.60 ",80,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,004.85 ",55,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,735.65 ",95,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,735.65 ",95,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,370.25 ",75,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,552.95 ",85,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,772.19 ",97,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,004.85 ",55,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,644.30 ",90,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,772.19 ",97,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,772.19 ",97,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,772.19 ",97,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,552.95 ",85,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,644.30 ",90,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,004.85 ",55,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,735.65 ",90,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,004.85 ",55,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,699.11 ",93,,,"$1,004.85 ","$1,772.19 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12051 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< TechFee,8022651,CDM,450,RC,12051,HCPCS,outpatient,,,$942.00 ,$706.50 ,,$866.64 ,92,,,$518.10 ,$913.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$518.10 ,$913.74 ,other,,Not applicable. No negotiated rates per contract,$810.12 ,86,,,$518.10 ,$913.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$753.60 ,80,,,$518.10 ,$913.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$706.50 ,75,,,$518.10 ,$913.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$876.06 ,93,,,$518.10 ,$913.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
12052 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM TechFee,8022652,CDM,450,RC,12052,HCPCS,outpatient,,,"$1,046.00 ",$784.50 ,,$962.32 ,92,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$575.30 ,"$1,014.62 ",other,,Not applicable. No negotiated rates per contract,$899.56 ,86,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$836.80 ,80,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$993.70 ,95,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$993.70 ,95,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$784.50 ,75,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$889.10 ,85,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$941.40 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$889.10 ,85,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$941.40 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$993.70 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$972.78 ,93,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12053 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM TechFee,8022653,CDM,450,RC,12053,HCPCS,outpatient,,,"$1,222.00 ",$916.50 ,,"$1,124.24 ",92,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$672.10 ,"$1,185.34 ",other,,Not applicable. No negotiated rates per contract,"$1,050.92 ",86,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$977.60 ,80,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,160.90 ",95,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,160.90 ",95,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$916.50 ,75,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,038.70 ",85,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,099.80 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,038.70 ",85,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,099.80 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,160.90 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,136.46 ",93,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12054 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM TechFee,8022654,CDM,450,RC,12054,HCPCS,outpatient,,,"$1,288.00 ",$966.00 ,,"$1,184.96 ",92,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$708.40 ,55,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$708.40 ,"$1,249.36 ",other,,Not applicable. No negotiated rates per contract,"$1,107.68 ",86,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,030.40 ",80,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$708.40 ,55,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,223.60 ",95,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,223.60 ",95,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$966.00 ,75,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,094.80 ",85,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,249.36 ",97,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$708.40 ,55,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,159.20 ",90,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,249.36 ",97,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,249.36 ",97,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,249.36 ",97,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,094.80 ",85,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,159.20 ",90,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$708.40 ,55,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,223.60 ",90,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$708.40 ,55,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,197.84 ",93,,,$708.40 ,"$1,249.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12055 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM TechFee,8022655,CDM,450,RC,12055,HCPCS,outpatient,,,"$1,679.00 ","$1,259.25 ",,"$1,544.68 ",92,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$923.45 ,55,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$923.45 ,"$1,628.63 ",other,,Not applicable. No negotiated rates per contract,"$1,443.94 ",86,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,343.20 ",80,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$923.45 ,55,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,595.05 ",95,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,595.05 ",95,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,259.25 ",75,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,427.15 ",85,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,628.63 ",97,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$923.45 ,55,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,511.10 ",90,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,628.63 ",97,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,628.63 ",97,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,628.63 ",97,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,427.15 ",85,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,511.10 ",90,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$923.45 ,55,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,595.05 ",90,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$923.45 ,55,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,561.47 ",93,,,$923.45 ,"$1,628.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12056 REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM TechFee,8022656,CDM,450,RC,12056,HCPCS,outpatient,,,"$1,934.00 ","$1,450.50 ",,"$1,779.28 ",92,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,063.70 ",55,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,063.70 ","$1,875.98 ",other,,Not applicable. No negotiated rates per contract,"$1,663.24 ",86,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,547.20 ",80,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,063.70 ",55,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.30 ",95,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,837.30 ",95,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,450.50 ",75,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,643.90 ",85,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,875.98 ",97,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.70 ",55,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,740.60 ",90,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,875.98 ",97,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.98 ",97,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.98 ",97,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,643.90 ",85,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,740.60 ",90,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.70 ",55,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.30 ",90,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.70 ",55,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.62 ",93,,,"$1,063.70 ","$1,875.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
12057 REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM TechFee,8022657,CDM,450,RC,12057,HCPCS,outpatient,,,"$2,044.00 ","$1,533.00 ",,"$1,880.48 ",92,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,124.20 ",55,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,124.20 ","$1,982.68 ",other,,Not applicable. No negotiated rates per contract,"$1,757.84 ",86,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,635.20 ",80,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,124.20 ",55,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,941.80 ",95,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,941.80 ",95,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,533.00 ",75,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,737.40 ",85,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,982.68 ",97,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,124.20 ",55,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,839.60 ",90,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,982.68 ",97,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,982.68 ",97,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,982.68 ",97,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,737.40 ",85,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,839.60 ",90,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,124.20 ",55,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,941.80 ",90,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,124.20 ",55,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,900.92 ",93,,,"$1,124.20 ","$1,982.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13100 REPAIR COMPLEX TRUNK 1.1-2.5 CM TechFee,8022658,CDM,450,RC,13100,HCPCS,outpatient,,,"$1,153.00 ",$864.75 ,,"$1,060.76 ",92,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$634.15 ,55,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$634.15 ,"$1,118.41 ",other,,Not applicable. No negotiated rates per contract,$991.58 ,86,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$922.40 ,80,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$634.15 ,55,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,095.35 ",95,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,095.35 ",95,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$864.75 ,75,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$980.05 ,85,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,118.41 ",97,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$634.15 ,55,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,037.70 ",90,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,118.41 ",97,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,118.41 ",97,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,118.41 ",97,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$980.05 ,85,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,037.70 ",90,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$634.15 ,55,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,095.35 ",90,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$634.15 ,55,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,072.29 ",93,,,$634.15 ,"$1,118.41 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13101 REPAIR COMPLEX TRUNK 2.6-7.5 CM TechFee,8022659,CDM,450,RC,13101,HCPCS,outpatient,,,"$1,345.00 ","$1,008.75 ",,"$1,237.40 ",92,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$739.75 ,55,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$739.75 ,"$1,304.65 ",other,,Not applicable. No negotiated rates per contract,"$1,156.70 ",86,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,076.00 ",80,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$739.75 ,55,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,277.75 ",95,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,277.75 ",95,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,008.75 ",75,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,143.25 ",85,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,304.65 ",97,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$739.75 ,55,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,210.50 ",90,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,304.65 ",97,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,304.65 ",97,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,304.65 ",97,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,143.25 ",85,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,210.50 ",90,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$739.75 ,55,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,277.75 ",90,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$739.75 ,55,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,250.85 ",93,,,$739.75 ,"$1,304.65 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13102 REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< TechFee,8022660,CDM,450,RC,13102,HCPCS,outpatient,,,$394.00 ,$295.50 ,,$362.48 ,92,,,$216.70 ,$382.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.70 ,$382.18 ,other,,Not applicable. No negotiated rates per contract,$338.84 ,86,,,$216.70 ,$382.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$315.20 ,80,,,$216.70 ,$382.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.30 ,95,,,$216.70 ,$382.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$374.30 ,95,,,$216.70 ,$382.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$295.50 ,75,,,$216.70 ,$382.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.90 ,85,,,$216.70 ,$382.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.60 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.90 ,85,,,$216.70 ,$382.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.60 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.30 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$366.42 ,93,,,$216.70 ,$382.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
13120 REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM TechFee,8022661,CDM,450,RC,13120,HCPCS,outpatient,,,"$1,197.00 ",$897.75 ,,"$1,101.24 ",92,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$658.35 ,55,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$658.35 ,"$1,161.09 ",other,,Not applicable. No negotiated rates per contract,"$1,029.42 ",86,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$957.60 ,80,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$658.35 ,55,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,137.15 ",95,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,137.15 ",95,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$897.75 ,75,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,017.45 ",85,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,161.09 ",97,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$658.35 ,55,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,077.30 ",90,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,161.09 ",97,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,161.09 ",97,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,161.09 ",97,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,017.45 ",85,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,077.30 ",90,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$658.35 ,55,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,137.15 ",90,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$658.35 ,55,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,113.21 ",93,,,$658.35 ,"$1,161.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13121 REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM TechFee,8022662,CDM,450,RC,13121,HCPCS,outpatient,,,"$1,437.00 ","$1,077.75 ",,"$1,322.04 ",92,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$790.35 ,"$1,393.89 ",other,,Not applicable. No negotiated rates per contract,"$1,235.82 ",86,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,149.60 ",80,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.15 ",95,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,365.15 ",95,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,077.75 ",75,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,221.45 ",85,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,293.30 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,221.45 ",85,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,293.30 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.15 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,336.41 ",93,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13122 REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< TechFee,8022663,CDM,450,RC,13122,HCPCS,outpatient,,,$426.00 ,$319.50 ,,$391.92 ,92,,,$234.30 ,$413.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$234.30 ,55,,,$234.30 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$234.30 ,$413.22 ,other,,Not applicable. No negotiated rates per contract,$366.36 ,86,,,$234.30 ,$413.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$340.80 ,80,,,$234.30 ,$413.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$234.30 ,55,,,$234.30 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.70 ,95,,,$234.30 ,$413.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$404.70 ,95,,,$234.30 ,$413.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$319.50 ,75,,,$234.30 ,$413.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$362.10 ,85,,,$234.30 ,$413.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$413.22 ,97,,,$234.30 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$234.30 ,55,,,$234.30 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.40 ,90,,,$234.30 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$413.22 ,97,,,$234.30 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.22 ,97,,,$234.30 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.22 ,97,,,$234.30 ,$413.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.10 ,85,,,$234.30 ,$413.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$383.40 ,90,,,$234.30 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$234.30 ,55,,,$234.30 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.70 ,90,,,$234.30 ,$413.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$234.30 ,55,,,$234.30 ,$413.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$396.18 ,93,,,$234.30 ,$413.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
13131 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee,8022664,CDM,450,RC,13131,HCPCS,outpatient,,,"$1,304.00 ",$978.00 ,,"$1,199.68 ",92,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$717.20 ,55,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$717.20 ,"$1,264.88 ",other,,Not applicable. No negotiated rates per contract,"$1,121.44 ",86,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,043.20 ",80,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$717.20 ,55,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,238.80 ",95,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,238.80 ",95,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$978.00 ,75,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,108.40 ",85,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,264.88 ",97,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$717.20 ,55,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,173.60 ",90,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,264.88 ",97,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,264.88 ",97,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,264.88 ",97,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,108.40 ",85,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,173.60 ",90,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$717.20 ,55,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,238.80 ",90,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$717.20 ,55,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,212.72 ",93,,,$717.20 ,"$1,264.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13132 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee,8022665,CDM,450,RC,13132,HCPCS,outpatient,,,"$1,581.00 ","$1,185.75 ",,"$1,454.52 ",92,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$869.55 ,55,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$869.55 ,"$1,533.57 ",other,,Not applicable. No negotiated rates per contract,"$1,359.66 ",86,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,264.80 ",80,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$869.55 ,55,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,501.95 ",95,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,501.95 ",95,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,185.75 ",75,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,343.85 ",85,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,533.57 ",97,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$869.55 ,55,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,422.90 ",90,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,533.57 ",97,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,533.57 ",97,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,533.57 ",97,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,343.85 ",85,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,422.90 ",90,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$869.55 ,55,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,501.95 ",90,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$869.55 ,55,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,470.33 ",93,,,$869.55 ,"$1,533.57 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13133 REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< TechFee,8022666,CDM,450,RC,13133,HCPCS,outpatient,,,$561.00 ,$420.75 ,,$516.12 ,92,,,$308.55 ,$544.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$308.55 ,$544.17 ,other,,Not applicable. No negotiated rates per contract,$482.46 ,86,,,$308.55 ,$544.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$448.80 ,80,,,$308.55 ,$544.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.95 ,95,,,$308.55 ,$544.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.95 ,95,,,$308.55 ,$544.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.75 ,75,,,$308.55 ,$544.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$476.85 ,85,,,$308.55 ,$544.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.90 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$476.85 ,85,,,$308.55 ,$544.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.90 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.95 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$521.73 ,93,,,$308.55 ,$544.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
13151 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM TechFee,8022668,CDM,450,RC,13151,HCPCS,outpatient,,,"$1,418.00 ","$1,063.50 ",,"$1,304.56 ",92,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$779.90 ,55,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$779.90 ,"$1,375.46 ",other,,Not applicable. No negotiated rates per contract,"$1,219.48 ",86,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,134.40 ",80,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$779.90 ,55,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,347.10 ",95,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,347.10 ",95,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,063.50 ",75,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,205.30 ",85,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,375.46 ",97,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$779.90 ,55,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,276.20 ",90,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,375.46 ",97,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,375.46 ",97,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,375.46 ",97,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.30 ",85,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,276.20 ",90,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$779.90 ,55,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,347.10 ",90,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$779.90 ,55,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,318.74 ",93,,,$779.90 ,"$1,375.46 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13152 REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM TechFee,8022669,CDM,450,RC,13152,HCPCS,outpatient,,,"$1,666.00 ","$1,249.50 ",,"$1,532.72 ",92,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$916.30 ,55,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$916.30 ,"$1,616.02 ",other,,Not applicable. No negotiated rates per contract,"$1,432.76 ",86,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,332.80 ",80,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$916.30 ,55,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,582.70 ",95,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,582.70 ",95,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,249.50 ",75,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,416.10 ",85,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,616.02 ",97,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$916.30 ,55,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,499.40 ",90,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,616.02 ",97,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,616.02 ",97,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,616.02 ",97,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,416.10 ",85,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.40 ",90,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$916.30 ,55,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,582.70 ",90,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$916.30 ,55,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,549.38 ",93,,,$916.30 ,"$1,616.02 ",percent of total billed charges,,93% of total billed charges for outpatient setting
13153 REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/ TechFee,8022670,CDM,450,RC,13153,HCPCS,outpatient,,,$614.00 ,$460.50 ,,$564.88 ,92,,,$337.70 ,$595.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$337.70 ,55,,,$337.70 ,$595.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$337.70 ,$595.58 ,other,,Not applicable. No negotiated rates per contract,$528.04 ,86,,,$337.70 ,$595.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$491.20 ,80,,,$337.70 ,$595.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$337.70 ,55,,,$337.70 ,$595.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$583.30 ,95,,,$337.70 ,$595.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$583.30 ,95,,,$337.70 ,$595.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.50 ,75,,,$337.70 ,$595.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$521.90 ,85,,,$337.70 ,$595.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$595.58 ,97,,,$337.70 ,$595.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.70 ,55,,,$337.70 ,$595.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$552.60 ,90,,,$337.70 ,$595.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$595.58 ,97,,,$337.70 ,$595.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$595.58 ,97,,,$337.70 ,$595.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$595.58 ,97,,,$337.70 ,$595.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$521.90 ,85,,,$337.70 ,$595.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$552.60 ,90,,,$337.70 ,$595.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.70 ,55,,,$337.70 ,$595.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$583.30 ,90,,,$337.70 ,$595.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.70 ,55,,,$337.70 ,$595.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$571.02 ,93,,,$337.70 ,$595.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
14040 SKIN PLASTY TechFee,8022674,CDM,450,RC,14040,HCPCS,outpatient,,,"$2,473.00 ","$1,854.75 ",,"$2,275.16 ",92,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,360.15 ",55,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,360.15 ","$2,398.81 ",other,,Not applicable. No negotiated rates per contract,"$2,126.78 ",86,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,978.40 ",80,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,360.15 ",55,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,349.35 ",95,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,349.35 ",95,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,854.75 ",75,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,102.05 ",85,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,398.81 ",97,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,360.15 ",55,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,225.70 ",90,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,398.81 ",97,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,398.81 ",97,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,398.81 ",97,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,102.05 ",85,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,225.70 ",90,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,360.15 ",55,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,349.35 ",90,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,360.15 ",55,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,299.89 ",93,,,"$1,360.15 ","$2,398.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
16000 INITIAL TX 1ST DEGREE BURN LOCAL TX TechFee,8022702,CDM,450,RC,16000,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$223.56 ,92,,,$133.65 ,$235.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$133.65 ,$235.71 ,other,,Not applicable. No negotiated rates per contract,$208.98 ,86,,,$133.65 ,$235.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$194.40 ,80,,,$133.65 ,$235.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,95,,,$133.65 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$230.85 ,95,,,$133.65 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.25 ,75,,,$133.65 ,$235.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$206.55 ,85,,,$133.65 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.70 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.55 ,85,,,$133.65 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.70 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.99 ,93,,,$133.65 ,$235.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
16020 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL TechFee,8022703,CDM,450,RC,16020,HCPCS,outpatient,,,$280.00 ,$210.00 ,,$257.60 ,92,,,$154.00 ,$271.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$154.00 ,55,,,$154.00 ,$271.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$154.00 ,$271.60 ,other,,Not applicable. No negotiated rates per contract,$240.80 ,86,,,$154.00 ,$271.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$224.00 ,80,,,$154.00 ,$271.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$154.00 ,55,,,$154.00 ,$271.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.00 ,95,,,$154.00 ,$271.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$266.00 ,95,,,$154.00 ,$271.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$210.00 ,75,,,$154.00 ,$271.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$238.00 ,85,,,$154.00 ,$271.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$271.60 ,97,,,$154.00 ,$271.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.00 ,55,,,$154.00 ,$271.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.00 ,90,,,$154.00 ,$271.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.60 ,97,,,$154.00 ,$271.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.60 ,97,,,$154.00 ,$271.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.60 ,97,,,$154.00 ,$271.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.00 ,85,,,$154.00 ,$271.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.00 ,90,,,$154.00 ,$271.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.00 ,55,,,$154.00 ,$271.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.00 ,90,,,$154.00 ,$271.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.00 ,55,,,$154.00 ,$271.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.40 ,93,,,$154.00 ,$271.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
16025 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM TechFee,8022704,CDM,450,RC,16025,HCPCS,outpatient,,,$510.00 ,$382.50 ,,$469.20 ,92,,,$280.50 ,$494.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$280.50 ,55,,,$280.50 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$280.50 ,$494.70 ,other,,Not applicable. No negotiated rates per contract,$438.60 ,86,,,$280.50 ,$494.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$408.00 ,80,,,$280.50 ,$494.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$280.50 ,55,,,$280.50 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$484.50 ,95,,,$280.50 ,$494.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$484.50 ,95,,,$280.50 ,$494.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$382.50 ,75,,,$280.50 ,$494.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$433.50 ,85,,,$280.50 ,$494.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$494.70 ,97,,,$280.50 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.50 ,55,,,$280.50 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.00 ,90,,,$280.50 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$494.70 ,97,,,$280.50 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$494.70 ,97,,,$280.50 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$494.70 ,97,,,$280.50 ,$494.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.50 ,85,,,$280.50 ,$494.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$459.00 ,90,,,$280.50 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$280.50 ,55,,,$280.50 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$484.50 ,90,,,$280.50 ,$494.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$280.50 ,55,,,$280.50 ,$494.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$474.30 ,93,,,$280.50 ,$494.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
16030 DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE TechFee,8022705,CDM,450,RC,16030,HCPCS,outpatient,,,$636.00 ,$477.00 ,,$585.12 ,92,,,$349.80 ,$616.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$349.80 ,55,,,$349.80 ,$616.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$349.80 ,$616.92 ,other,,Not applicable. No negotiated rates per contract,$546.96 ,86,,,$349.80 ,$616.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$508.80 ,80,,,$349.80 ,$616.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$349.80 ,55,,,$349.80 ,$616.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$604.20 ,95,,,$349.80 ,$616.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$604.20 ,95,,,$349.80 ,$616.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$477.00 ,75,,,$349.80 ,$616.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$540.60 ,85,,,$349.80 ,$616.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$616.92 ,97,,,$349.80 ,$616.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.80 ,55,,,$349.80 ,$616.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$572.40 ,90,,,$349.80 ,$616.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$616.92 ,97,,,$349.80 ,$616.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$616.92 ,97,,,$349.80 ,$616.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$616.92 ,97,,,$349.80 ,$616.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$540.60 ,85,,,$349.80 ,$616.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$572.40 ,90,,,$349.80 ,$616.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.80 ,55,,,$349.80 ,$616.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$604.20 ,90,,,$349.80 ,$616.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.80 ,55,,,$349.80 ,$616.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$591.48 ,93,,,$349.80 ,$616.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
17110 DESTRUCT BENIGN LESION OTHER THAN SKIN TAG UP TO 14 LESION TechFee,8022709,CDM,450,RC,17110,HCPCS,outpatient,,,$378.00 ,$283.50 ,,$347.76 ,92,,,$207.90 ,$366.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.90 ,$366.66 ,other,,Not applicable. No negotiated rates per contract,$325.08 ,86,,,$207.90 ,$366.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$302.40 ,80,,,$207.90 ,$366.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,95,,,$207.90 ,$366.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$359.10 ,95,,,$207.90 ,$366.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.50 ,75,,,$207.90 ,$366.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$321.30 ,85,,,$207.90 ,$366.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$340.20 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.30 ,85,,,$207.90 ,$366.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$340.20 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.54 ,93,,,$207.90 ,$366.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
17250 CHEMICAL CAUTERIZATION GRANULATION TISSUE tech,8022710,CDM,450,RC,17250,HCPCS,outpatient,,,$299.00 ,$224.25 ,,$275.08 ,92,,,$164.45 ,$290.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$164.45 ,$290.03 ,other,,Not applicable. No negotiated rates per contract,$257.14 ,86,,,$164.45 ,$290.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$239.20 ,80,,,$164.45 ,$290.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,95,,,$164.45 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.05 ,95,,,$164.45 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.25 ,75,,,$164.45 ,$290.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$254.15 ,85,,,$164.45 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.10 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.15 ,85,,,$164.45 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.10 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.07 ,93,,,$164.45 ,$290.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS,8022715,CDM,450,RC,19020,HCPCS,outpatient,,,"$1,594.00 ","$1,195.50 ",,"$1,466.48 ",92,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$876.70 ,"$1,546.18 ",other,,Not applicable. No negotiated rates per contract,"$1,370.84 ",86,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,275.20 ",80,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.30 ",95,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,514.30 ",95,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,195.50 ",75,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,354.90 ",85,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,434.60 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,354.90 ",85,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,434.60 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.30 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,482.42 ",93,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
20102 EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK TechFee,8022744,CDM,450,RC,20102,HCPCS,outpatient,,,"$2,101.00 ","$1,575.75 ",,"$1,932.92 ",92,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,155.55 ",55,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,155.55 ","$2,037.97 ",other,,Not applicable. No negotiated rates per contract,"$1,806.86 ",86,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,680.80 ",80,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,155.55 ",55,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,995.95 ",95,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,995.95 ",95,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,575.75 ",75,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,785.85 ",85,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,037.97 ",97,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,155.55 ",55,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,890.90 ",90,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,037.97 ",97,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,037.97 ",97,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,037.97 ",97,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,785.85 ",85,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,890.90 ",90,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.55 ",55,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,995.95 ",90,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.55 ",55,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,953.93 ",93,,,"$1,155.55 ","$2,037.97 ",percent of total billed charges,,93% of total billed charges for outpatient setting
20103 EXPLORATION PENETRATING WOUND SPX EXTREMITY TechFee,8022745,CDM,450,RC,20103,HCPCS,outpatient,,,"$1,918.00 ","$1,438.50 ",,"$1,764.56 ",92,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,054.90 ",55,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,054.90 ","$1,860.46 ",other,,Not applicable. No negotiated rates per contract,"$1,649.48 ",86,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,534.40 ",80,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,054.90 ",55,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,822.10 ",95,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,822.10 ",95,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,438.50 ",75,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,630.30 ",85,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,860.46 ",97,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.90 ",55,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,726.20 ",90,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,860.46 ",97,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,860.46 ",97,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,860.46 ",97,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,630.30 ",85,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,726.20 ",90,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.90 ",55,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,822.10 ",90,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.90 ",55,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,783.74 ",93,,,"$1,054.90 ","$1,860.46 ",percent of total billed charges,,93% of total billed charges for outpatient setting
20612 ASPIRATION CYST-ER SERV PROCEDURE,8051003,CDM,450,RC,20612,HCPCS,outpatient,,,$208.00 ,$156.00 ,,$191.36 ,92,,,$114.40 ,$201.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$114.40 ,$201.76 ,other,,Not applicable. No negotiated rates per contract,$178.88 ,86,,,$114.40 ,$201.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$166.40 ,80,,,$114.40 ,$201.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.00 ,75,,,$114.40 ,$201.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.44 ,93,,,$114.40 ,$201.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
21320 CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION TechFee,8022791,CDM,450,RC,21320,HCPCS,outpatient,,,$876.00 ,$657.00 ,,$805.92 ,92,,,$481.80 ,$849.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$481.80 ,55,,,$481.80 ,$849.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$481.80 ,$849.72 ,other,,Not applicable. No negotiated rates per contract,$753.36 ,86,,,$481.80 ,$849.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$700.80 ,80,,,$481.80 ,$849.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$481.80 ,55,,,$481.80 ,$849.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$832.20 ,95,,,$481.80 ,$849.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$832.20 ,95,,,$481.80 ,$849.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$657.00 ,75,,,$481.80 ,$849.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$744.60 ,85,,,$481.80 ,$849.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$849.72 ,97,,,$481.80 ,$849.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.80 ,55,,,$481.80 ,$849.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$788.40 ,90,,,$481.80 ,$849.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$849.72 ,97,,,$481.80 ,$849.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$849.72 ,97,,,$481.80 ,$849.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$849.72 ,97,,,$481.80 ,$849.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$744.60 ,85,,,$481.80 ,$849.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$788.40 ,90,,,$481.80 ,$849.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$481.80 ,55,,,$481.80 ,$849.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$832.20 ,90,,,$481.80 ,$849.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$481.80 ,55,,,$481.80 ,$849.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$814.68 ,93,,,$481.80 ,$849.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
21480 CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee,8022817,CDM,450,RC,21480,HCPCS,outpatient,,,$460.00 ,$345.00 ,,$423.20 ,92,,,$253.00 ,$446.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$253.00 ,55,,,$253.00 ,$446.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$253.00 ,$446.20 ,other,,Not applicable. No negotiated rates per contract,$395.60 ,86,,,$253.00 ,$446.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$368.00 ,80,,,$253.00 ,$446.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$253.00 ,55,,,$253.00 ,$446.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.00 ,95,,,$253.00 ,$446.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$437.00 ,95,,,$253.00 ,$446.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$345.00 ,75,,,$253.00 ,$446.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$391.00 ,85,,,$253.00 ,$446.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$446.20 ,97,,,$253.00 ,$446.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.00 ,55,,,$253.00 ,$446.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$414.00 ,90,,,$253.00 ,$446.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$446.20 ,97,,,$253.00 ,$446.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$446.20 ,97,,,$253.00 ,$446.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$446.20 ,97,,,$253.00 ,$446.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.00 ,85,,,$253.00 ,$446.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$414.00 ,90,,,$253.00 ,$446.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.00 ,55,,,$253.00 ,$446.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.00 ,90,,,$253.00 ,$446.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.00 ,55,,,$253.00 ,$446.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$427.80 ,93,,,$253.00 ,$446.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
23605 CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ TechFee,8022882,CDM,450,RC,23605,HCPCS,outpatient,,,"$1,556.00 ","$1,167.00 ",,"$1,431.52 ",92,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$855.80 ,"$1,509.32 ",other,,Not applicable. No negotiated rates per contract,"$1,338.16 ",86,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,244.80 ",80,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,167.00 ",75,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,447.08 ",93,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
23650 CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee,8022886,CDM,450,RC,23650,HCPCS,outpatient,,,"$1,065.00 ",$798.75 ,,$979.80 ,92,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$585.75 ,"$1,033.05 ",other,,Not applicable. No negotiated rates per contract,$915.90 ,86,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$852.00 ,80,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,011.75 ",95,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,011.75 ",95,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$798.75 ,75,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$905.25 ,85,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$958.50 ,90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$905.25 ,85,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$958.50 ,90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,011.75 ",90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$990.45 ,93,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,93% of total billed charges for outpatient setting
23655 CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES TechFee,8022887,CDM,450,RC,23655,HCPCS,outpatient,,,"$1,339.00 ","$1,004.25 ",,"$1,231.88 ",92,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$736.45 ,55,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$736.45 ,"$1,298.83 ",other,,Not applicable. No negotiated rates per contract,"$1,151.54 ",86,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,071.20 ",80,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$736.45 ,55,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,272.05 ",95,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,272.05 ",95,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,004.25 ",75,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,138.15 ",85,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,298.83 ",97,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$736.45 ,55,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,205.10 ",90,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,298.83 ",97,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,298.83 ",97,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,298.83 ",97,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,138.15 ",85,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,205.10 ",90,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$736.45 ,55,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,272.05 ",90,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$736.45 ,55,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,245.27 ",93,,,$736.45 ,"$1,298.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
23665 CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ TechFee,8022888,CDM,450,RC,23665,HCPCS,outpatient,,,"$1,424.00 ","$1,068.00 ",,"$1,310.08 ",92,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$783.20 ,55,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$783.20 ,"$1,381.28 ",other,,Not applicable. No negotiated rates per contract,"$1,224.64 ",86,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,139.20 ",80,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$783.20 ,55,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.80 ",95,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,352.80 ",95,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,068.00 ",75,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,210.40 ",85,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,381.28 ",97,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$783.20 ,55,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,281.60 ",90,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,381.28 ",97,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.28 ",97,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.28 ",97,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,210.40 ",85,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,281.60 ",90,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.20 ,55,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.80 ",90,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.20 ,55,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,324.32 ",93,,,$783.20 ,"$1,381.28 ",percent of total billed charges,,93% of total billed charges for outpatient setting
23931 INCISION AND DRAINAGE,8022894,CDM,450,RC,23931,HCPCS,outpatient,,,"$1,033.00 ",$774.75 ,,$950.36 ,92,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$568.15 ,55,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$568.15 ,"$1,002.01 ",other,,Not applicable. No negotiated rates per contract,$888.38 ,86,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$826.40 ,80,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$568.15 ,55,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$981.35 ,95,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$981.35 ,95,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$774.75 ,75,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$878.05 ,85,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,002.01 ",97,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$568.15 ,55,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$929.70 ,90,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,002.01 ",97,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,002.01 ",97,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,002.01 ",97,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$878.05 ,85,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$929.70 ,90,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$568.15 ,55,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$981.35 ,90,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$568.15 ,55,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$960.69 ,93,,,$568.15 ,"$1,002.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24200 Fb Rem Upper Arm/Elbow-Sq TechFee,8022905,CDM,450,RC,24200,HCPCS,outpatient,,,$737.00 ,$552.75 ,,$678.04 ,92,,,$405.35 ,$714.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$405.35 ,55,,,$405.35 ,$714.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$405.35 ,$714.89 ,other,,Not applicable. No negotiated rates per contract,$633.82 ,86,,,$405.35 ,$714.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$589.60 ,80,,,$405.35 ,$714.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$405.35 ,55,,,$405.35 ,$714.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$700.15 ,95,,,$405.35 ,$714.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$700.15 ,95,,,$405.35 ,$714.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$552.75 ,75,,,$405.35 ,$714.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$626.45 ,85,,,$405.35 ,$714.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$714.89 ,97,,,$405.35 ,$714.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$405.35 ,55,,,$405.35 ,$714.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$663.30 ,90,,,$405.35 ,$714.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$714.89 ,97,,,$405.35 ,$714.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$714.89 ,97,,,$405.35 ,$714.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$714.89 ,97,,,$405.35 ,$714.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$626.45 ,85,,,$405.35 ,$714.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$663.30 ,90,,,$405.35 ,$714.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$405.35 ,55,,,$405.35 ,$714.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$700.15 ,90,,,$405.35 ,$714.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$405.35 ,55,,,$405.35 ,$714.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$685.41 ,93,,,$405.35 ,$714.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
24505 CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ TechFee,8022917,CDM,450,RC,24505,HCPCS,outpatient,,,"$1,660.00 ","$1,245.00 ",,"$1,527.20 ",92,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$913.00 ,55,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$913.00 ,"$1,610.20 ",other,,Not applicable. No negotiated rates per contract,"$1,427.60 ",86,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,328.00 ",80,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$913.00 ,55,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,577.00 ",95,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,577.00 ",95,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,245.00 ",75,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,411.00 ",85,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,610.20 ",97,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$913.00 ,55,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,494.00 ",90,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,610.20 ",97,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,610.20 ",97,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,610.20 ",97,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,411.00 ",85,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,494.00 ",90,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$913.00 ,55,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,577.00 ",90,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$913.00 ,55,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,543.80 ",93,,,$913.00 ,"$1,610.20 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24560 CLOSED TREAT HUM EPICON FRAC MEDIAL OR LAT; W/OUT MANIP TechFee,8022924,CDM,450,RC,24560,HCPCS,outpatient,,,"$1,109.00 ",$831.75 ,,"$1,020.28 ",92,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$609.95 ,55,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$609.95 ,"$1,075.73 ",other,,Not applicable. No negotiated rates per contract,$953.74 ,86,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$887.20 ,80,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$609.95 ,55,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,053.55 ",95,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,053.55 ",95,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$831.75 ,75,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$942.65 ,85,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,075.73 ",97,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$609.95 ,55,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$998.10 ,90,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,075.73 ",97,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,075.73 ",97,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,075.73 ",97,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$942.65 ,85,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$998.10 ,90,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$609.95 ,55,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,053.55 ",90,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$609.95 ,55,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,031.37 ",93,,,$609.95 ,"$1,075.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24577 CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ TechFee,8022929,CDM,450,RC,24577,HCPCS,outpatient,,,"$1,833.00 ","$1,374.75 ",,"$1,686.36 ",92,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,008.15 ",55,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,008.15 ","$1,778.01 ",other,,Not applicable. No negotiated rates per contract,"$1,576.38 ",86,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,466.40 ",80,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,008.15 ",55,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,741.35 ",95,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,741.35 ",95,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,374.75 ",75,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,558.05 ",85,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,778.01 ",97,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,008.15 ",55,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,649.70 ",90,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,778.01 ",97,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,778.01 ",97,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,778.01 ",97,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,558.05 ",85,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,649.70 ",90,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,008.15 ",55,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,741.35 ",90,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,008.15 ",55,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,704.69 ",93,,,"$1,008.15 ","$1,778.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24600 TREATMENT CLOSED ELBOW DISLOCATION W/O ANES TechFee,8022932,CDM,450,RC,24600,HCPCS,outpatient,,,"$1,222.00 ",$916.50 ,,"$1,124.24 ",92,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$672.10 ,"$1,185.34 ",other,,Not applicable. No negotiated rates per contract,"$1,050.92 ",86,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$977.60 ,80,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,160.90 ",95,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,160.90 ",95,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$916.50 ,75,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,038.70 ",85,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,099.80 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,185.34 ",97,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,038.70 ",85,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,099.80 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,160.90 ",90,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$672.10 ,55,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,136.46 ",93,,,$672.10 ,"$1,185.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24605 TREATMENT CLOSED ELBOW DISLOCATION REQ ANES TechFee,8022933,CDM,450,RC,24605,HCPCS,outpatient,,,"$1,569.00 ","$1,176.75 ",,"$1,443.48 ",92,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$862.95 ,55,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$862.95 ,"$1,521.93 ",other,,Not applicable. No negotiated rates per contract,"$1,349.34 ",86,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,255.20 ",80,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$862.95 ,55,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,490.55 ",95,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,490.55 ",95,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,176.75 ",75,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,333.65 ",85,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,521.93 ",97,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$862.95 ,55,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,412.10 ",90,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,521.93 ",97,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,521.93 ",97,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,521.93 ",97,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,333.65 ",85,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,412.10 ",90,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$862.95 ,55,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,490.55 ",90,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$862.95 ,55,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,459.17 ",93,,,$862.95 ,"$1,521.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24620 CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ TechFee,8022934,CDM,450,RC,24620,HCPCS,outpatient,,,"$1,837.00 ","$1,377.75 ",,"$1,690.04 ",92,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,010.35 ",55,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,010.35 ","$1,781.89 ",other,,Not applicable. No negotiated rates per contract,"$1,579.82 ",86,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,469.60 ",80,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,010.35 ",55,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,745.15 ",95,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,745.15 ",95,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,377.75 ",75,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,561.45 ",85,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,781.89 ",97,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,010.35 ",55,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,653.30 ",90,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,781.89 ",97,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,781.89 ",97,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,781.89 ",97,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,561.45 ",85,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,653.30 ",90,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,010.35 ",55,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,745.15 ",90,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,010.35 ",55,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,708.41 ",93,,,"$1,010.35 ","$1,781.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
24640 CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ TechFee,8022936,CDM,450,RC,24640,HCPCS,outpatient,,,$346.00 ,$259.50 ,,$318.32 ,92,,,$190.30 ,$335.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$190.30 ,$335.62 ,other,,Not applicable. No negotiated rates per contract,$297.56 ,86,,,$190.30 ,$335.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.80 ,80,,,$190.30 ,$335.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$328.70 ,95,,,$190.30 ,$335.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$328.70 ,95,,,$190.30 ,$335.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$259.50 ,75,,,$190.30 ,$335.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$294.10 ,85,,,$190.30 ,$335.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.40 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.10 ,85,,,$190.30 ,$335.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$311.40 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$328.70 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.78 ,93,,,$190.30 ,$335.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
24675 CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ TechFee,8022942,CDM,450,RC,24675,HCPCS,outpatient,,,"$1,515.00 ","$1,136.25 ",,"$1,393.80 ",92,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$833.25 ,55,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$833.25 ,"$1,469.55 ",other,,Not applicable. No negotiated rates per contract,"$1,302.90 ",86,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,212.00 ",80,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$833.25 ,55,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,439.25 ",95,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,439.25 ",95,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,136.25 ",75,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,287.75 ",85,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,469.55 ",97,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$833.25 ,55,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,363.50 ",90,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,469.55 ",97,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,469.55 ",97,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,469.55 ",97,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,287.75 ",85,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,363.50 ",90,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$833.25 ,55,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,439.25 ",90,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$833.25 ,55,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,408.95 ",93,,,$833.25 ,"$1,469.55 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25500 TREAT FRACTURE OF RADIUS TechFee,8022979,CDM,450,RC,25500,HCPCS,outpatient,,,$942.00 ,$706.50 ,,$866.64 ,92,,,$518.10 ,$913.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$518.10 ,$913.74 ,other,,Not applicable. No negotiated rates per contract,$810.12 ,86,,,$518.10 ,$913.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$753.60 ,80,,,$518.10 ,$913.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$706.50 ,75,,,$518.10 ,$913.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$876.06 ,93,,,$518.10 ,$913.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
25505 CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION TechFee,8022980,CDM,450,RC,25505,HCPCS,outpatient,,,"$1,663.00 ","$1,247.25 ",,"$1,529.96 ",92,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$914.65 ,55,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$914.65 ,"$1,613.11 ",other,,Not applicable. No negotiated rates per contract,"$1,430.18 ",86,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,330.40 ",80,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$914.65 ,55,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,579.85 ",95,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,579.85 ",95,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,247.25 ",75,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,413.55 ",85,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,613.11 ",97,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$914.65 ,55,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,496.70 ",90,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,613.11 ",97,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,613.11 ",97,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,613.11 ",97,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,413.55 ",85,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,496.70 ",90,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$914.65 ,55,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,579.85 ",90,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$914.65 ,55,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,546.59 ",93,,,$914.65 ,"$1,613.11 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION TechFee,8022984,CDM,450,RC,25535,HCPCS,outpatient,,,"$1,641.00 ","$1,230.75 ",,"$1,509.72 ",92,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$902.55 ,55,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$902.55 ,"$1,591.77 ",other,,Not applicable. No negotiated rates per contract,"$1,411.26 ",86,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,312.80 ",80,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$902.55 ,55,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,558.95 ",95,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,558.95 ",95,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,230.75 ",75,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,394.85 ",85,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,591.77 ",97,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$902.55 ,55,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,476.90 ",90,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,591.77 ",97,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,591.77 ",97,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,591.77 ",97,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,394.85 ",85,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,476.90 ",90,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$902.55 ,55,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,558.95 ",90,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$902.55 ,55,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,526.13 ",93,,,$902.55 ,"$1,591.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25560 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN TechFee,8022986,CDM,450,RC,25560,HCPCS,outpatient,,,$961.00 ,$720.75 ,,$884.12 ,92,,,$528.55 ,$932.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$528.55 ,$932.17 ,other,,Not applicable. No negotiated rates per contract,$826.46 ,86,,,$528.55 ,$932.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$768.80 ,80,,,$528.55 ,$932.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$912.95 ,95,,,$528.55 ,$932.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$912.95 ,95,,,$528.55 ,$932.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$720.75 ,75,,,$528.55 ,$932.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$816.85 ,85,,,$528.55 ,$932.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$864.90 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$816.85 ,85,,,$528.55 ,$932.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$864.90 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$912.95 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$893.73 ,93,,,$528.55 ,$932.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
25565 CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ TechFee,8022987,CDM,450,RC,25565,HCPCS,outpatient,,,"$1,704.00 ","$1,278.00 ",,"$1,567.68 ",92,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$937.20 ,55,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$937.20 ,"$1,652.88 ",other,,Not applicable. No negotiated rates per contract,"$1,465.44 ",86,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,363.20 ",80,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$937.20 ,55,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,618.80 ",95,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,618.80 ",95,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,278.00 ",75,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,448.40 ",85,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,652.88 ",97,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$937.20 ,55,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,533.60 ",90,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,652.88 ",97,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,652.88 ",97,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,652.88 ",97,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,448.40 ",85,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,533.60 ",90,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$937.20 ,55,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,618.80 ",90,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$937.20 ,55,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,584.72 ",93,,,$937.20 ,"$1,652.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25600 CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ TechFee,8022989,CDM,450,RC,25600,HCPCS,outpatient,,,"$1,122.00 ",$841.50 ,,"$1,032.24 ",92,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$617.10 ,55,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$617.10 ,"$1,088.34 ",other,,Not applicable. No negotiated rates per contract,$964.92 ,86,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$897.60 ,80,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$617.10 ,55,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,065.90 ",95,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,065.90 ",95,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$841.50 ,75,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$953.70 ,85,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,088.34 ",97,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$617.10 ,55,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,009.80 ",90,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,088.34 ",97,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,088.34 ",97,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,088.34 ",97,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$953.70 ,85,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,009.80 ",90,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$617.10 ,55,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,065.90 ",90,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$617.10 ,55,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,043.46 ",93,,,$617.10 ,"$1,088.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25605 CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF TechFee,8022990,CDM,450,RC,25605,HCPCS,outpatient,,,"$1,780.00 ","$1,335.00 ",,"$1,637.60 ",92,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$979.00 ,55,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$979.00 ,"$1,726.60 ",other,,Not applicable. No negotiated rates per contract,"$1,530.80 ",86,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,424.00 ",80,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$979.00 ,55,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,691.00 ",95,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,691.00 ",95,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,335.00 ",75,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,513.00 ",85,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,726.60 ",97,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$979.00 ,55,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,602.00 ",90,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,726.60 ",97,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,726.60 ",97,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,726.60 ",97,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,513.00 ",85,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,602.00 ",90,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$979.00 ,55,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,691.00 ",90,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$979.00 ,55,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,655.40 ",93,,,$979.00 ,"$1,726.60 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25660 CLOSED TREAT RADIO/INTERCARP DISLOC 1-MORE BONES W/MANIP TechFee,8023004,CDM,450,RC,25660,HCPCS,outpatient,,,"$1,471.00 ","$1,103.25 ",,"$1,353.32 ",92,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$809.05 ,55,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$809.05 ,"$1,426.87 ",other,,Not applicable. No negotiated rates per contract,"$1,265.06 ",86,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,176.80 ",80,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$809.05 ,55,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,397.45 ",95,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,397.45 ",95,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,103.25 ",75,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,250.35 ",85,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,426.87 ",97,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$809.05 ,55,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,323.90 ",90,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,426.87 ",97,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,426.87 ",97,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,426.87 ",97,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,250.35 ",85,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,323.90 ",90,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$809.05 ,55,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,397.45 ",90,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$809.05 ,55,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,368.03 ",93,,,$809.05 ,"$1,426.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
25690 CLOSED TX LUNATE DISLOCATION W/MANIPULATION TechFee,8023007,CDM,450,RC,25690,HCPCS,outpatient,,,"$1,610.00 ","$1,207.50 ",,"$1,481.20 ",92,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$885.50 ,"$1,561.70 ",other,,Not applicable. No negotiated rates per contract,"$1,384.60 ",86,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,288.00 ",80,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,529.50 ",95,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,529.50 ",95,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,207.50 ",75,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,368.50 ",85,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,449.00 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,561.70 ",97,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,368.50 ",85,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,449.00 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,529.50 ",90,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$885.50 ,55,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,497.30 ",93,,,$885.50 ,"$1,561.70 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26010 DRAINAGE FINGER ABSCESS SIMPLE TechFee,8023012,CDM,450,RC,26010,HCPCS,outpatient,,,"$1,134.00 ",$850.50 ,,"$1,043.28 ",92,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$623.70 ,55,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$623.70 ,"$1,099.98 ",other,,Not applicable. No negotiated rates per contract,$975.24 ,86,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$907.20 ,80,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$623.70 ,55,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,077.30 ",95,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,077.30 ",95,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$850.50 ,75,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$963.90 ,85,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,099.98 ",97,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$623.70 ,55,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,020.60 ",90,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,099.98 ",97,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,099.98 ",97,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,099.98 ",97,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$963.90 ,85,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,020.60 ",90,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$623.70 ,55,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,077.30 ",90,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$623.70 ,55,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,054.62 ",93,,,$623.70 ,"$1,099.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26011 DRAINAGE FINGER ABSCESS COMPLICATED TechFee,8023013,CDM,450,RC,26011,HCPCS,outpatient,,,"$1,613.00 ","$1,209.75 ",,"$1,483.96 ",92,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$887.15 ,55,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$887.15 ,"$1,564.61 ",other,,Not applicable. No negotiated rates per contract,"$1,387.18 ",86,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,290.40 ",80,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$887.15 ,55,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,532.35 ",95,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,532.35 ",95,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,209.75 ",75,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,371.05 ",85,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,564.61 ",97,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$887.15 ,55,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,451.70 ",90,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,564.61 ",97,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,564.61 ",97,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,564.61 ",97,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,371.05 ",85,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,451.70 ",90,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$887.15 ,55,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,532.35 ",90,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$887.15 ,55,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,500.09 ",93,,,$887.15 ,"$1,564.61 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26605 CLTX METACARPAL FX W/MANIPULATION EACH BONE TechFee,8023059,CDM,450,RC,26605,HCPCS,outpatient,,,"$1,093.00 ",$819.75 ,,"$1,005.56 ",92,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$601.15 ,"$1,060.21 ",other,,Not applicable. No negotiated rates per contract,$939.98 ,86,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$874.40 ,80,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.35 ",95,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,038.35 ",95,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$819.75 ,75,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$929.05 ,85,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$983.70 ,90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$929.05 ,85,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$983.70 ,90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.35 ",90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,016.49 ",93,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26641 CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ TechFee,8023062,CDM,450,RC,26641,HCPCS,outpatient,,,"$1,386.00 ","$1,039.50 ",,"$1,275.12 ",92,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$762.30 ,"$1,344.42 ",other,,Not applicable. No negotiated rates per contract,"$1,191.96 ",86,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,108.80 ",80,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.70 ",95,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,316.70 ",95,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,039.50 ",75,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,178.10 ",85,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,247.40 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,178.10 ",85,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,247.40 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.70 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,288.98 ",93,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26670 CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES TechFee,8023066,CDM,450,RC,26670,HCPCS,outpatient,,,"$1,150.00 ",$862.50 ,,"$1,058.00 ",92,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$632.50 ,"$1,115.50 ",other,,Not applicable. No negotiated rates per contract,$989.00 ,86,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$920.00 ,80,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$862.50 ,75,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,069.50 ",93,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26700 CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee,8023067,CDM,450,RC,26700,HCPCS,outpatient,,,"$1,103.00 ",$827.25 ,,"$1,014.76 ",92,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$606.65 ,55,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$606.65 ,"$1,069.91 ",other,,Not applicable. No negotiated rates per contract,$948.58 ,86,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$882.40 ,80,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$606.65 ,55,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,047.85 ",95,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,047.85 ",95,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$827.25 ,75,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$937.55 ,85,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,069.91 ",97,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$606.65 ,55,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$992.70 ,90,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,069.91 ",97,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,069.91 ",97,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,069.91 ",97,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$937.55 ,85,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$992.70 ,90,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$606.65 ,55,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,047.85 ",90,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$606.65 ,55,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,025.79 ",93,,,$606.65 ,"$1,069.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26720 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee,8023068,CDM,450,RC,26720,HCPCS,outpatient,,,$662.00 ,$496.50 ,,$609.04 ,92,,,$364.10 ,$642.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$364.10 ,55,,,$364.10 ,$642.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$364.10 ,$642.14 ,other,,Not applicable. No negotiated rates per contract,$569.32 ,86,,,$364.10 ,$642.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$529.60 ,80,,,$364.10 ,$642.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$364.10 ,55,,,$364.10 ,$642.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$628.90 ,95,,,$364.10 ,$642.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$628.90 ,95,,,$364.10 ,$642.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$496.50 ,75,,,$364.10 ,$642.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$562.70 ,85,,,$364.10 ,$642.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$642.14 ,97,,,$364.10 ,$642.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.10 ,55,,,$364.10 ,$642.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$595.80 ,90,,,$364.10 ,$642.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$642.14 ,97,,,$364.10 ,$642.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$642.14 ,97,,,$364.10 ,$642.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$642.14 ,97,,,$364.10 ,$642.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$562.70 ,85,,,$364.10 ,$642.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$595.80 ,90,,,$364.10 ,$642.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$364.10 ,55,,,$364.10 ,$642.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$628.90 ,90,,,$364.10 ,$642.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$364.10 ,55,,,$364.10 ,$642.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$615.66 ,93,,,$364.10 ,$642.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
26725 CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA TechFee,8023069,CDM,450,RC,26725,HCPCS,outpatient,,,"$1,131.00 ",$848.25 ,,"$1,040.52 ",92,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$622.05 ,55,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$622.05 ,"$1,097.07 ",other,,Not applicable. No negotiated rates per contract,$972.66 ,86,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$904.80 ,80,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$622.05 ,55,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.45 ",95,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,074.45 ",95,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$848.25 ,75,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$961.35 ,85,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,097.07 ",97,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$622.05 ,55,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,017.90 ",90,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,097.07 ",97,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,097.07 ",97,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,097.07 ",97,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$961.35 ,85,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,017.90 ",90,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$622.05 ,55,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.45 ",90,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$622.05 ,55,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,051.83 ",93,,,$622.05 ,"$1,097.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26742 CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ TechFee,8023072,CDM,450,RC,26742,HCPCS,outpatient,,,"$1,241.00 ",$930.75 ,,"$1,141.72 ",92,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$682.55 ,"$1,203.77 ",other,,Not applicable. No negotiated rates per contract,"$1,067.26 ",86,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$992.80 ,80,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$930.75 ,75,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,154.13 ",93,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26750 CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee,8023074,CDM,450,RC,26750,HCPCS,outpatient,,,$618.00 ,$463.50 ,,$568.56 ,92,,,$339.90 ,$599.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$339.90 ,55,,,$339.90 ,$599.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$339.90 ,$599.46 ,other,,Not applicable. No negotiated rates per contract,$531.48 ,86,,,$339.90 ,$599.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$494.40 ,80,,,$339.90 ,$599.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$339.90 ,55,,,$339.90 ,$599.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$587.10 ,95,,,$339.90 ,$599.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.10 ,95,,,$339.90 ,$599.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$463.50 ,75,,,$339.90 ,$599.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$525.30 ,85,,,$339.90 ,$599.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$599.46 ,97,,,$339.90 ,$599.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.90 ,55,,,$339.90 ,$599.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$556.20 ,90,,,$339.90 ,$599.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$599.46 ,97,,,$339.90 ,$599.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$599.46 ,97,,,$339.90 ,$599.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$599.46 ,97,,,$339.90 ,$599.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$525.30 ,85,,,$339.90 ,$599.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$556.20 ,90,,,$339.90 ,$599.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$339.90 ,55,,,$339.90 ,$599.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$587.10 ,90,,,$339.90 ,$599.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$339.90 ,55,,,$339.90 ,$599.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$574.74 ,93,,,$339.90 ,$599.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
26755 CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA TechFee,8023075,CDM,450,RC,26755,HCPCS,outpatient,,,"$1,062.00 ",$796.50 ,,$977.04 ,92,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$584.10 ,55,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$584.10 ,"$1,030.14 ",other,,Not applicable. No negotiated rates per contract,$913.32 ,86,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$849.60 ,80,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$584.10 ,55,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,008.90 ",95,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,008.90 ",95,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$796.50 ,75,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$902.70 ,85,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,030.14 ",97,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$584.10 ,55,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$955.80 ,90,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,030.14 ",97,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,030.14 ",97,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,030.14 ",97,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$902.70 ,85,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$955.80 ,90,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$584.10 ,55,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,008.90 ",90,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$584.10 ,55,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$987.66 ,93,,,$584.10 ,"$1,030.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26765 OPEN TX DISTAL PHALANGEAL FRACTURE EACH TechFee,8023077,CDM,450,RC,26765,HCPCS,outpatient,,,"$1,648.00 ","$1,236.00 ",,"$1,516.16 ",92,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$906.40 ,55,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$906.40 ,"$1,598.56 ",other,,Not applicable. No negotiated rates per contract,"$1,417.28 ",86,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,318.40 ",80,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$906.40 ,55,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,565.60 ",95,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,565.60 ",95,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,236.00 ",75,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,400.80 ",85,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,598.56 ",97,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$906.40 ,55,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,483.20 ",90,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,598.56 ",97,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,598.56 ",97,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,598.56 ",97,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,400.80 ",85,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,483.20 ",90,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$906.40 ,55,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,565.60 ",90,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$906.40 ,55,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,532.64 ",93,,,$906.40 ,"$1,598.56 ",percent of total billed charges,,93% of total billed charges for outpatient setting
26770 CLTX IPHAL JT DISLC W/MANJ W/O ANES TechFee,8023078,CDM,450,RC,26770,HCPCS,outpatient,,,$936.00 ,$702.00 ,,$861.12 ,92,,,$514.80 ,$907.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$514.80 ,55,,,$514.80 ,$907.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$514.80 ,$907.92 ,other,,Not applicable. No negotiated rates per contract,$804.96 ,86,,,$514.80 ,$907.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$748.80 ,80,,,$514.80 ,$907.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$514.80 ,55,,,$514.80 ,$907.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$889.20 ,95,,,$514.80 ,$907.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$889.20 ,95,,,$514.80 ,$907.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$702.00 ,75,,,$514.80 ,$907.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$795.60 ,85,,,$514.80 ,$907.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$907.92 ,97,,,$514.80 ,$907.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$514.80 ,55,,,$514.80 ,$907.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$842.40 ,90,,,$514.80 ,$907.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$907.92 ,97,,,$514.80 ,$907.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$907.92 ,97,,,$514.80 ,$907.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$907.92 ,97,,,$514.80 ,$907.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$795.60 ,85,,,$514.80 ,$907.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$842.40 ,90,,,$514.80 ,$907.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$514.80 ,55,,,$514.80 ,$907.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$889.20 ,90,,,$514.80 ,$907.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$514.80 ,55,,,$514.80 ,$907.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$870.48 ,93,,,$514.80 ,$907.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
26775 CLTX IPHAL JT DISLC W/MANJ REQ ANES TechFee,8023079,CDM,450,RC,26775,HCPCS,outpatient,,,"$1,298.00 ",$973.50 ,,"$1,194.16 ",92,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$713.90 ,"$1,259.06 ",other,,Not applicable. No negotiated rates per contract,"$1,116.28 ",86,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,038.40 ",80,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",95,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,233.10 ",95,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$973.50 ,75,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,168.20 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,168.20 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,207.14 ",93,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27232 TREATMENT CLOSED FEMORAL FRAC-ER SERV PR,8051008,CDM,450,RC,27232,HCPCS,outpatient,,,"$2,325.00 ","$1,743.75 ",,"$2,139.00 ",92,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,278.75 ",55,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,278.75 ","$2,255.25 ",other,,Not applicable. No negotiated rates per contract,"$1,999.50 ",86,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,860.00 ",80,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,278.75 ",55,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,208.75 ",95,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,208.75 ",95,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,743.75 ",75,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,976.25 ",85,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,255.25 ",97,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,278.75 ",55,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,092.50 ",90,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,255.25 ",97,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,255.25 ",97,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,255.25 ",97,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,976.25 ",85,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,092.50 ",90,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,278.75 ",55,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,208.75 ",90,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,278.75 ",55,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,162.25 ",93,,,"$1,278.75 ","$2,255.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27250 CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA TechFee,8023102,CDM,450,RC,27250,HCPCS,outpatient,,,$567.00 ,$425.25 ,,$521.64 ,92,,,$311.85 ,$549.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$311.85 ,$549.99 ,other,,Not applicable. No negotiated rates per contract,$487.62 ,86,,,$311.85 ,$549.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$453.60 ,80,,,$311.85 ,$549.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.65 ,95,,,$311.85 ,$549.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$538.65 ,95,,,$311.85 ,$549.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$425.25 ,75,,,$311.85 ,$549.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$481.95 ,85,,,$311.85 ,$549.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$510.30 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.99 ,97,,,$311.85 ,$549.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.95 ,85,,,$311.85 ,$549.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$510.30 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.65 ,90,,,$311.85 ,$549.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.85 ,55,,,$311.85 ,$549.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.31 ,93,,,$311.85 ,$549.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
27265 CLTX POST HIP ARTHRP DISLC W/O ANES TechFee,8023104,CDM,450,RC,27265,HCPCS,outpatient,,,"$1,326.00 ",$994.50 ,,"$1,219.92 ",92,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$729.30 ,55,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$729.30 ,"$1,286.22 ",other,,Not applicable. No negotiated rates per contract,"$1,140.36 ",86,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,060.80 ",80,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$729.30 ,55,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,259.70 ",95,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,259.70 ",95,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$994.50 ,75,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,127.10 ",85,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,286.22 ",97,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$729.30 ,55,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,193.40 ",90,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,286.22 ",97,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,286.22 ",97,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,286.22 ",97,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,127.10 ",85,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,193.40 ",90,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$729.30 ,55,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,259.70 ",90,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$729.30 ,55,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.18 ",93,,,$729.30 ,"$1,286.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27301 I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION TechFee,8023108,CDM,450,RC,27301,HCPCS,outpatient,,,"$2,252.00 ","$1,689.00 ",,"$2,071.84 ",92,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,238.60 ",55,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,238.60 ","$2,184.44 ",other,,Not applicable. No negotiated rates per contract,"$1,936.72 ",86,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,801.60 ",80,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,238.60 ",55,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,139.40 ",95,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,139.40 ",95,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,689.00 ",75,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,914.20 ",85,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,184.44 ",97,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,238.60 ",55,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,026.80 ",90,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,184.44 ",97,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,184.44 ",97,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,184.44 ",97,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,914.20 ",85,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,026.80 ",90,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,238.60 ",55,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,139.40 ",90,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,238.60 ",55,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,094.36 ",93,,,"$1,238.60 ","$2,184.44 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27502 CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ TechFee,8023139,CDM,450,RC,27502,HCPCS,outpatient,,,"$2,445.00 ","$1,833.75 ",,"$2,249.40 ",92,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,344.75 ",55,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,344.75 ","$2,371.65 ",other,,Not applicable. No negotiated rates per contract,"$2,102.70 ",86,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,956.00 ",80,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,344.75 ",55,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,322.75 ",95,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,322.75 ",95,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.75 ",75,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,078.25 ",85,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,371.65 ",97,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.75 ",55,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,200.50 ",90,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,371.65 ",97,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,371.65 ",97,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,371.65 ",97,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,078.25 ",85,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,200.50 ",90,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.75 ",55,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,322.75 ",90,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.75 ",55,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,273.85 ",93,,,"$1,344.75 ","$2,371.65 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27510 ED TREATMENT OF THIGH FRACTURE TechFee,8258846,CDM,450,RC,27510,HCPCS,outpatient,,,"$2,208.00 ","$1,656.00 ",,"$2,031.36 ",92,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,214.40 ",55,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,214.40 ","$2,141.76 ",other,,Not applicable. No negotiated rates per contract,"$1,898.88 ",86,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,766.40 ",80,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,214.40 ",55,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,097.60 ",95,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,097.60 ",95,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,656.00 ",75,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,876.80 ",85,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,141.76 ",97,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,214.40 ",55,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,987.20 ",90,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,141.76 ",97,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,141.76 ",97,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,141.76 ",97,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,876.80 ",85,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,987.20 ",90,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,214.40 ",55,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,097.60 ",90,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,214.40 ",55,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,053.44 ",93,,,"$1,214.40 ","$2,141.76 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27550 CLOSED TX KNEE DISLOCATION W/O ANESTHESIA TechFee,8023153,CDM,450,RC,27550,HCPCS,outpatient,,,"$1,733.00 ","$1,299.75 ",,"$1,594.36 ",92,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$953.15 ,55,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$953.15 ,"$1,681.01 ",other,,Not applicable. No negotiated rates per contract,"$1,490.38 ",86,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,386.40 ",80,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$953.15 ,55,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,646.35 ",95,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,646.35 ",95,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,299.75 ",75,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,473.05 ",85,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,681.01 ",97,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$953.15 ,55,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,559.70 ",90,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,681.01 ",97,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,681.01 ",97,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,681.01 ",97,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,473.05 ",85,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,559.70 ",90,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$953.15 ,55,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,646.35 ",90,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$953.15 ,55,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,611.69 ",93,,,$953.15 ,"$1,681.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27552 TREATMENT CL KNEE DISLOCATIO-ER SERV PRO,8051011,CDM,450,RC,27552,HCPCS,outpatient,,,"$2,067.00 ","$1,550.25 ",,"$1,901.64 ",92,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,136.85 ",55,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,136.85 ","$2,004.99 ",other,,Not applicable. No negotiated rates per contract,"$1,777.62 ",86,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,653.60 ",80,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,136.85 ",55,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,963.65 ",95,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,963.65 ",95,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,550.25 ",75,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,756.95 ",85,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,004.99 ",97,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,136.85 ",55,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,860.30 ",90,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,004.99 ",97,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,004.99 ",97,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,004.99 ",97,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,756.95 ",85,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,860.30 ",90,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,136.85 ",55,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,963.65 ",90,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,136.85 ",55,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,922.31 ",93,,,"$1,136.85 ","$2,004.99 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27560 CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee,8023154,CDM,450,RC,27560,HCPCS,outpatient,,,"$1,241.00 ",$930.75 ,,"$1,141.72 ",92,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$682.55 ,"$1,203.77 ",other,,Not applicable. No negotiated rates per contract,"$1,067.26 ",86,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$992.80 ,80,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$930.75 ,75,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,154.13 ",93,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27752 CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ TechFee,8023194,CDM,450,RC,27752,HCPCS,outpatient,,,"$1,764.00 ","$1,323.00 ",,"$1,622.88 ",92,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$970.20 ,55,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$970.20 ,"$1,711.08 ",other,,Not applicable. No negotiated rates per contract,"$1,517.04 ",86,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,411.20 ",80,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$970.20 ,55,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,675.80 ",95,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,675.80 ",95,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,323.00 ",75,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,499.40 ",85,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,711.08 ",97,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$970.20 ,55,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,587.60 ",90,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,711.08 ",97,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,711.08 ",97,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,711.08 ",97,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.40 ",85,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,587.60 ",90,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$970.20 ,55,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,675.80 ",90,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$970.20 ,55,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,640.52 ",93,,,$970.20 ,"$1,711.08 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27762 CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ TechFee,8023199,CDM,450,RC,27762,HCPCS,outpatient,,,"$1,575.00 ","$1,181.25 ",,"$1,449.00 ",92,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$866.25 ,55,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$866.25 ,"$1,527.75 ",other,,Not applicable. No negotiated rates per contract,"$1,354.50 ",86,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,260.00 ",80,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$866.25 ,55,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,496.25 ",95,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,496.25 ",95,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,181.25 ",75,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,338.75 ",85,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,527.75 ",97,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$866.25 ,55,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,417.50 ",90,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,527.75 ",97,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,527.75 ",97,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,527.75 ",97,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,338.75 ",85,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,417.50 ",90,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$866.25 ,55,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,496.25 ",90,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$866.25 ,55,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,464.75 ",93,,,$866.25 ,"$1,527.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION. TechFee,8023201,CDM,450,RC,27768,HCPCS,outpatient,,,"$1,437.00 ","$1,077.75 ",,"$1,322.04 ",92,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$790.35 ,"$1,393.89 ",other,,Not applicable. No negotiated rates per contract,"$1,235.82 ",86,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,149.60 ",80,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.15 ",95,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,365.15 ",95,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,077.75 ",75,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,221.45 ",85,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,293.30 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.89 ",97,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,221.45 ",85,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,293.30 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.15 ",90,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.35 ,55,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,336.41 ",93,,,$790.35 ,"$1,393.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27786 CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee,8023205,CDM,450,RC,27786,HCPCS,outpatient,,,"$1,046.00 ",$784.50 ,,$962.32 ,92,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$575.30 ,"$1,014.62 ",other,,Not applicable. No negotiated rates per contract,$899.56 ,86,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$836.80 ,80,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$993.70 ,95,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$993.70 ,95,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$784.50 ,75,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$889.10 ,85,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$941.40 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.62 ",97,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$889.10 ,85,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$941.40 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$993.70 ,90,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$575.30 ,55,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$972.78 ,93,,,$575.30 ,"$1,014.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27788 CLTX DSTL FIBULAR FX LAT MALLS W/MANJ TechFee,8023206,CDM,450,RC,27788,HCPCS,outpatient,,,"$1,402.00 ","$1,051.50 ",,"$1,289.84 ",92,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$771.10 ,55,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$771.10 ,"$1,359.94 ",other,,Not applicable. No negotiated rates per contract,"$1,205.72 ",86,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,121.60 ",80,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$771.10 ,55,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,331.90 ",95,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,331.90 ",95,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,051.50 ",75,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,191.70 ",85,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,359.94 ",97,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$771.10 ,55,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,261.80 ",90,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,359.94 ",97,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,359.94 ",97,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,359.94 ",97,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,191.70 ",85,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,261.80 ",90,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$771.10 ,55,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,331.90 ",90,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$771.10 ,55,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,303.86 ",93,,,$771.10 ,"$1,359.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27808 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG,8023208,CDM,450,RC,27808,HCPCS,outpatient,,,"$1,115.00 ",$836.25 ,,"$1,025.80 ",92,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$613.25 ,55,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$613.25 ,"$1,081.55 ",other,,Not applicable. No negotiated rates per contract,$958.90 ,86,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$892.00 ,80,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$613.25 ,55,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,059.25 ",95,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,059.25 ",95,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$836.25 ,75,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$947.75 ,85,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,081.55 ",97,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$613.25 ,55,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,003.50 ",90,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,081.55 ",97,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,081.55 ",97,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,081.55 ",97,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$947.75 ,85,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,003.50 ",90,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$613.25 ,55,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,059.25 ",90,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$613.25 ,55,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,036.95 ",93,,,$613.25 ,"$1,081.55 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27818 CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION TechFee,8023212,CDM,450,RC,27818,HCPCS,outpatient,,,"$1,607.00 ","$1,205.25 ",,"$1,478.44 ",92,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$883.85 ,55,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$883.85 ,"$1,558.79 ",other,,Not applicable. No negotiated rates per contract,"$1,382.02 ",86,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,285.60 ",80,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$883.85 ,55,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,526.65 ",95,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,526.65 ",95,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,205.25 ",75,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,365.95 ",85,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,558.79 ",97,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$883.85 ,55,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,446.30 ",90,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,558.79 ",97,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,558.79 ",97,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,558.79 ",97,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,365.95 ",85,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,446.30 ",90,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$883.85 ,55,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,526.65 ",90,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$883.85 ,55,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,494.51 ",93,,,$883.85 ,"$1,558.79 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27825 CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ TechFee,8023216,CDM,450,RC,27825,HCPCS,outpatient,,,"$1,783.00 ","$1,337.25 ",,"$1,640.36 ",92,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$980.65 ,"$1,729.51 ",other,,Not applicable. No negotiated rates per contract,"$1,533.38 ",86,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,426.40 ",80,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,693.85 ",95,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,693.85 ",95,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,337.25 ",75,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,515.55 ",85,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,604.70 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,729.51 ",97,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,515.55 ",85,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,604.70 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,693.85 ",90,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$980.65 ,55,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,658.19 ",93,,,$980.65 ,"$1,729.51 ",percent of total billed charges,,93% of total billed charges for outpatient setting
27840 CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA TechFee,8023220,CDM,450,RC,27840,HCPCS,outpatient,,,"$1,241.00 ",$930.75 ,,"$1,141.72 ",92,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$682.55 ,"$1,203.77 ",other,,Not applicable. No negotiated rates per contract,"$1,067.26 ",86,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$992.80 ,80,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,178.95 ",95,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$930.75 ,75,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.77 ",97,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.85 ",85,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,116.90 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.95 ",90,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$682.55 ,55,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,154.13 ",93,,,$682.55 ,"$1,203.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
28435 CLOSED TX TALUS FRACTURE W/MANIPULATION TechFee,8023297,CDM,450,RC,28435,HCPCS,outpatient,,,"$1,096.00 ",$822.00 ,,"$1,008.32 ",92,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$602.80 ,55,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$602.80 ,"$1,063.12 ",other,,Not applicable. No negotiated rates per contract,$942.56 ,86,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$876.80 ,80,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$602.80 ,55,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,041.20 ",95,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,041.20 ",95,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$822.00 ,75,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$931.60 ,85,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,063.12 ",97,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$602.80 ,55,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$986.40 ,90,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.12 ",97,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.12 ",97,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.12 ",97,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$931.60 ,85,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$986.40 ,90,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$602.80 ,55,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,041.20 ",90,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$602.80 ,55,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,019.28 ",93,,,$602.80 ,"$1,063.12 ",percent of total billed charges,,93% of total billed charges for outpatient setting
28495 CLTX FX GRT TOE PHLX/PHLG W/MANJ TechFee,8023306,CDM,450,RC,28495,HCPCS,outpatient,,,$586.00 ,$439.50 ,,$539.12 ,92,,,$322.30 ,$568.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$322.30 ,55,,,$322.30 ,$568.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$322.30 ,$568.42 ,other,,Not applicable. No negotiated rates per contract,$503.96 ,86,,,$322.30 ,$568.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$468.80 ,80,,,$322.30 ,$568.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$322.30 ,55,,,$322.30 ,$568.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$556.70 ,95,,,$322.30 ,$568.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$556.70 ,95,,,$322.30 ,$568.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$439.50 ,75,,,$322.30 ,$568.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$498.10 ,85,,,$322.30 ,$568.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$568.42 ,97,,,$322.30 ,$568.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.30 ,55,,,$322.30 ,$568.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.40 ,90,,,$322.30 ,$568.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$568.42 ,97,,,$322.30 ,$568.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.42 ,97,,,$322.30 ,$568.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.42 ,97,,,$322.30 ,$568.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.10 ,85,,,$322.30 ,$568.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$527.40 ,90,,,$322.30 ,$568.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.30 ,55,,,$322.30 ,$568.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$556.70 ,90,,,$322.30 ,$568.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.30 ,55,,,$322.30 ,$568.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$544.98 ,93,,,$322.30 ,$568.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
28510 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ TechFee,8023309,CDM,450,RC,28510,HCPCS,outpatient,,,$400.00 ,$300.00 ,,$368.00 ,92,,,$220.00 ,$388.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.00 ,55,,,$220.00 ,$388.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.00 ,$388.00 ,other,,Not applicable. No negotiated rates per contract,$344.00 ,86,,,$220.00 ,$388.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.00 ,80,,,$220.00 ,$388.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.00 ,55,,,$220.00 ,$388.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.00 ,95,,,$220.00 ,$388.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.00 ,95,,,$220.00 ,$388.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.00 ,75,,,$220.00 ,$388.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.00 ,85,,,$220.00 ,$388.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.00 ,97,,,$220.00 ,$388.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.00 ,55,,,$220.00 ,$388.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.00 ,90,,,$220.00 ,$388.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.00 ,97,,,$220.00 ,$388.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.00 ,97,,,$220.00 ,$388.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.00 ,97,,,$220.00 ,$388.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.00 ,85,,,$220.00 ,$388.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.00 ,90,,,$220.00 ,$388.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.00 ,55,,,$220.00 ,$388.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.00 ,90,,,$220.00 ,$388.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.00 ,55,,,$220.00 ,$388.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.00 ,93,,,$220.00 ,$388.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
28515 CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ TechFee,8023310,CDM,450,RC,28515,HCPCS,outpatient,,,$536.00 ,$402.00 ,,$493.12 ,92,,,$294.80 ,$519.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.80 ,$519.92 ,other,,Not applicable. No negotiated rates per contract,$460.96 ,86,,,$294.80 ,$519.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.80 ,80,,,$294.80 ,$519.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.20 ,95,,,$294.80 ,$519.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$509.20 ,95,,,$294.80 ,$519.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$402.00 ,75,,,$294.80 ,$519.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.60 ,85,,,$294.80 ,$519.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$482.40 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.92 ,97,,,$294.80 ,$519.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.60 ,85,,,$294.80 ,$519.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.40 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.20 ,90,,,$294.80 ,$519.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.80 ,55,,,$294.80 ,$519.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$498.48 ,93,,,$294.80 ,$519.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
28630 CLTX METATARSOPHLNGL JT DISLC W/O ANES TechFee,8023318,CDM,450,RC,28630,HCPCS,outpatient,,,$507.00 ,$380.25 ,,$466.44 ,92,,,$278.85 ,$491.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$278.85 ,$491.79 ,other,,Not applicable. No negotiated rates per contract,$436.02 ,86,,,$278.85 ,$491.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$405.60 ,80,,,$278.85 ,$491.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.25 ,75,,,$278.85 ,$491.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.51 ,93,,,$278.85 ,$491.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
28660 CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES TechFee,8023320,CDM,450,RC,28660,HCPCS,outpatient,,,$397.00 ,$297.75 ,,$365.24 ,92,,,$218.35 ,$385.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.35 ,55,,,$218.35 ,$385.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$218.35 ,$385.09 ,other,,Not applicable. No negotiated rates per contract,$341.42 ,86,,,$218.35 ,$385.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$317.60 ,80,,,$218.35 ,$385.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.35 ,55,,,$218.35 ,$385.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.15 ,95,,,$218.35 ,$385.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$377.15 ,95,,,$218.35 ,$385.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$297.75 ,75,,,$218.35 ,$385.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$337.45 ,85,,,$218.35 ,$385.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$385.09 ,97,,,$218.35 ,$385.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.35 ,55,,,$218.35 ,$385.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.30 ,90,,,$218.35 ,$385.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$385.09 ,97,,,$218.35 ,$385.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.09 ,97,,,$218.35 ,$385.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.09 ,97,,,$218.35 ,$385.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.45 ,85,,,$218.35 ,$385.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$357.30 ,90,,,$218.35 ,$385.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.35 ,55,,,$218.35 ,$385.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.15 ,90,,,$218.35 ,$385.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.35 ,55,,,$218.35 ,$385.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$369.21 ,93,,,$218.35 ,$385.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29105 APPLICATION LONG ARM SPLINT SHOULDER HAND TechFee,8023336,CDM,450,RC,29105,HCPCS,outpatient,,,$268.00 ,$201.00 ,,$246.56 ,92,,,$147.40 ,$259.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$147.40 ,$259.96 ,other,,Not applicable. No negotiated rates per contract,$230.48 ,86,,,$147.40 ,$259.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$214.40 ,80,,,$147.40 ,$259.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.60 ,95,,,$147.40 ,$259.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$254.60 ,95,,,$147.40 ,$259.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.00 ,75,,,$147.40 ,$259.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$227.80 ,85,,,$147.40 ,$259.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.20 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.80 ,85,,,$147.40 ,$259.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.20 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.60 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$249.24 ,93,,,$147.40 ,$259.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29125 APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee,8023337,CDM,450,RC,29125,HCPCS,outpatient,,,$211.00 ,$158.25 ,,$194.12 ,92,,,$116.05 ,$204.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$116.05 ,$204.67 ,other,,Not applicable. No negotiated rates per contract,$181.46 ,86,,,$116.05 ,$204.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$168.80 ,80,,,$116.05 ,$204.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,95,,,$116.05 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.45 ,95,,,$116.05 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.25 ,75,,,$116.05 ,$204.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.35 ,85,,,$116.05 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.90 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.35 ,85,,,$116.05 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.90 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.23 ,93,,,$116.05 ,$204.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29130 APPLICATION FINGER SPLINT STATIC TechFee,8023339,CDM,450,RC,29130,HCPCS,outpatient,,,$132.00 ,$99.00 ,,$121.44 ,92,,,$72.60 ,$128.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.60 ,$128.04 ,other,,Not applicable. No negotiated rates per contract,$113.52 ,86,,,$72.60 ,$128.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$105.60 ,80,,,$72.60 ,$128.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,95,,,$72.60 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.40 ,95,,,$72.60 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.00 ,75,,,$72.60 ,$128.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.20 ,85,,,$72.60 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.80 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$72.60 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,85,,,$72.60 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.80 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,90,,,$72.60 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$72.60 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.76 ,93,,,$72.60 ,$128.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29505 APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee,8023349,CDM,450,RC,29505,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$156.20 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.20 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$156.20 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$156.20 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$156.20 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$156.20 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$156.20 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$156.20 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$156.20 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$156.20 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.12 ,93,,,$156.20 ,$275.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29515 APPLICATION SHORT LEG SPLINT CALF FOOT TechFee,8023350,CDM,450,RC,29515,HCPCS,outpatient,,,$230.00 ,$172.50 ,,$211.60 ,92,,,$126.50 ,$223.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$126.50 ,$223.10 ,other,,Not applicable. No negotiated rates per contract,$197.80 ,86,,,$126.50 ,$223.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$184.00 ,80,,,$126.50 ,$223.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.50 ,95,,,$126.50 ,$223.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$218.50 ,95,,,$126.50 ,$223.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.50 ,75,,,$126.50 ,$223.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$195.50 ,85,,,$126.50 ,$223.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.00 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.50 ,85,,,$126.50 ,$223.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$207.00 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.50 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.90 ,93,,,$126.50 ,$223.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29550 STRAPPING TOES TechFee,8023353,CDM,450,RC,29550,HCPCS,outpatient,,,$63.00 ,$47.25 ,,$57.96 ,92,,,$34.65 ,$61.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.65 ,55,,,$34.65 ,$61.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$34.65 ,$61.11 ,other,,Not applicable. No negotiated rates per contract,$54.18 ,86,,,$34.65 ,$61.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$50.40 ,80,,,$34.65 ,$61.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.65 ,55,,,$34.65 ,$61.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.85 ,95,,,$34.65 ,$61.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.85 ,95,,,$34.65 ,$61.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.25 ,75,,,$34.65 ,$61.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$53.55 ,85,,,$34.65 ,$61.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.11 ,97,,,$34.65 ,$61.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.65 ,55,,,$34.65 ,$61.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.70 ,90,,,$34.65 ,$61.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.11 ,97,,,$34.65 ,$61.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.11 ,97,,,$34.65 ,$61.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.11 ,97,,,$34.65 ,$61.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.55 ,85,,,$34.65 ,$61.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.70 ,90,,,$34.65 ,$61.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.65 ,55,,,$34.65 ,$61.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.85 ,90,,,$34.65 ,$61.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.65 ,55,,,$34.65 ,$61.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.59 ,93,,,$34.65 ,$61.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29580 STRAPPING UNNA BOOT TechFee,8023354,CDM,450,RC,29580,HCPCS,outpatient,,,$214.00 ,$160.50 ,,$196.88 ,92,,,$117.70 ,$207.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$117.70 ,55,,,$117.70 ,$207.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.70 ,$207.58 ,other,,Not applicable. No negotiated rates per contract,$184.04 ,86,,,$117.70 ,$207.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$171.20 ,80,,,$117.70 ,$207.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$117.70 ,55,,,$117.70 ,$207.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.30 ,95,,,$117.70 ,$207.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.30 ,95,,,$117.70 ,$207.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$160.50 ,75,,,$117.70 ,$207.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$181.90 ,85,,,$117.70 ,$207.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$207.58 ,97,,,$117.70 ,$207.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.70 ,55,,,$117.70 ,$207.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.60 ,90,,,$117.70 ,$207.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.58 ,97,,,$117.70 ,$207.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.58 ,97,,,$117.70 ,$207.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.58 ,97,,,$117.70 ,$207.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.90 ,85,,,$117.70 ,$207.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.60 ,90,,,$117.70 ,$207.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.70 ,55,,,$117.70 ,$207.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.30 ,90,,,$117.70 ,$207.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.70 ,55,,,$117.70 ,$207.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.02 ,93,,,$117.70 ,$207.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29705 REMOVAL/BIVALVING FULL ARM/FULL LEG CAST TechFee,8023357,CDM,450,RC,29705,HCPCS,outpatient,,,$208.00 ,$156.00 ,,$191.36 ,92,,,$114.40 ,$201.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$114.40 ,$201.76 ,other,,Not applicable. No negotiated rates per contract,$178.88 ,86,,,$114.40 ,$201.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$166.40 ,80,,,$114.40 ,$201.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.00 ,75,,,$114.40 ,$201.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.44 ,93,,,$114.40 ,$201.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
29893 ENDOSCOPIC PLANTAR FASCIOTOMY TechFee,8023401,CDM,360,RC,29893,HCPCS,outpatient,,,"$1,399.00 ","$1,049.25 ",,"$1,287.08 ",92,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$769.45 ,55,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$769.45 ,"$1,357.03 ",other,,Not applicable. No negotiated rates per contract,"$1,203.14 ",86,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,119.20 ",80,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$769.45 ,55,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,329.05 ",95,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,329.05 ",95,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,049.25 ",75,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,189.15 ",85,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,357.03 ",97,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$769.45 ,55,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,259.10 ",90,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,357.03 ",97,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,357.03 ",97,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,357.03 ",97,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,189.15 ",85,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,259.10 ",90,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.45 ,55,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,329.05 ",90,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.45 ,55,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,301.07 ",93,,,$769.45 ,"$1,357.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
30300 REMOVAL NASAL FOREIGN BODY-ER SERV PROCE,8051015,CDM,450,RC,30300,HCPCS,outpatient,,,$687.00 ,$515.25 ,,$632.04 ,92,,,$377.85 ,$666.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$377.85 ,$666.39 ,other,,Not applicable. No negotiated rates per contract,$590.82 ,86,,,$377.85 ,$666.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$549.60 ,80,,,$377.85 ,$666.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.65 ,95,,,$377.85 ,$666.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$652.65 ,95,,,$377.85 ,$666.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.25 ,75,,,$377.85 ,$666.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$583.95 ,85,,,$377.85 ,$666.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.30 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$583.95 ,85,,,$377.85 ,$666.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$618.30 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.65 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.91 ,93,,,$377.85 ,$666.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
30901 CONTROL ANT. NASAL HEMORRHAGE- ER SERV P,8051016,CDM,450,RC,30901,HCPCS,outpatient,,,$523.00 ,$392.25 ,,$481.16 ,92,,,$287.65 ,$507.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$287.65 ,55,,,$287.65 ,$507.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$287.65 ,$507.31 ,other,,Not applicable. No negotiated rates per contract,$449.78 ,86,,,$287.65 ,$507.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$418.40 ,80,,,$287.65 ,$507.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$287.65 ,55,,,$287.65 ,$507.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$496.85 ,95,,,$287.65 ,$507.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$496.85 ,95,,,$287.65 ,$507.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$392.25 ,75,,,$287.65 ,$507.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$444.55 ,85,,,$287.65 ,$507.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$507.31 ,97,,,$287.65 ,$507.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.65 ,55,,,$287.65 ,$507.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.70 ,90,,,$287.65 ,$507.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$507.31 ,97,,,$287.65 ,$507.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$507.31 ,97,,,$287.65 ,$507.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$507.31 ,97,,,$287.65 ,$507.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$444.55 ,85,,,$287.65 ,$507.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$470.70 ,90,,,$287.65 ,$507.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$287.65 ,55,,,$287.65 ,$507.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$496.85 ,90,,,$287.65 ,$507.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$287.65 ,55,,,$287.65 ,$507.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$486.39 ,93,,,$287.65 ,$507.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
30903 CONTROL ANT. NASAL HEMOR,8051017,CDM,450,RC,30903,HCPCS,outpatient,,,$822.00 ,$616.50 ,,$756.24 ,92,,,$452.10 ,$797.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$452.10 ,$797.34 ,other,,Not applicable. No negotiated rates per contract,$706.92 ,86,,,$452.10 ,$797.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$657.60 ,80,,,$452.10 ,$797.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$780.90 ,95,,,$452.10 ,$797.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$780.90 ,95,,,$452.10 ,$797.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$616.50 ,75,,,$452.10 ,$797.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$698.70 ,85,,,$452.10 ,$797.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$739.80 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$797.34 ,97,,,$452.10 ,$797.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$698.70 ,85,,,$452.10 ,$797.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$739.80 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$780.90 ,90,,,$452.10 ,$797.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.10 ,55,,,$452.10 ,$797.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$764.46 ,93,,,$452.10 ,$797.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
30905 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST TechFee,8211213,CDM,450,RC,30905,HCPCS,outpatient,,,"$1,200.00 ",$900.00 ,,"$1,104.00 ",92,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$660.00 ,55,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$660.00 ,"$1,164.00 ",other,,Not applicable. No negotiated rates per contract,"$1,032.00 ",86,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$960.00 ,80,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$660.00 ,55,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,140.00 ",95,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,140.00 ",95,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$900.00 ,75,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,020.00 ",85,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,164.00 ",97,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$660.00 ,55,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,080.00 ",90,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,164.00 ",97,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,164.00 ",97,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,164.00 ",97,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,020.00 ",85,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,080.00 ",90,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$660.00 ,55,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,140.00 ",90,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$660.00 ,55,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,116.00 ",93,,,$660.00 ,"$1,164.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
30906 CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ TechFee,8211214,CDM,450,RC,30906,HCPCS,outpatient,,,"$1,235.00 ",$926.25 ,,"$1,136.20 ",92,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$679.25 ,55,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$679.25 ,"$1,197.95 ",other,,Not applicable. No negotiated rates per contract,"$1,062.10 ",86,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$988.00 ,80,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$679.25 ,55,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,173.25 ",95,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,173.25 ",95,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$926.25 ,75,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,049.75 ",85,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,197.95 ",97,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$679.25 ,55,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,111.50 ",90,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,197.95 ",97,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,197.95 ",97,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,197.95 ",97,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,049.75 ",85,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,111.50 ",90,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$679.25 ,55,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,173.25 ",90,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$679.25 ,55,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,148.55 ",93,,,$679.25 ,"$1,197.95 ",percent of total billed charges,,93% of total billed charges for outpatient setting
31500 INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE TechFee,8211215,CDM,450,RC,31500,HCPCS,outpatient,,,$451.00 ,$338.25 ,,$414.92 ,92,,,$248.05 ,$437.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$248.05 ,$437.47 ,other,,Not applicable. No negotiated rates per contract,$387.86 ,86,,,$248.05 ,$437.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$360.80 ,80,,,$248.05 ,$437.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.45 ,95,,,$248.05 ,$437.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$428.45 ,95,,,$248.05 ,$437.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$338.25 ,75,,,$248.05 ,$437.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$383.35 ,85,,,$248.05 ,$437.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$405.90 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.35 ,85,,,$248.05 ,$437.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$405.90 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.45 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$419.43 ,93,,,$248.05 ,$437.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
31502 INTRO PROC ON LARYNX TechFee,8575012,CDM,450,RC,31502,HCPCS,outpatient,,,$110.00 ,$82.50 ,,$101.20 ,92,,,$60.50 ,$106.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.50 ,$106.70 ,other,,Not applicable. No negotiated rates per contract,$94.60 ,86,,,$60.50 ,$106.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.00 ,80,,,$60.50 ,$106.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.50 ,75,,,$60.50 ,$106.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.30 ,93,,,$60.50 ,$106.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
31505 DIAGNOSTIC LARYNGOSCOPY TechFee,8638182,CDM,450,RC,31505,HCPCS,outpatient,,,$303.00 ,$227.25 ,,$278.76 ,92,,,$166.65 ,$293.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$166.65 ,55,,,$166.65 ,$293.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$166.65 ,$293.91 ,other,,Not applicable. No negotiated rates per contract,$260.58 ,86,,,$166.65 ,$293.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$242.40 ,80,,,$166.65 ,$293.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$166.65 ,55,,,$166.65 ,$293.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$287.85 ,95,,,$166.65 ,$293.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$287.85 ,95,,,$166.65 ,$293.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$227.25 ,75,,,$166.65 ,$293.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$257.55 ,85,,,$166.65 ,$293.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$293.91 ,97,,,$166.65 ,$293.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.65 ,55,,,$166.65 ,$293.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.70 ,90,,,$166.65 ,$293.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$293.91 ,97,,,$166.65 ,$293.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.91 ,97,,,$166.65 ,$293.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.91 ,97,,,$166.65 ,$293.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.55 ,85,,,$166.65 ,$293.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$272.70 ,90,,,$166.65 ,$293.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.65 ,55,,,$166.65 ,$293.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$287.85 ,90,,,$166.65 ,$293.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.65 ,55,,,$166.65 ,$293.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.79 ,93,,,$166.65 ,$293.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
31525 LARYNGOSCOPY W/WO TRACHEOSCOPY DX EXCEPT NEWBORN TechFee,8211216,CDM,450,RC,31525,HCPCS,outpatient,,,$829.00 ,$621.75 ,,$762.68 ,92,,,$455.95 ,$804.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$455.95 ,55,,,$455.95 ,$804.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$455.95 ,$804.13 ,other,,Not applicable. No negotiated rates per contract,$712.94 ,86,,,$455.95 ,$804.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$663.20 ,80,,,$455.95 ,$804.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$455.95 ,55,,,$455.95 ,$804.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$787.55 ,95,,,$455.95 ,$804.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$787.55 ,95,,,$455.95 ,$804.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$621.75 ,75,,,$455.95 ,$804.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$704.65 ,85,,,$455.95 ,$804.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$804.13 ,97,,,$455.95 ,$804.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.95 ,55,,,$455.95 ,$804.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$746.10 ,90,,,$455.95 ,$804.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$804.13 ,97,,,$455.95 ,$804.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$804.13 ,97,,,$455.95 ,$804.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$804.13 ,97,,,$455.95 ,$804.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$704.65 ,85,,,$455.95 ,$804.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$746.10 ,90,,,$455.95 ,$804.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$455.95 ,55,,,$455.95 ,$804.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$787.55 ,90,,,$455.95 ,$804.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$455.95 ,55,,,$455.95 ,$804.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$770.97 ,93,,,$455.95 ,$804.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
31603 TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL TechFee,8211217,CDM,450,RC,31603,HCPCS,outpatient,,,"$1,018.00 ",$763.50 ,,$936.56 ,92,,,$559.90 ,$987.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$559.90 ,55,,,$559.90 ,$987.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$559.90 ,$987.46 ,other,,Not applicable. No negotiated rates per contract,$875.48 ,86,,,$559.90 ,$987.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$814.40 ,80,,,$559.90 ,$987.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$559.90 ,55,,,$559.90 ,$987.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$967.10 ,95,,,$559.90 ,$987.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$967.10 ,95,,,$559.90 ,$987.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$763.50 ,75,,,$559.90 ,$987.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$865.30 ,85,,,$559.90 ,$987.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$987.46 ,97,,,$559.90 ,$987.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$559.90 ,55,,,$559.90 ,$987.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$916.20 ,90,,,$559.90 ,$987.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$987.46 ,97,,,$559.90 ,$987.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$987.46 ,97,,,$559.90 ,$987.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$987.46 ,97,,,$559.90 ,$987.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.30 ,85,,,$559.90 ,$987.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$916.20 ,90,,,$559.90 ,$987.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$559.90 ,55,,,$559.90 ,$987.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$967.10 ,90,,,$559.90 ,$987.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$559.90 ,55,,,$559.90 ,$987.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$946.74 ,93,,,$559.90 ,$987.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
31605 TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE TechFee,8211218,CDM,450,RC,31605,HCPCS,outpatient,,,"$1,049.00 ",$786.75 ,,$965.08 ,92,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$576.95 ,"$1,017.53 ",other,,Not applicable. No negotiated rates per contract,$902.14 ,86,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$839.20 ,80,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$996.55 ,95,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$996.55 ,95,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$786.75 ,75,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$891.65 ,85,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$944.10 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$891.65 ,85,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$944.10 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$996.55 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.57 ,93,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
32550 ED INSERT PLEURAL CATH WITH CUFF TechFee,8258853,CDM,450,RC,32550,HCPCS,outpatient,,,"$2,797.00 ","$2,097.75 ",,"$2,573.24 ",92,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,538.35 ",55,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,538.35 ","$2,713.09 ",other,,Not applicable. No negotiated rates per contract,"$2,405.42 ",86,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,237.60 ",80,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,538.35 ",55,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,657.15 ",95,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,657.15 ",95,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,097.75 ",75,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,377.45 ",85,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,713.09 ",97,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,538.35 ",55,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,517.30 ",90,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,713.09 ",97,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,713.09 ",97,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,713.09 ",97,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,377.45 ",85,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,517.30 ",90,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,538.35 ",55,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,657.15 ",90,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,538.35 ",55,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,601.21 ",93,,,"$1,538.35 ","$2,713.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
32551 TUBE THORACOSTOMY INCLUDES WATER SEAL TechFee,8211298,CDM,450,RC,32551,HCPCS,outpatient,,,$495.00 ,$371.25 ,,$455.40 ,92,,,$272.25 ,$480.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$272.25 ,$480.15 ,other,,Not applicable. No negotiated rates per contract,$425.70 ,86,,,$272.25 ,$480.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$396.00 ,80,,,$272.25 ,$480.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.25 ,75,,,$272.25 ,$480.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.35 ,93,,,$272.25 ,$480.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
32554 THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING TechFee,8211299,CDM,450,RC,32554,HCPCS,outpatient,,,$800.00 ,$600.00 ,,$736.00 ,92,,,$440.00 ,$776.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$440.00 ,55,,,$440.00 ,$776.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$440.00 ,$776.00 ,other,,Not applicable. No negotiated rates per contract,$688.00 ,86,,,$440.00 ,$776.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$640.00 ,80,,,$440.00 ,$776.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$440.00 ,55,,,$440.00 ,$776.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$760.00 ,95,,,$440.00 ,$776.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$760.00 ,95,,,$440.00 ,$776.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$600.00 ,75,,,$440.00 ,$776.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$680.00 ,85,,,$440.00 ,$776.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$776.00 ,97,,,$440.00 ,$776.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.00 ,55,,,$440.00 ,$776.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$720.00 ,90,,,$440.00 ,$776.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$776.00 ,97,,,$440.00 ,$776.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$776.00 ,97,,,$440.00 ,$776.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$776.00 ,97,,,$440.00 ,$776.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$680.00 ,85,,,$440.00 ,$776.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$720.00 ,90,,,$440.00 ,$776.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$440.00 ,55,,,$440.00 ,$776.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$760.00 ,90,,,$440.00 ,$776.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$440.00 ,55,,,$440.00 ,$776.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.00 ,93,,,$440.00 ,$776.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
32555 THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING TechFee,8211300,CDM,450,RC,32555,HCPCS,outpatient,,,"$1,087.00 ",$815.25 ,,"$1,000.04 ",92,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$597.85 ,"$1,054.39 ",other,,Not applicable. No negotiated rates per contract,$934.82 ,86,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$869.60 ,80,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,032.65 ",95,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,032.65 ",95,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$815.25 ,75,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$923.95 ,85,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$978.30 ,90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$923.95 ,85,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$978.30 ,90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,032.65 ",90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,010.91 ",93,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
36000 INTRODUCTION NEEDLE/INTRACATHETER VEIN TechFee,8211302,CDM,450,RC,36000,HCPCS,outpatient,,,$16.00 ,$12.00 ,,$14.72 ,92,,,$8.80 ,$15.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$8.80 ,55,,,$8.80 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.80 ,$15.52 ,other,,Not applicable. No negotiated rates per contract,$13.76 ,86,,,$8.80 ,$15.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$12.80 ,80,,,$8.80 ,$15.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$8.80 ,55,,,$8.80 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.20 ,95,,,$8.80 ,$15.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.20 ,95,,,$8.80 ,$15.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$12.00 ,75,,,$8.80 ,$15.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$13.60 ,85,,,$8.80 ,$15.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$15.52 ,97,,,$8.80 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$8.80 ,55,,,$8.80 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$14.40 ,90,,,$8.80 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.52 ,97,,,$8.80 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.52 ,97,,,$8.80 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.52 ,97,,,$8.80 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.60 ,85,,,$8.80 ,$15.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$14.40 ,90,,,$8.80 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$8.80 ,55,,,$8.80 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.20 ,90,,,$8.80 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$8.80 ,55,,,$8.80 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$14.88 ,93,,,$8.80 ,$15.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36410 VNPNXR 3 YEARS/> PHYS/QHP SKILL TechFee,8218191,CDM,450,RC,36410,HCPCS,outpatient,,,$57.00 ,$42.75 ,,$52.44 ,92,,,$31.35 ,$55.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.35 ,$55.29 ,other,,Not applicable. No negotiated rates per contract,$49.02 ,86,,,$31.35 ,$55.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.60 ,80,,,$31.35 ,$55.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,75,,,$31.35 ,$55.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.01 ,93,,,$31.35 ,$55.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36556 INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE 5 YR/> TechFee,8211304,CDM,450,RC,36556,HCPCS,outpatient,,,$740.00 ,$555.00 ,,$680.80 ,92,,,$407.00 ,$717.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$407.00 ,55,,,$407.00 ,$717.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$407.00 ,$717.80 ,other,,Not applicable. No negotiated rates per contract,$636.40 ,86,,,$407.00 ,$717.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$592.00 ,80,,,$407.00 ,$717.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$407.00 ,55,,,$407.00 ,$717.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.00 ,95,,,$407.00 ,$717.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$703.00 ,95,,,$407.00 ,$717.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$555.00 ,75,,,$407.00 ,$717.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$629.00 ,85,,,$407.00 ,$717.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$717.80 ,97,,,$407.00 ,$717.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.00 ,55,,,$407.00 ,$717.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$666.00 ,90,,,$407.00 ,$717.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$717.80 ,97,,,$407.00 ,$717.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$717.80 ,97,,,$407.00 ,$717.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$717.80 ,97,,,$407.00 ,$717.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$629.00 ,85,,,$407.00 ,$717.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.00 ,90,,,$407.00 ,$717.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.00 ,55,,,$407.00 ,$717.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.00 ,90,,,$407.00 ,$717.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.00 ,55,,,$407.00 ,$717.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$688.20 ,93,,,$407.00 ,$717.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36569 INSERTION PICC W/O IMG GDN 5 YR/> TechFee,8211306,CDM,450,RC,36569,HCPCS,outpatient,,,$296.00 ,$222.00 ,,$272.32 ,92,,,$162.80 ,$287.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$162.80 ,$287.12 ,other,,Not applicable. No negotiated rates per contract,$254.56 ,86,,,$162.80 ,$287.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$236.80 ,80,,,$162.80 ,$287.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.20 ,95,,,$162.80 ,$287.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$281.20 ,95,,,$162.80 ,$287.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.00 ,75,,,$162.80 ,$287.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$251.60 ,85,,,$162.80 ,$287.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.40 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.12 ,97,,,$162.80 ,$287.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.60 ,85,,,$162.80 ,$287.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$266.40 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.20 ,90,,,$162.80 ,$287.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.80 ,55,,,$162.80 ,$287.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.28 ,93,,,$162.80 ,$287.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36573 INSERTION OF PICC,8703514,CDM,450,RC,36573,HCPCS,outpatient,,,"$1,386.00 ","$1,039.50 ",,"$1,275.12 ",92,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$762.30 ,"$1,344.42 ",other,,Not applicable. No negotiated rates per contract,"$1,191.96 ",86,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,108.80 ",80,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.70 ",95,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,316.70 ",95,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,039.50 ",75,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,178.10 ",85,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,247.40 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.42 ",97,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,178.10 ",85,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,247.40 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.70 ",90,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.30 ,55,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,288.98 ",93,,,$762.30 ,"$1,344.42 ",percent of total billed charges,,93% of total billed charges for outpatient setting
36591 COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE TechFee,8211309,CDM,450,RC,36591,HCPCS,outpatient,,,$88.00 ,$66.00 ,,$80.96 ,92,,,$48.40 ,$85.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.40 ,55,,,$48.40 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.40 ,$85.36 ,other,,Not applicable. No negotiated rates per contract,$75.68 ,86,,,$48.40 ,$85.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$70.40 ,80,,,$48.40 ,$85.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.40 ,55,,,$48.40 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,95,,,$48.40 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.60 ,95,,,$48.40 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.00 ,75,,,$48.40 ,$85.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.80 ,85,,,$48.40 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.36 ,97,,,$48.40 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.40 ,55,,,$48.40 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.20 ,90,,,$48.40 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.36 ,97,,,$48.40 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$48.40 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$48.40 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,85,,,$48.40 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.20 ,90,,,$48.40 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$48.40 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,90,,,$48.40 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$48.40 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.84 ,93,,,$48.40 ,$85.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36600 ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX TechFee,8211312,CDM,450,RC,36600,HCPCS,outpatient,,,$98.00 ,$73.50 ,,$90.16 ,92,,,$53.90 ,$95.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.90 ,55,,,$53.90 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$53.90 ,$95.06 ,other,,Not applicable. No negotiated rates per contract,$84.28 ,86,,,$53.90 ,$95.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$78.40 ,80,,,$53.90 ,$95.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.90 ,55,,,$53.90 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.10 ,95,,,$53.90 ,$95.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.10 ,95,,,$53.90 ,$95.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.50 ,75,,,$53.90 ,$95.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$83.30 ,85,,,$53.90 ,$95.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.06 ,97,,,$53.90 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.90 ,55,,,$53.90 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.20 ,90,,,$53.90 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.06 ,97,,,$53.90 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.06 ,97,,,$53.90 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.06 ,97,,,$53.90 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.30 ,85,,,$53.90 ,$95.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.20 ,90,,,$53.90 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.90 ,55,,,$53.90 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.10 ,90,,,$53.90 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.90 ,55,,,$53.90 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.14 ,93,,,$53.90 ,$95.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36620 INSERTION CATHETER ARTERY TechFee,8638186,CDM,450,RC,36620,HCPCS,outpatient,,,$142.00 ,$106.50 ,,$130.64 ,92,,,$78.10 ,$137.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.10 ,55,,,$78.10 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$78.10 ,$137.74 ,other,,Not applicable. No negotiated rates per contract,$122.12 ,86,,,$78.10 ,$137.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$113.60 ,80,,,$78.10 ,$137.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.10 ,55,,,$78.10 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,95,,,$78.10 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.90 ,95,,,$78.10 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.50 ,75,,,$78.10 ,$137.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$120.70 ,85,,,$78.10 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.74 ,97,,,$78.10 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.10 ,55,,,$78.10 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$127.80 ,90,,,$78.10 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.74 ,97,,,$78.10 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$78.10 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$78.10 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.70 ,85,,,$78.10 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.80 ,90,,,$78.10 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$78.10 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,90,,,$78.10 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$78.10 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.06 ,93,,,$78.10 ,$137.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36680 PLACEMENT NEEDLE INTRAOSSEOUS INFUSION TechFee,8211313,CDM,450,RC,36680,HCPCS,outpatient,,,$602.00 ,$451.50 ,,$553.84 ,92,,,$331.10 ,$583.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$331.10 ,55,,,$331.10 ,$583.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$331.10 ,$583.94 ,other,,Not applicable. No negotiated rates per contract,$517.72 ,86,,,$331.10 ,$583.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$481.60 ,80,,,$331.10 ,$583.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$331.10 ,55,,,$331.10 ,$583.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$571.90 ,95,,,$331.10 ,$583.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$571.90 ,95,,,$331.10 ,$583.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$451.50 ,75,,,$331.10 ,$583.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$511.70 ,85,,,$331.10 ,$583.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$583.94 ,97,,,$331.10 ,$583.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.10 ,55,,,$331.10 ,$583.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$541.80 ,90,,,$331.10 ,$583.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$583.94 ,97,,,$331.10 ,$583.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$583.94 ,97,,,$331.10 ,$583.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$583.94 ,97,,,$331.10 ,$583.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$511.70 ,85,,,$331.10 ,$583.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$541.80 ,90,,,$331.10 ,$583.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$331.10 ,55,,,$331.10 ,$583.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$571.90 ,90,,,$331.10 ,$583.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$331.10 ,55,,,$331.10 ,$583.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$559.86 ,93,,,$331.10 ,$583.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
37195 THROMBOLYTIC THERAPY STROKE TechFee,8638165,CDM,450,RC,37195,HCPCS,outpatient,,,$513.00 ,$384.75 ,,$471.96 ,92,,,$282.15 ,$497.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.15 ,55,,,$282.15 ,$497.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$282.15 ,$497.61 ,other,,Not applicable. No negotiated rates per contract,$441.18 ,86,,,$282.15 ,$497.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$410.40 ,80,,,$282.15 ,$497.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.15 ,55,,,$282.15 ,$497.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$487.35 ,95,,,$282.15 ,$497.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$487.35 ,95,,,$282.15 ,$497.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,75,,,$282.15 ,$497.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.05 ,85,,,$282.15 ,$497.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$497.61 ,97,,,$282.15 ,$497.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.15 ,55,,,$282.15 ,$497.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$461.70 ,90,,,$282.15 ,$497.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$497.61 ,97,,,$282.15 ,$497.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$497.61 ,97,,,$282.15 ,$497.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$497.61 ,97,,,$282.15 ,$497.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.05 ,85,,,$282.15 ,$497.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$461.70 ,90,,,$282.15 ,$497.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.15 ,55,,,$282.15 ,$497.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$487.35 ,90,,,$282.15 ,$497.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.15 ,55,,,$282.15 ,$497.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$477.09 ,93,,,$282.15 ,$497.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
40650 RPR LIP FULL THICKNESS VERMILION ONLY TechFee,8211314,CDM,450,RC,40650,HCPCS,outpatient,,,"$1,594.00 ","$1,195.50 ",,"$1,466.48 ",92,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$876.70 ,"$1,546.18 ",other,,Not applicable. No negotiated rates per contract,"$1,370.84 ",86,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,275.20 ",80,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.30 ",95,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,514.30 ",95,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,195.50 ",75,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,354.90 ",85,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,434.60 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,546.18 ",97,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,354.90 ",85,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,434.60 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.30 ",90,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.70 ,55,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,482.42 ",93,,,$876.70 ,"$1,546.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
40800 DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL TechFee,8211315,CDM,450,RC,40800,HCPCS,outpatient,,,$706.00 ,$529.50 ,,$649.52 ,92,,,$388.30 ,$684.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$388.30 ,55,,,$388.30 ,$684.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$388.30 ,$684.82 ,other,,Not applicable. No negotiated rates per contract,$607.16 ,86,,,$388.30 ,$684.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$564.80 ,80,,,$388.30 ,$684.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$388.30 ,55,,,$388.30 ,$684.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.70 ,95,,,$388.30 ,$684.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$670.70 ,95,,,$388.30 ,$684.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$529.50 ,75,,,$388.30 ,$684.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$600.10 ,85,,,$388.30 ,$684.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$684.82 ,97,,,$388.30 ,$684.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.30 ,55,,,$388.30 ,$684.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.40 ,90,,,$388.30 ,$684.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$684.82 ,97,,,$388.30 ,$684.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$684.82 ,97,,,$388.30 ,$684.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$684.82 ,97,,,$388.30 ,$684.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$600.10 ,85,,,$388.30 ,$684.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$635.40 ,90,,,$388.30 ,$684.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.30 ,55,,,$388.30 ,$684.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.70 ,90,,,$388.30 ,$684.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.30 ,55,,,$388.30 ,$684.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$656.58 ,93,,,$388.30 ,$684.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
41250 RPR LAC 2.5 CM/< MOUTH&/ANT TWO-THIRDS TONG TechFee,8211317,CDM,450,RC,41250,HCPCS,outpatient,,,$961.00 ,$720.75 ,,$884.12 ,92,,,$528.55 ,$932.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$528.55 ,$932.17 ,other,,Not applicable. No negotiated rates per contract,$826.46 ,86,,,$528.55 ,$932.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$768.80 ,80,,,$528.55 ,$932.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$912.95 ,95,,,$528.55 ,$932.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$912.95 ,95,,,$528.55 ,$932.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$720.75 ,75,,,$528.55 ,$932.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$816.85 ,85,,,$528.55 ,$932.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$864.90 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$932.17 ,97,,,$528.55 ,$932.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$816.85 ,85,,,$528.55 ,$932.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$864.90 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$912.95 ,90,,,$528.55 ,$932.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$528.55 ,55,,,$528.55 ,$932.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$893.73 ,93,,,$528.55 ,$932.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
41251 REPAIR OF LACERATION 2.5 CM OR LESS TechFee,8702667,CDM,450,RC,41251,HCPCS,outpatient,,,"$1,052.00 ",$789.00 ,,$967.84 ,92,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$578.60 ,55,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$578.60 ,"$1,020.44 ",other,,Not applicable. No negotiated rates per contract,$904.72 ,86,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$841.60 ,80,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$578.60 ,55,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$999.40 ,95,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$999.40 ,95,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$789.00 ,75,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$894.20 ,85,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,020.44 ",97,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$578.60 ,55,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$946.80 ,90,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,020.44 ",97,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,020.44 ",97,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,020.44 ",97,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$894.20 ,85,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$946.80 ,90,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$578.60 ,55,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$999.40 ,90,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$578.60 ,55,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$978.36 ,93,,,$578.60 ,"$1,020.44 ",percent of total billed charges,,93% of total billed charges for outpatient setting
41252 REPAIR PROCEDURES ON THE TONGUE AND FLOOR OF MOUTH TechFee,8702669,CDM,450,RC,41252,HCPCS,outpatient,,,"$1,093.00 ",$819.75 ,,"$1,005.56 ",92,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$601.15 ,"$1,060.21 ",other,,Not applicable. No negotiated rates per contract,$939.98 ,86,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$874.40 ,80,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.35 ",95,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,038.35 ",95,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$819.75 ,75,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$929.05 ,85,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$983.70 ,90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.21 ",97,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$929.05 ,85,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$983.70 ,90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.35 ",90,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.15 ,55,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,016.49 ",93,,,$601.15 ,"$1,060.21 ",percent of total billed charges,,93% of total billed charges for outpatient setting
41800 DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS TechFee,8211318,CDM,450,RC,41800,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$99.00 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$99.00 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$154.80 ,86,,,$99.00 ,$174.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$144.00 ,80,,,$99.00 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$99.00 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$99.00 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
42700 I&D ABSCESS PERITONSILLAR TechFee,8211321,CDM,450,RC,42700,HCPCS,outpatient,,,$643.00 ,$482.25 ,,$591.56 ,92,,,$353.65 ,$623.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$353.65 ,55,,,$353.65 ,$623.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$353.65 ,$623.71 ,other,,Not applicable. No negotiated rates per contract,$552.98 ,86,,,$353.65 ,$623.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$514.40 ,80,,,$353.65 ,$623.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$353.65 ,55,,,$353.65 ,$623.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.85 ,95,,,$353.65 ,$623.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$610.85 ,95,,,$353.65 ,$623.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$482.25 ,75,,,$353.65 ,$623.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$546.55 ,85,,,$353.65 ,$623.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$623.71 ,97,,,$353.65 ,$623.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$353.65 ,55,,,$353.65 ,$623.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$578.70 ,90,,,$353.65 ,$623.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$623.71 ,97,,,$353.65 ,$623.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$623.71 ,97,,,$353.65 ,$623.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$623.71 ,97,,,$353.65 ,$623.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.55 ,85,,,$353.65 ,$623.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$578.70 ,90,,,$353.65 ,$623.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$353.65 ,55,,,$353.65 ,$623.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.85 ,90,,,$353.65 ,$623.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$353.65 ,55,,,$353.65 ,$623.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$597.99 ,93,,,$353.65 ,$623.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
42809 REMOVAL FOREIGN BODY PHARYNX TechFee,8211322,CDM,450,RC,42809,HCPCS,outpatient,,,$671.00 ,$503.25 ,,$617.32 ,92,,,$369.05 ,$650.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$369.05 ,$650.87 ,other,,Not applicable. No negotiated rates per contract,$577.06 ,86,,,$369.05 ,$650.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$536.80 ,80,,,$369.05 ,$650.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$637.45 ,95,,,$369.05 ,$650.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$637.45 ,95,,,$369.05 ,$650.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$503.25 ,75,,,$369.05 ,$650.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$570.35 ,85,,,$369.05 ,$650.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$603.90 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$650.87 ,97,,,$369.05 ,$650.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$570.35 ,85,,,$369.05 ,$650.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$603.90 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$637.45 ,90,,,$369.05 ,$650.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$369.05 ,55,,,$369.05 ,$650.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$624.03 ,93,,,$369.05 ,$650.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
43752 NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE TechFee,8211323,CDM,450,RC,43752,HCPCS,outpatient,,,$129.00 ,$96.75 ,,$118.68 ,92,,,$70.95 ,$125.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.95 ,55,,,$70.95 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.95 ,$125.13 ,other,,Not applicable. No negotiated rates per contract,$110.94 ,86,,,$70.95 ,$125.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$103.20 ,80,,,$70.95 ,$125.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.95 ,55,,,$70.95 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,95,,,$70.95 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.55 ,95,,,$70.95 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.75 ,75,,,$70.95 ,$125.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$109.65 ,85,,,$70.95 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.13 ,97,,,$70.95 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.95 ,55,,,$70.95 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.10 ,90,,,$70.95 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.13 ,97,,,$70.95 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$70.95 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$70.95 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.65 ,85,,,$70.95 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.10 ,90,,,$70.95 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$70.95 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,90,,,$70.95 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$70.95 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.97 ,93,,,$70.95 ,$125.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
43753 GASTRIC INTUBATJ & ASPIRAJ W/PHYS SKILL/LAVAGE TechFee,8211324,CDM,450,RC,43753,HCPCS,outpatient,,,$69.00 ,$51.75 ,,$63.48 ,92,,,$37.95 ,$66.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.95 ,$66.93 ,other,,Not applicable. No negotiated rates per contract,$59.34 ,86,,,$37.95 ,$66.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.20 ,80,,,$37.95 ,$66.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.75 ,75,,,$37.95 ,$66.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.17 ,93,,,$37.95 ,$66.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
43760 CHANGE GASTROSTOMY TUBE,8258856,CDM,450,RC,43760,HCPCS,outpatient,,,$370.00 ,$277.50 ,,$340.40 ,92,,,$203.50 ,$358.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$203.50 ,55,,,$203.50 ,$358.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$203.50 ,$358.90 ,other,,Not applicable. No negotiated rates per contract,$318.20 ,86,,,$203.50 ,$358.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$296.00 ,80,,,$203.50 ,$358.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$203.50 ,55,,,$203.50 ,$358.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.50 ,95,,,$203.50 ,$358.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$351.50 ,95,,,$203.50 ,$358.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.50 ,75,,,$203.50 ,$358.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$314.50 ,85,,,$203.50 ,$358.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.90 ,97,,,$203.50 ,$358.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.50 ,55,,,$203.50 ,$358.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$333.00 ,90,,,$203.50 ,$358.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.90 ,97,,,$203.50 ,$358.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.90 ,97,,,$203.50 ,$358.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.90 ,97,,,$203.50 ,$358.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$314.50 ,85,,,$203.50 ,$358.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$333.00 ,90,,,$203.50 ,$358.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.50 ,55,,,$203.50 ,$358.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.50 ,90,,,$203.50 ,$358.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.50 ,55,,,$203.50 ,$358.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.10 ,93,,,$203.50 ,$358.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
46040 I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX TechFee,8211329,CDM,450,RC,46040,HCPCS,outpatient,,,"$1,855.00 ","$1,391.25 ",,"$1,706.60 ",92,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,020.25 ",55,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,020.25 ","$1,799.35 ",other,,Not applicable. No negotiated rates per contract,"$1,595.30 ",86,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,484.00 ",80,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,020.25 ",55,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.25 ",95,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,762.25 ",95,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,391.25 ",75,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,576.75 ",85,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,799.35 ",97,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,020.25 ",55,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,669.50 ",90,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,799.35 ",97,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,799.35 ",97,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,799.35 ",97,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,576.75 ",85,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,669.50 ",90,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,020.25 ",55,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.25 ",90,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,020.25 ",55,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,725.15 ",93,,,"$1,020.25 ","$1,799.35 ",percent of total billed charges,,93% of total billed charges for outpatient setting
46050 I&D PERIANAL ABSCESS SUPERFICIAL TechFee,8211330,CDM,450,RC,46050,HCPCS,outpatient,,,$797.00 ,$597.75 ,,$733.24 ,92,,,$438.35 ,$773.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$438.35 ,55,,,$438.35 ,$773.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$438.35 ,$773.09 ,other,,Not applicable. No negotiated rates per contract,$685.42 ,86,,,$438.35 ,$773.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$637.60 ,80,,,$438.35 ,$773.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$438.35 ,55,,,$438.35 ,$773.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$757.15 ,95,,,$438.35 ,$773.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$757.15 ,95,,,$438.35 ,$773.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$597.75 ,75,,,$438.35 ,$773.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$677.45 ,85,,,$438.35 ,$773.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$773.09 ,97,,,$438.35 ,$773.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$438.35 ,55,,,$438.35 ,$773.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$717.30 ,90,,,$438.35 ,$773.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$773.09 ,97,,,$438.35 ,$773.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$773.09 ,97,,,$438.35 ,$773.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$773.09 ,97,,,$438.35 ,$773.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$677.45 ,85,,,$438.35 ,$773.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$717.30 ,90,,,$438.35 ,$773.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$438.35 ,55,,,$438.35 ,$773.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$757.15 ,90,,,$438.35 ,$773.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$438.35 ,55,,,$438.35 ,$773.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$741.21 ,93,,,$438.35 ,$773.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
46083 INCISION THROMBOSED HEMORRHOID EXTERNAL TechFee,8211331,CDM,450,RC,46083,HCPCS,outpatient,,,$699.00 ,$524.25 ,,$643.08 ,92,,,$384.45 ,$678.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$384.45 ,$678.03 ,other,,Not applicable. No negotiated rates per contract,$601.14 ,86,,,$384.45 ,$678.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$559.20 ,80,,,$384.45 ,$678.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.05 ,95,,,$384.45 ,$678.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$664.05 ,95,,,$384.45 ,$678.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$524.25 ,75,,,$384.45 ,$678.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$594.15 ,85,,,$384.45 ,$678.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.10 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$594.15 ,85,,,$384.45 ,$678.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$629.10 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.05 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$650.07 ,93,,,$384.45 ,$678.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
46320 ED REMOVAL OF HEMORRHOID CLOT TechFee,8258860,CDM,450,RC,46320,HCPCS,outpatient,,,$709.00 ,$531.75 ,,$652.28 ,92,,,$389.95 ,$687.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$389.95 ,55,,,$389.95 ,$687.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$389.95 ,$687.73 ,other,,Not applicable. No negotiated rates per contract,$609.74 ,86,,,$389.95 ,$687.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$567.20 ,80,,,$389.95 ,$687.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$389.95 ,55,,,$389.95 ,$687.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.55 ,95,,,$389.95 ,$687.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$673.55 ,95,,,$389.95 ,$687.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$531.75 ,75,,,$389.95 ,$687.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$602.65 ,85,,,$389.95 ,$687.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$687.73 ,97,,,$389.95 ,$687.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$389.95 ,55,,,$389.95 ,$687.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.10 ,90,,,$389.95 ,$687.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$687.73 ,97,,,$389.95 ,$687.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$687.73 ,97,,,$389.95 ,$687.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$687.73 ,97,,,$389.95 ,$687.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$602.65 ,85,,,$389.95 ,$687.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$638.10 ,90,,,$389.95 ,$687.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$389.95 ,55,,,$389.95 ,$687.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.55 ,90,,,$389.95 ,$687.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$389.95 ,55,,,$389.95 ,$687.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$659.37 ,93,,,$389.95 ,$687.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
49082 INCISION PROC ON THE ABDM,8540258,CDM,450,RC,49082,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49083 ED ABDOMINAL PARACENTESIS W GUIDE CHARGE,8258862,CDM,450,RC,49083,HCPCS,outpatient,,,"$1,027.00 ",$770.25 ,,$944.84 ,92,,,$564.85 ,$996.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$564.85 ,$996.19 ,other,,Not applicable. No negotiated rates per contract,$883.22 ,86,,,$564.85 ,$996.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$821.60 ,80,,,$564.85 ,$996.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.65 ,95,,,$564.85 ,$996.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$975.65 ,95,,,$564.85 ,$996.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$770.25 ,75,,,$564.85 ,$996.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$872.95 ,85,,,$564.85 ,$996.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$924.30 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$872.95 ,85,,,$564.85 ,$996.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$924.30 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.65 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$955.11 ,93,,,$564.85 ,$996.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
51700 BLDR IRRIGATION SMPL LAVAGE &/INSTLJ TechFee,8211333,CDM,450,RC,51700,HCPCS,outpatient,,,$262.00 ,$196.50 ,,$241.04 ,92,,,$144.10 ,$254.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$144.10 ,55,,,$144.10 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$144.10 ,$254.14 ,other,,Not applicable. No negotiated rates per contract,$225.32 ,86,,,$144.10 ,$254.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$209.60 ,80,,,$144.10 ,$254.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$144.10 ,55,,,$144.10 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.90 ,95,,,$144.10 ,$254.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.90 ,95,,,$144.10 ,$254.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$196.50 ,75,,,$144.10 ,$254.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$222.70 ,85,,,$144.10 ,$254.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.14 ,97,,,$144.10 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.10 ,55,,,$144.10 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.80 ,90,,,$144.10 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.14 ,97,,,$144.10 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.14 ,97,,,$144.10 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.14 ,97,,,$144.10 ,$254.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.70 ,85,,,$144.10 ,$254.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.80 ,90,,,$144.10 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.10 ,55,,,$144.10 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.90 ,90,,,$144.10 ,$254.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.10 ,55,,,$144.10 ,$254.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.66 ,93,,,$144.10 ,$254.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
51701 INSJ NON-NDWELLG BLADDER CATHETER TechFee,8211334,CDM,450,RC,51701,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
51702 INSJ TEMP NDWELLG BLADDER CATHETER SIMPLE TechFee,8211335,CDM,450,RC,51702,HCPCS,outpatient,,,$211.00 ,$158.25 ,,$194.12 ,92,,,$116.05 ,$204.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$116.05 ,$204.67 ,other,,Not applicable. No negotiated rates per contract,$181.46 ,86,,,$116.05 ,$204.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$168.80 ,80,,,$116.05 ,$204.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,95,,,$116.05 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.45 ,95,,,$116.05 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.25 ,75,,,$116.05 ,$204.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.35 ,85,,,$116.05 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.90 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$116.05 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.35 ,85,,,$116.05 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.90 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,90,,,$116.05 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$116.05 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.23 ,93,,,$116.05 ,$204.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
51703 INSJ TEMP NDWELLG BLADDER CATHETER COMPLICATED TechFee,8211336,CDM,450,RC,51703,HCPCS,outpatient,,,$492.00 ,$369.00 ,,$452.64 ,92,,,$270.60 ,$477.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$270.60 ,$477.24 ,other,,Not applicable. No negotiated rates per contract,$423.12 ,86,,,$270.60 ,$477.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$393.60 ,80,,,$270.60 ,$477.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$369.00 ,75,,,$270.60 ,$477.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.56 ,93,,,$270.60 ,$477.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
51705 CHANGE CYSTOSTOMY TUBE SIMPLE TechFee,8211337,CDM,450,RC,51705,HCPCS,outpatient,,,$321.00 ,$240.75 ,,$295.32 ,92,,,$176.55 ,$311.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.55 ,55,,,$176.55 ,$311.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.55 ,$311.37 ,other,,Not applicable. No negotiated rates per contract,$276.06 ,86,,,$176.55 ,$311.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.80 ,80,,,$176.55 ,$311.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.55 ,55,,,$176.55 ,$311.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.95 ,95,,,$176.55 ,$311.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.95 ,95,,,$176.55 ,$311.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.75 ,75,,,$176.55 ,$311.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.85 ,85,,,$176.55 ,$311.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$311.37 ,97,,,$176.55 ,$311.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.55 ,55,,,$176.55 ,$311.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.90 ,90,,,$176.55 ,$311.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.37 ,97,,,$176.55 ,$311.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.37 ,97,,,$176.55 ,$311.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.37 ,97,,,$176.55 ,$311.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.85 ,85,,,$176.55 ,$311.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.90 ,90,,,$176.55 ,$311.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.55 ,55,,,$176.55 ,$311.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.95 ,90,,,$176.55 ,$311.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.55 ,55,,,$176.55 ,$311.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.53 ,93,,,$176.55 ,$311.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
54700 ED INCISION AND DRAINAGE EPIDIDYMIS TSTIS&/SCROTAL SPACE TechFee,8405258,CDM,450,RC,54700,HCPCS,outpatient,,,$687.00 ,$515.25 ,,$632.04 ,92,,,$377.85 ,$666.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$377.85 ,$666.39 ,other,,Not applicable. No negotiated rates per contract,$590.82 ,86,,,$377.85 ,$666.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$549.60 ,80,,,$377.85 ,$666.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.65 ,95,,,$377.85 ,$666.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$652.65 ,95,,,$377.85 ,$666.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.25 ,75,,,$377.85 ,$666.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$583.95 ,85,,,$377.85 ,$666.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.30 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.39 ,97,,,$377.85 ,$666.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$583.95 ,85,,,$377.85 ,$666.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$618.30 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.65 ,90,,,$377.85 ,$666.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.85 ,55,,,$377.85 ,$666.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.91 ,93,,,$377.85 ,$666.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
56405 I&D VULVA/PERINEAL ABSCESS TechFee,8211339,CDM,450,RC,56405,HCPCS,outpatient,,,$466.00 ,$349.50 ,,$428.72 ,92,,,$256.30 ,$452.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$256.30 ,55,,,$256.30 ,$452.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$256.30 ,$452.02 ,other,,Not applicable. No negotiated rates per contract,$400.76 ,86,,,$256.30 ,$452.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$372.80 ,80,,,$256.30 ,$452.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$256.30 ,55,,,$256.30 ,$452.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.70 ,95,,,$256.30 ,$452.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$442.70 ,95,,,$256.30 ,$452.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$349.50 ,75,,,$256.30 ,$452.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$396.10 ,85,,,$256.30 ,$452.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$452.02 ,97,,,$256.30 ,$452.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.30 ,55,,,$256.30 ,$452.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$419.40 ,90,,,$256.30 ,$452.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.02 ,97,,,$256.30 ,$452.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.02 ,97,,,$256.30 ,$452.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.02 ,97,,,$256.30 ,$452.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$396.10 ,85,,,$256.30 ,$452.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.40 ,90,,,$256.30 ,$452.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.30 ,55,,,$256.30 ,$452.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.70 ,90,,,$256.30 ,$452.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.30 ,55,,,$256.30 ,$452.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.38 ,93,,,$256.30 ,$452.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
56420 I&D OF BARTHOLINS GLAND ABSCESS TechFee,8211340,CDM,450,RC,56420,HCPCS,outpatient,,,$583.00 ,$437.25 ,,$536.36 ,92,,,$320.65 ,$565.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$320.65 ,55,,,$320.65 ,$565.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$320.65 ,$565.51 ,other,,Not applicable. No negotiated rates per contract,$501.38 ,86,,,$320.65 ,$565.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$466.40 ,80,,,$320.65 ,$565.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$320.65 ,55,,,$320.65 ,$565.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$553.85 ,95,,,$320.65 ,$565.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$553.85 ,95,,,$320.65 ,$565.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$437.25 ,75,,,$320.65 ,$565.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$495.55 ,85,,,$320.65 ,$565.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$565.51 ,97,,,$320.65 ,$565.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$320.65 ,55,,,$320.65 ,$565.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$524.70 ,90,,,$320.65 ,$565.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$565.51 ,97,,,$320.65 ,$565.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$565.51 ,97,,,$320.65 ,$565.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$565.51 ,97,,,$320.65 ,$565.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,85,,,$320.65 ,$565.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$524.70 ,90,,,$320.65 ,$565.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$320.65 ,55,,,$320.65 ,$565.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$553.85 ,90,,,$320.65 ,$565.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$320.65 ,55,,,$320.65 ,$565.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$542.19 ,93,,,$320.65 ,$565.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
58301 REMOVAL INTRAUTERINE DEVICE IUD TechFee,8211341,CDM,450,RC,58301,HCPCS,outpatient,,,$356.00 ,$267.00 ,,$327.52 ,92,,,$195.80 ,$345.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$195.80 ,55,,,$195.80 ,$345.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$195.80 ,$345.32 ,other,,Not applicable. No negotiated rates per contract,$306.16 ,86,,,$195.80 ,$345.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$284.80 ,80,,,$195.80 ,$345.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$195.80 ,55,,,$195.80 ,$345.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.20 ,95,,,$195.80 ,$345.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$338.20 ,95,,,$195.80 ,$345.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.00 ,75,,,$195.80 ,$345.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$302.60 ,85,,,$195.80 ,$345.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$345.32 ,97,,,$195.80 ,$345.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.80 ,55,,,$195.80 ,$345.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.40 ,90,,,$195.80 ,$345.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$345.32 ,97,,,$195.80 ,$345.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.32 ,97,,,$195.80 ,$345.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.32 ,97,,,$195.80 ,$345.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.60 ,85,,,$195.80 ,$345.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$320.40 ,90,,,$195.80 ,$345.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$195.80 ,55,,,$195.80 ,$345.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.20 ,90,,,$195.80 ,$345.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$195.80 ,55,,,$195.80 ,$345.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$331.08 ,93,,,$195.80 ,$345.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
59409 VAGINAL DELIVERY ONLY TechFee,8023419,CDM,450,RC,59409,HCPCS,outpatient,,,"$2,536.00 ","$1,902.00 ",,"$2,333.12 ",92,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,394.80 ",55,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,394.80 ","$2,459.92 ",other,,Not applicable. No negotiated rates per contract,"$2,180.96 ",86,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,028.80 ",80,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,394.80 ",55,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,409.20 ",95,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,409.20 ",95,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,902.00 ",75,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,155.60 ",85,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,459.92 ",97,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,394.80 ",55,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,282.40 ",90,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,459.92 ",97,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,459.92 ",97,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,459.92 ",97,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,155.60 ",85,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,282.40 ",90,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,394.80 ",55,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,409.20 ",90,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,394.80 ",55,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,358.48 ",93,,,"$1,394.80 ","$2,459.92 ",percent of total billed charges,,93% of total billed charges for outpatient setting
62273 INJECTION,8310307,CDM,450,RC,62273,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64400 INJECTION,8540259,CDM,450,RC,64400,HCPCS,outpatient,,,$375.00 ,$281.25 ,,$345.00 ,92,,,$206.25 ,$363.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$206.25 ,55,,,$206.25 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$206.25 ,$363.75 ,other,,Not applicable. No negotiated rates per contract,$322.50 ,86,,,$206.25 ,$363.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$300.00 ,80,,,$206.25 ,$363.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$206.25 ,55,,,$206.25 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.25 ,95,,,$206.25 ,$363.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.25 ,95,,,$206.25 ,$363.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$281.25 ,75,,,$206.25 ,$363.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$318.75 ,85,,,$206.25 ,$363.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$363.75 ,97,,,$206.25 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.25 ,55,,,$206.25 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$337.50 ,90,,,$206.25 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$363.75 ,97,,,$206.25 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.75 ,97,,,$206.25 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.75 ,97,,,$206.25 ,$363.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.75 ,85,,,$206.25 ,$363.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.50 ,90,,,$206.25 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.25 ,55,,,$206.25 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.25 ,90,,,$206.25 ,$363.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.25 ,55,,,$206.25 ,$363.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$348.75 ,93,,,$206.25 ,$363.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
64405 INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV TechFee,8211345,CDM,450,RC,64405,HCPCS,outpatient,,,$240.00 ,$180.00 ,,$220.80 ,92,,,$132.00 ,$232.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.00 ,$232.80 ,other,,Not applicable. No negotiated rates per contract,$206.40 ,86,,,$132.00 ,$232.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.00 ,80,,,$132.00 ,$232.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.00 ,95,,,$132.00 ,$232.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.00 ,95,,,$132.00 ,$232.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.00 ,75,,,$132.00 ,$232.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.00 ,85,,,$132.00 ,$232.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.80 ,97,,,$132.00 ,$232.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.00 ,85,,,$132.00 ,$232.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.00 ,90,,,$132.00 ,$232.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.00 ,55,,,$132.00 ,$232.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.20 ,93,,,$132.00 ,$232.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
64450 INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH TechFee,8211346,CDM,450,RC,64450,HCPCS,outpatient,,,$258.00 ,$193.50 ,,$237.36 ,92,,,$141.90 ,$250.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.90 ,55,,,$141.90 ,$250.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$141.90 ,$250.26 ,other,,Not applicable. No negotiated rates per contract,$221.88 ,86,,,$141.90 ,$250.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$206.40 ,80,,,$141.90 ,$250.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.90 ,55,,,$141.90 ,$250.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.10 ,95,,,$141.90 ,$250.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$245.10 ,95,,,$141.90 ,$250.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.50 ,75,,,$141.90 ,$250.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$219.30 ,85,,,$141.90 ,$250.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.26 ,97,,,$141.90 ,$250.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.90 ,55,,,$141.90 ,$250.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.20 ,90,,,$141.90 ,$250.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.26 ,97,,,$141.90 ,$250.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.26 ,97,,,$141.90 ,$250.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.26 ,97,,,$141.90 ,$250.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.30 ,85,,,$141.90 ,$250.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$232.20 ,90,,,$141.90 ,$250.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.90 ,55,,,$141.90 ,$250.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.10 ,90,,,$141.90 ,$250.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.90 ,55,,,$141.90 ,$250.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.94 ,93,,,$141.90 ,$250.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
65205 REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee,8211348,CDM,450,RC,65205,HCPCS,outpatient,,,$95.00 ,$71.25 ,,$87.40 ,92,,,$52.25 ,$92.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.25 ,55,,,$52.25 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.25 ,$92.15 ,other,,Not applicable. No negotiated rates per contract,$81.70 ,86,,,$52.25 ,$92.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.00 ,80,,,$52.25 ,$92.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.25 ,55,,,$52.25 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.25 ,95,,,$52.25 ,$92.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.25 ,95,,,$52.25 ,$92.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.25 ,75,,,$52.25 ,$92.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$80.75 ,85,,,$52.25 ,$92.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.15 ,97,,,$52.25 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.25 ,55,,,$52.25 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,90,,,$52.25 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.15 ,97,,,$52.25 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.15 ,97,,,$52.25 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.15 ,97,,,$52.25 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.75 ,85,,,$52.25 ,$92.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.50 ,90,,,$52.25 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.25 ,55,,,$52.25 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.25 ,90,,,$52.25 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.25 ,55,,,$52.25 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,93,,,$52.25 ,$92.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
65220 RMVL FB XTRNL EYE CORNEAL W/O SLIT LAMP TechFee,8211350,CDM,450,RC,65220,HCPCS,outpatient,,,$199.00 ,$149.25 ,,$183.08 ,92,,,$109.45 ,$193.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$109.45 ,$193.03 ,other,,Not applicable. No negotiated rates per contract,$171.14 ,86,,,$109.45 ,$193.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$159.20 ,80,,,$109.45 ,$193.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,95,,,$109.45 ,$193.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.05 ,95,,,$109.45 ,$193.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.25 ,75,,,$109.45 ,$193.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$169.15 ,85,,,$109.45 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.10 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.15 ,85,,,$109.45 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.10 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.07 ,93,,,$109.45 ,$193.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
65222 RMVL FB XTRNL EYE CORNEAL W/SLIT LAMP TechFee,8211351,CDM,450,RC,65222,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
67700 ED DRAINAGE OF EYELID ABSCESS TechFee,8258866,CDM,450,RC,67700,HCPCS,outpatient,,,$986.00 ,$739.50 ,,$907.12 ,92,,,$542.30 ,$956.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$542.30 ,55,,,$542.30 ,$956.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$542.30 ,$956.42 ,other,,Not applicable. No negotiated rates per contract,$847.96 ,86,,,$542.30 ,$956.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$788.80 ,80,,,$542.30 ,$956.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$542.30 ,55,,,$542.30 ,$956.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$936.70 ,95,,,$542.30 ,$956.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$936.70 ,95,,,$542.30 ,$956.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$739.50 ,75,,,$542.30 ,$956.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$838.10 ,85,,,$542.30 ,$956.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$956.42 ,97,,,$542.30 ,$956.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$542.30 ,55,,,$542.30 ,$956.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$887.40 ,90,,,$542.30 ,$956.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$956.42 ,97,,,$542.30 ,$956.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$956.42 ,97,,,$542.30 ,$956.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$956.42 ,97,,,$542.30 ,$956.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$838.10 ,85,,,$542.30 ,$956.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$887.40 ,90,,,$542.30 ,$956.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$542.30 ,55,,,$542.30 ,$956.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$936.70 ,90,,,$542.30 ,$956.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$542.30 ,55,,,$542.30 ,$956.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$916.98 ,93,,,$542.30 ,$956.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
67938 REMOVAL EMBEDDED FOREIGN BODY EYELID TechFee,8211353,CDM,450,RC,67938,HCPCS,outpatient,,,$933.00 ,$699.75 ,,$858.36 ,92,,,$513.15 ,$905.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$513.15 ,55,,,$513.15 ,$905.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$513.15 ,$905.01 ,other,,Not applicable. No negotiated rates per contract,$802.38 ,86,,,$513.15 ,$905.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$746.40 ,80,,,$513.15 ,$905.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$513.15 ,55,,,$513.15 ,$905.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$886.35 ,95,,,$513.15 ,$905.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$886.35 ,95,,,$513.15 ,$905.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$699.75 ,75,,,$513.15 ,$905.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$793.05 ,85,,,$513.15 ,$905.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$905.01 ,97,,,$513.15 ,$905.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.15 ,55,,,$513.15 ,$905.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$839.70 ,90,,,$513.15 ,$905.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$905.01 ,97,,,$513.15 ,$905.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$905.01 ,97,,,$513.15 ,$905.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$905.01 ,97,,,$513.15 ,$905.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$793.05 ,85,,,$513.15 ,$905.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$839.70 ,90,,,$513.15 ,$905.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$513.15 ,55,,,$513.15 ,$905.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$886.35 ,90,,,$513.15 ,$905.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$513.15 ,55,,,$513.15 ,$905.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$867.69 ,93,,,$513.15 ,$905.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
69000 DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPL,8211354,CDM,450,RC,69000,HCPCS,outpatient,,,$627.00 ,$470.25 ,,$576.84 ,92,,,$344.85 ,$608.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$344.85 ,55,,,$344.85 ,$608.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$344.85 ,$608.19 ,other,,Not applicable. No negotiated rates per contract,$539.22 ,86,,,$344.85 ,$608.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$501.60 ,80,,,$344.85 ,$608.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$344.85 ,55,,,$344.85 ,$608.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$595.65 ,95,,,$344.85 ,$608.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$595.65 ,95,,,$344.85 ,$608.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$470.25 ,75,,,$344.85 ,$608.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$532.95 ,85,,,$344.85 ,$608.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$608.19 ,97,,,$344.85 ,$608.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.85 ,55,,,$344.85 ,$608.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$564.30 ,90,,,$344.85 ,$608.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$608.19 ,97,,,$344.85 ,$608.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$608.19 ,97,,,$344.85 ,$608.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$608.19 ,97,,,$344.85 ,$608.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$532.95 ,85,,,$344.85 ,$608.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$564.30 ,90,,,$344.85 ,$608.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$344.85 ,55,,,$344.85 ,$608.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$595.65 ,90,,,$344.85 ,$608.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$344.85 ,55,,,$344.85 ,$608.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$583.11 ,93,,,$344.85 ,$608.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
69200 RMVL FB XTRNL AUDITORY CANAL W/O ANES TechFee,8211355,CDM,450,RC,69200,HCPCS,outpatient,,,$268.00 ,$201.00 ,,$246.56 ,92,,,$147.40 ,$259.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$147.40 ,$259.96 ,other,,Not applicable. No negotiated rates per contract,$230.48 ,86,,,$147.40 ,$259.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$214.40 ,80,,,$147.40 ,$259.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.60 ,95,,,$147.40 ,$259.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$254.60 ,95,,,$147.40 ,$259.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.00 ,75,,,$147.40 ,$259.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$227.80 ,85,,,$147.40 ,$259.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.20 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.96 ,97,,,$147.40 ,$259.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.80 ,85,,,$147.40 ,$259.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.20 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.60 ,90,,,$147.40 ,$259.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.40 ,55,,,$147.40 ,$259.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$249.24 ,93,,,$147.40 ,$259.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,8310290,CDM,450,RC,69209,HCPCS,outpatient,,,$51.00 ,$38.25 ,,$46.92 ,92,,,$28.05 ,$49.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.05 ,$49.47 ,other,,Not applicable. No negotiated rates per contract,$43.86 ,86,,,$28.05 ,$49.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.80 ,80,,,$28.05 ,$49.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,95,,,$28.05 ,$49.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.45 ,95,,,$28.05 ,$49.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.25 ,75,,,$28.05 ,$49.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$49.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.90 ,90,,,$28.05 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$49.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.90 ,90,,,$28.05 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,90,,,$28.05 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.43 ,93,,,$28.05 ,$49.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
69210 REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT TechFee,8211356,CDM,450,RC,69210,HCPCS,outpatient,,,$154.00 ,$115.50 ,,$141.68 ,92,,,$84.70 ,$149.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.70 ,55,,,$84.70 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.70 ,$149.38 ,other,,Not applicable. No negotiated rates per contract,$132.44 ,86,,,$84.70 ,$149.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.20 ,80,,,$84.70 ,$149.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.70 ,55,,,$84.70 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.30 ,95,,,$84.70 ,$149.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.30 ,95,,,$84.70 ,$149.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.50 ,75,,,$84.70 ,$149.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.90 ,85,,,$84.70 ,$149.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.38 ,97,,,$84.70 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.70 ,55,,,$84.70 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.60 ,90,,,$84.70 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.38 ,97,,,$84.70 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.38 ,97,,,$84.70 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.38 ,97,,,$84.70 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.90 ,85,,,$84.70 ,$149.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.60 ,90,,,$84.70 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.70 ,55,,,$84.70 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.30 ,90,,,$84.70 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.70 ,55,,,$84.70 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.22 ,93,,,$84.70 ,$149.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
76937 POCUS Vascular Access TechFee,9304718,CDM,450,RC,76937,HCPCS,outpatient,,,$131.00 ,$98.25 ,,$120.52 ,92,,,$72.05 ,$127.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.05 ,55,,,$72.05 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.05 ,$127.07 ,other,,Not applicable. No negotiated rates per contract,$112.66 ,86,,,$72.05 ,$127.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$104.80 ,80,,,$72.05 ,$127.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.05 ,55,,,$72.05 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,95,,,$72.05 ,$127.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.45 ,95,,,$72.05 ,$127.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.25 ,75,,,$72.05 ,$127.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$111.35 ,85,,,$72.05 ,$127.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.07 ,97,,,$72.05 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.05 ,55,,,$72.05 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.90 ,90,,,$72.05 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.07 ,97,,,$72.05 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$72.05 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$72.05 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.35 ,85,,,$72.05 ,$127.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.90 ,90,,,$72.05 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.05 ,55,,,$72.05 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,90,,,$72.05 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.05 ,55,,,$72.05 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.83 ,93,,,$72.05 ,$127.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
92950 CARDIOPULMONARY RESUSCITATION TechFee,8211357,CDM,450,RC,92950,HCPCS,outpatient,,,"$1,087.00 ",$815.25 ,,"$1,000.04 ",92,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$597.85 ,"$1,054.39 ",other,,Not applicable. No negotiated rates per contract,$934.82 ,86,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$869.60 ,80,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,032.65 ",95,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,032.65 ",95,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$815.25 ,75,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$923.95 ,85,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$978.30 ,90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.39 ",97,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$923.95 ,85,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$978.30 ,90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,032.65 ",90,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$597.85 ,55,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,010.91 ",93,,,$597.85 ,"$1,054.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
92960 CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL TechFee,8211358,CDM,450,RC,92960,HCPCS,outpatient,,,$520.00 ,$390.00 ,,$478.40 ,92,,,$286.00 ,$504.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$286.00 ,$504.40 ,other,,Not applicable. No negotiated rates per contract,$447.20 ,86,,,$286.00 ,$504.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$416.00 ,80,,,$286.00 ,$504.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.00 ,75,,,$286.00 ,$504.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$483.60 ,93,,,$286.00 ,$504.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97597 ED DEBRIDEMENT OPEN WOUND 20 SQ CM/ OR GREATER TechFee,8405257,CDM,450,RC,97597,HCPCS,outpatient,,,$334.00 ,$250.50 ,,$307.28 ,92,,,$183.70 ,$323.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.70 ,55,,,$183.70 ,$323.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.70 ,$323.98 ,other,,Not applicable. No negotiated rates per contract,$287.24 ,86,,,$183.70 ,$323.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.20 ,80,,,$183.70 ,$323.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.70 ,55,,,$183.70 ,$323.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.30 ,95,,,$183.70 ,$323.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.30 ,95,,,$183.70 ,$323.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.50 ,75,,,$183.70 ,$323.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$283.90 ,85,,,$183.70 ,$323.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$323.98 ,97,,,$183.70 ,$323.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.70 ,55,,,$183.70 ,$323.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.60 ,90,,,$183.70 ,$323.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$323.98 ,97,,,$183.70 ,$323.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$323.98 ,97,,,$183.70 ,$323.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$323.98 ,97,,,$183.70 ,$323.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.90 ,85,,,$183.70 ,$323.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.60 ,90,,,$183.70 ,$323.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.70 ,55,,,$183.70 ,$323.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.30 ,90,,,$183.70 ,$323.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.70 ,55,,,$183.70 ,$323.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.62 ,93,,,$183.70 ,$323.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99151 MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS,8208322,CDM,370,RC,99151,HCPCS,outpatient,,,$290.00 ,$217.50 ,,$266.80 ,92,,,$159.50 ,$281.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.50 ,$281.30 ,other,,Not applicable. No negotiated rates per contract,$249.40 ,86,,,$159.50 ,$281.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$232.00 ,80,,,$159.50 ,$281.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.50 ,75,,,$159.50 ,$281.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.70 ,93,,,$159.50 ,$281.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99152 MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS,8208323,CDM,370,RC,99152,HCPCS,outpatient,,,$173.00 ,$129.75 ,,$159.16 ,92,,,$95.15 ,$167.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.15 ,55,,,$95.15 ,$167.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$95.15 ,$167.81 ,other,,Not applicable. No negotiated rates per contract,$148.78 ,86,,,$95.15 ,$167.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$138.40 ,80,,,$95.15 ,$167.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.15 ,55,,,$95.15 ,$167.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.35 ,95,,,$95.15 ,$167.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$164.35 ,95,,,$95.15 ,$167.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$129.75 ,75,,,$95.15 ,$167.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.05 ,85,,,$95.15 ,$167.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$167.81 ,97,,,$95.15 ,$167.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.15 ,55,,,$95.15 ,$167.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.70 ,90,,,$95.15 ,$167.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.81 ,97,,,$95.15 ,$167.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.81 ,97,,,$95.15 ,$167.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.81 ,97,,,$95.15 ,$167.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.05 ,85,,,$95.15 ,$167.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$155.70 ,90,,,$95.15 ,$167.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.15 ,55,,,$95.15 ,$167.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.35 ,90,,,$95.15 ,$167.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.15 ,55,,,$95.15 ,$167.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.89 ,93,,,$95.15 ,$167.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99153 MOD SED SAME PHYS/QHP EACH ADDL 15 MINS,8208324,CDM,370,RC,99153,HCPCS,outpatient,,,$36.00 ,$27.00 ,,$33.12 ,92,,,$19.80 ,$34.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.80 ,55,,,$19.80 ,$34.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.80 ,$34.92 ,other,,Not applicable. No negotiated rates per contract,$30.96 ,86,,,$19.80 ,$34.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.80 ,80,,,$19.80 ,$34.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.80 ,55,,,$19.80 ,$34.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.20 ,95,,,$19.80 ,$34.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.20 ,95,,,$19.80 ,$34.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.00 ,75,,,$19.80 ,$34.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.60 ,85,,,$19.80 ,$34.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.92 ,97,,,$19.80 ,$34.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.80 ,55,,,$19.80 ,$34.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.40 ,90,,,$19.80 ,$34.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.92 ,97,,,$19.80 ,$34.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.92 ,97,,,$19.80 ,$34.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.92 ,97,,,$19.80 ,$34.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.60 ,85,,,$19.80 ,$34.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.40 ,90,,,$19.80 ,$34.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.80 ,55,,,$19.80 ,$34.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.20 ,90,,,$19.80 ,$34.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.80 ,55,,,$19.80 ,$34.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.48 ,93,,,$19.80 ,$34.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0390 TRAUMA RESPONS W/HOSP CRITI TechFee,8023495,CDM,450,RC,G0390,HCPCS,outpatient,,,"$1,774.00 ","$1,330.50 ",,"$1,632.08 ",92,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$975.70 ,55,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$975.70 ,"$1,720.78 ",other,,Not applicable. No negotiated rates per contract,"$1,525.64 ",86,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,419.20 ",80,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$975.70 ,55,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,685.30 ",95,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,685.30 ",95,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,330.50 ",75,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,507.90 ",85,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,720.78 ",97,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$975.70 ,55,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,596.60 ",90,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,720.78 ",97,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,720.78 ",97,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,720.78 ",97,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,507.90 ",85,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,596.60 ",90,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$975.70 ,55,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,685.30 ",90,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$975.70 ,55,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,649.82 ",93,,,$975.70 ,"$1,720.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
P9612 Catheterize for urine spec TechFee,8023496,CDM,300,RC,P9612,HCPCS,outpatient,,,$16.00 ,$12.00 ,,$14.72 ,92,,,$1.32 ,$15.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$8.80 ,55,,,$1.32 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$15.52 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$15.52 ,fee schedule,,44% of CMS Medicare lab fee schedule,$12.80 ,80,,,$1.32 ,$15.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$8.80 ,55,,,$1.32 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.20 ,95,,,$1.32 ,$15.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.20 ,95,,,$1.32 ,$15.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$12.00 ,75,,,$1.32 ,$15.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$13.60 ,85,,,$1.32 ,$15.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$15.52 ,97,,,$1.32 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$8.80 ,55,,,$1.32 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$14.40 ,90,,,$1.32 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.52 ,97,,,$1.32 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.52 ,97,,,$1.32 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.52 ,97,,,$1.32 ,$15.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.60 ,85,,,$1.32 ,$15.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$14.40 ,90,,,$1.32 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$8.80 ,55,,,$1.32 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.20 ,90,,,$1.32 ,$15.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$8.80 ,55,,,$1.32 ,$15.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$14.88 ,93,,,$1.32 ,$15.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Q3014 ED TELEHEALTH FACILITY FEE TechFee,8258875,CDM,450,RC,Q3014,HCPCS,outpatient,,,$119.00 ,$89.25 ,,$109.48 ,92,,,$65.45 ,$115.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.45 ,$115.43 ,other,,Not applicable. No negotiated rates per contract,$102.34 ,86,,,$65.45 ,$115.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.20 ,80,,,$65.45 ,$115.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.05 ,95,,,$65.45 ,$115.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.05 ,95,,,$65.45 ,$115.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.25 ,75,,,$65.45 ,$115.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.15 ,85,,,$65.45 ,$115.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.10 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.43 ,97,,,$65.45 ,$115.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.15 ,85,,,$65.45 ,$115.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.10 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.05 ,90,,,$65.45 ,$115.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.45 ,55,,,$65.45 ,$115.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.67 ,93,,,$65.45 ,$115.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
1123f Advance Care Planning discussed and documented advance care plan or surrogate decision maker d,8847909,CDM,521,RC,1123f,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
1124f Advance Care Planning discussed and documented in the medical record,8847910,CDM,521,RC,1124f,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
90785 Psytx complex interactive,9010798,CDM,961,RC,90785,HCPCS,outpatient,,,$47.00 ,$35.25 ,,,,,,$13.16 ,$44.65 ,other,,Not seperately reimbursible per contract terms,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$13.16 ,$44.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$18.47 ,100,,,$13.16 ,$44.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$27.30 ,100,physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$19.08 ,145,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$44.65 ,95,,,$13.16 ,$44.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$13.16 ,$44.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$19.74 ,100,,,$13.16 ,$44.65 ,fee schedule,,100% Humana physician fee schedule,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$13.16 ,$44.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$13.16 ,$44.65 ,other,,Not separately reimbursable per contract terms,$28.20 ,60,,,$13.16 ,$44.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$28.20 ,60,,,$13.16 ,$44.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$18.42 ,140,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$13.16 ,$44.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$44.65 ,95,,,$13.16 ,$44.65 ,percent of total billed charges,,95% of total billed charges,$13.16 ,100,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.42 ,124.753,CMS physician fee schedule,,$13.16 ,$44.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90791 Psychiatric diagnostic evaluation,8040963,CDM,961,RC,90791,HCPCS,outpatient,,,$373.00 ,$279.75 ,,,,,,$83.00 ,$373.00 ,other,,Not seperately reimbursible per contract terms,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.00 ,$373.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$83.00 ,100,,,$83.00 ,$373.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$373.00 ,100,physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$223.53 ,145,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$354.35 ,95,,,$83.00 ,$373.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$83.00 ,$373.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$179.05 ,100,,,$83.00 ,$373.00 ,fee schedule,,100% Humana physician fee schedule,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.00 ,$373.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$220.28 ,100,,,$83.00 ,$373.00 ,fee schedule,,100% Midlands Choice physician fee schedule,$223.80 ,60,,,$83.00 ,$373.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$223.80 ,60,,,$83.00 ,$373.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$215.82 ,140,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$83.00 ,$373.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$354.35 ,95,,,$83.00 ,$373.00 ,percent of total billed charges,,95% of total billed charges,$154.16 ,100,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.32 ,124.753,CMS physician fee schedule,,$83.00 ,$373.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90832 Psychotherapy,8040965,CDM,961,RC,90832,HCPCS,outpatient,,,$139.00 ,$104.25 ,,,,,,$36.00 ,$132.05 ,other,,Not seperately reimbursible per contract terms,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$36.00 ,$132.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.00 ,100,,,$36.00 ,$132.05 ,fee schedule,,100% of the Blue Cross physician fee schedule,$123.90 ,100,physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$99.88 ,145,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,145% CMS Medicare physician fee schedule ,$132.05 ,95,,,$36.00 ,$132.05 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$36.00 ,$132.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$89.49 ,100,,,$36.00 ,$132.05 ,fee schedule,,100% Humana physician fee schedule,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$36.00 ,$132.05 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$36.00 ,$132.05 ,other,,Not separately reimbursable per contract terms,$83.40 ,60,,,$36.00 ,$132.05 ,percent of total billed charges,,60% of total billed charges for physician settings,$83.40 ,60,,,$36.00 ,$132.05 ,percent of total billed charges,,60% of total billed charges for physician settings,$96.43 ,140,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$36.00 ,$132.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$132.05 ,95,,,$36.00 ,$132.05 ,percent of total billed charges,,95% of total billed charges,$68.88 ,100,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$85.93 ,124.753,CMS physician fee schedule,,$36.00 ,$132.05 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90834 Psychotherapy,8040967,CDM,961,RC,90834,HCPCS,outpatient,,,$230.00 ,$172.50 ,,,,,,$66.00 ,$218.50 ,other,,Not seperately reimbursible per contract terms,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$218.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$66.00 ,100,,,$66.00 ,$218.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$165.20 ,100,physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$131.52 ,145,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$218.50 ,95,,,$66.00 ,$218.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$66.00 ,$218.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.32 ,100,,,$66.00 ,$218.50 ,fee schedule,,100% Humana physician fee schedule,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$218.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$146.40 ,100,,,$66.00 ,$218.50 ,fee schedule,,100% Midlands Choice physician fee schedule,$138.00 ,60,,,$66.00 ,$218.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$138.00 ,60,,,$66.00 ,$218.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$126.98 ,140,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$66.00 ,$218.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$218.50 ,95,,,$66.00 ,$218.50 ,percent of total billed charges,,95% of total billed charges,$90.70 ,100,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$113.15 ,124.753,CMS physician fee schedule,,$66.00 ,$218.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90837 Psychotherapy,8040969,CDM,961,RC,90837,HCPCS,outpatient,,,$330.00 ,$247.50 ,,,,,,$77.00 ,$313.50 ,other,,Not seperately reimbursible per contract terms,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.00 ,$313.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.00 ,100,,,$77.00 ,$313.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$247.10 ,100,physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,145,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$313.50 ,95,,,$77.00 ,$313.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$77.00 ,$313.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$178.53 ,100,,,$77.00 ,$313.50 ,fee schedule,,100% Humana physician fee schedule,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.00 ,$313.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$219.70 ,100,,,$77.00 ,$313.50 ,fee schedule,,100% Midlands Choice physician fee schedule,$198.00 ,60,,,$77.00 ,$313.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$198.00 ,60,,,$77.00 ,$313.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$186.20 ,140,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$77.00 ,$313.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$313.50 ,95,,,$77.00 ,$313.50 ,percent of total billed charges,,95% of total billed charges,$133.00 ,100,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$165.92 ,124.753,CMS physician fee schedule,,$77.00 ,$313.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90846 Family psychotherapy without the patient present,8040973,CDM,961,RC,90846,HCPCS,outpatient,,,$280.00 ,$210.00 ,,$104.26 ,135,cms physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$266.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$66.00 ,100,,,$66.00 ,$266.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$199.50 ,100,physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$141.62 ,145,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$266.00 ,95,,,$66.00 ,$266.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$66.00 ,$266.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$144.17 ,100,,,$66.00 ,$266.00 ,fee schedule,,100% Humana physician fee schedule,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$266.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$66.00 ,$266.00 ,other,,Not separately reimbursable per contract terms,$168.00 ,60,,,$66.00 ,$266.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$168.00 ,60,,,$66.00 ,$266.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$136.74 ,140,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$66.00 ,$266.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$266.00 ,95,,,$66.00 ,$266.00 ,percent of total billed charges,,95% of total billed charges,$97.67 ,100,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.85 ,124.753,CMS physician fee schedule,,$66.00 ,$266.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90847 Family psychotherapy,8040974,CDM,961,RC,90847,HCPCS,outpatient,,,$279.00 ,$209.25 ,,$123.36 ,135,cms physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,135% of 2011 CMS physician fee schedule,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$265.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$66.00 ,100,,,$66.00 ,$265.05 ,fee schedule,,100% of the Blue Cross physician fee schedule,$207.20 ,100,physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$147.15 ,145,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,145% CMS Medicare physician fee schedule ,$265.05 ,95,,,$66.00 ,$265.05 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$66.00 ,$265.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$149.74 ,100,,,$66.00 ,$265.05 ,fee schedule,,100% Humana physician fee schedule,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$66.00 ,$265.05 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$66.00 ,$265.05 ,other,,Not separately reimbursable per contract terms,$105.98 ,100,,,$66.00 ,$265.05 ,fee schedule,,100% Multiplan physician fee schedule,$105.98 ,100,,,$66.00 ,$265.05 ,fee schedule,,100% Multiplan physician fee schedule,$142.07 ,140,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$66.00 ,$265.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$265.05 ,95,,,$66.00 ,$265.05 ,percent of total billed charges,,95% of total billed charges,$101.48 ,100,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$126.60 ,124.753,CMS physician fee schedule,,$66.00 ,$265.05 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90882 Environmental intervention for med mgmt with agencies,8040979,CDM,983,RC,90882,HCPCS,outpatient,,,$224.00 ,$168.00 ,,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursible per contract terms,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$105.66 ,100,,,$105.66 ,$212.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursable per contract terms,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$212.80 ,95,,,$105.66 ,$212.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$124.42 ,100,,,$105.66 ,$212.80 ,fee schedule,,100% Humana physician fee schedule,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursable per contract terms,$134.40 ,60,,,$105.66 ,$212.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$134.40 ,60,,,$105.66 ,$212.80 ,percent of total billed charges,,60% of total billed charges for physician settings,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursable per contract terms,,,,,$105.66 ,$212.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$212.80 ,95,,,$105.66 ,$212.80 ,percent of total billed charges,,95% of total billed charges,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,$212.80 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
90887 Interp/Explanation mgmt of patient to family or other responsible persons,8040981,CDM,983,RC,90887,HCPCS,outpatient,,,$152.00 ,$114.00 ,,$100.51 ,135,cms physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,135% of 2011 CMS physician fee schedule,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.23 ,100,,,$75.03 ,$144.40 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursable per contract terms,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$108.79 ,145,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,145% CMS Medicare physician fee schedule ,$144.40 ,95,,,$75.03 ,$144.40 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$109.56 ,100,,,$75.03 ,$144.40 ,fee schedule,,100% Humana physician fee schedule,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursable per contract terms,$91.20 ,60,,,$75.03 ,$144.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$91.20 ,60,,,$75.03 ,$144.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$105.04 ,140,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$75.03 ,$144.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$144.40 ,95,,,$75.03 ,$144.40 ,percent of total billed charges,,95% of total billed charges,$75.03 ,100,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$93.60 ,124.753,CMS physician fee schedule,,$75.03 ,$144.40 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
96110 Developmental screening,8084922,CDM,521,RC,96110,HCPCS,outpatient,,,$32.00 ,$24.00 ,,$29.44 ,92,,,$24.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$24.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$24.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$27.52 ,86,,,$24.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.60 ,80,,,$24.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$24.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.40 ,95,,,$24.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.40 ,95,,,$24.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.00 ,75,,,$24.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.20 ,85,,,$24.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.04 ,97,,,$24.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$24.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$28.80 ,90,,,$24.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.04 ,97,,,$24.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.04 ,97,,,$24.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.04 ,97,,,$24.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.20 ,85,,,$24.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.80 ,90,,,$24.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$24.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.40 ,90,,,$24.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$24.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
96118 Neuropsychological testing,8041000,CDM,983,RC,96118,HCPCS,outpatient,,,,,,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursable per contract terms,,,,,,,other,,Not separately reimbursible. Not contracted for physician rates,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,,,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
96127 Brief Emotional/Behavioral Assessment,9151838,CDM,521,RC,96127,HCPCS,outpatient,,,$21.00 ,$15.75 ,,$19.32 ,92,,,$15.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$15.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$15.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$18.06 ,86,,,$15.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$16.80 ,80,,,$15.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,95,,,$15.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.95 ,95,,,$15.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.75 ,75,,,$15.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$17.85 ,85,,,$15.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$15.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$18.90 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.85 ,85,,,$15.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$18.90 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
96130 Psychological testing evaluation services by physician or other qualified health care professi,9228556,CDM,983,RC,96130,HCPCS,outpatient,,,$382.00 ,$286.50 ,,,,,,$109.55 ,$362.90 ,other,,Not seperately reimbursible per contract terms,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$109.55 ,$362.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$146.03 ,100,,,$109.55 ,$362.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$238.00 ,100,physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$158.85 ,145,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$362.90 ,95,,,$109.55 ,$362.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$109.55 ,$362.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$155.90 ,100,,,$109.55 ,$362.90 ,fee schedule,,100% Humana physician fee schedule,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$109.55 ,$362.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$109.55 ,$362.90 ,other,,Not separately reimbursable per contract terms,$229.20 ,60,,,$109.55 ,$362.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$229.20 ,60,,,$109.55 ,$362.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$153.37 ,140,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$109.55 ,$362.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.90 ,95,,,$109.55 ,$362.90 ,percent of total billed charges,,95% of total billed charges,$109.55 ,100,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$136.67 ,124.753,CMS physician fee schedule,,$109.55 ,$362.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
96131 Psychological testing evaluation services by physician or other qualified health care professi,9228559,CDM,983,RC,96131,HCPCS,outpatient,,,$290.00 ,$217.50 ,,,,,,$80.29 ,$275.50 ,other,,Not seperately reimbursible per contract terms,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$80.29 ,$275.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$112.10 ,100,,,$80.29 ,$275.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$191.10 ,100,physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$116.42 ,145,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$275.50 ,95,,,$80.29 ,$275.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$80.29 ,$275.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.84 ,100,,,$80.29 ,$275.50 ,fee schedule,,100% Humana physician fee schedule,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$80.29 ,$275.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$80.29 ,$275.50 ,other,,Not separately reimbursable per contract terms,$174.00 ,60,,,$80.29 ,$275.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$174.00 ,60,,,$80.29 ,$275.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$112.41 ,140,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$80.29 ,$275.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$275.50 ,95,,,$80.29 ,$275.50 ,percent of total billed charges,,95% of total billed charges,$80.29 ,100,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$100.16 ,124.753,CMS physician fee schedule,,$80.29 ,$275.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
96132 Neuropsychological testing evaluation services by physician or other qualified health care pro,8680674,CDM,983,RC,96132,HCPCS,outpatient,,,$272.00 ,$204.00 ,,,,,,$107.05 ,$258.40 ,other,,Not seperately reimbursible per contract terms,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$107.05 ,$258.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$163.64 ,100,,,$107.05 ,$258.40 ,fee schedule,,100% of the Blue Cross physician fee schedule,$224.00 ,100,physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$155.22 ,145,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,145% CMS Medicare physician fee schedule ,$258.40 ,95,,,$107.05 ,$258.40 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$107.05 ,$258.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$153.82 ,100,,,$107.05 ,$258.40 ,fee schedule,,100% Humana physician fee schedule,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$107.05 ,$258.40 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$107.05 ,$258.40 ,other,,Not separately reimbursable per contract terms,$163.20 ,60,,,$107.05 ,$258.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$163.20 ,60,,,$107.05 ,$258.40 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.87 ,140,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$107.05 ,$258.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$258.40 ,95,,,$107.05 ,$258.40 ,percent of total billed charges,,95% of total billed charges,$107.05 ,100,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.55 ,124.753,CMS physician fee schedule,,$107.05 ,$258.40 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
96133 Neuropsychological testing evaluation services by physician or other qualified health care pro,9228563,CDM,983,RC,96133,HCPCS,outpatient,,,$241.00 ,$180.75 ,,,,,,$79.62 ,$228.95 ,other,,Not seperately reimbursible per contract terms,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$79.62 ,$228.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.84 ,100,,,$79.62 ,$228.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,$170.80 ,100,physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.45 ,145,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,145% CMS Medicare physician fee schedule ,$228.95 ,95,,,$79.62 ,$228.95 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$79.62 ,$228.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$118.34 ,100,,,$79.62 ,$228.95 ,fee schedule,,100% Humana physician fee schedule,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$79.62 ,$228.95 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$79.62 ,$228.95 ,other,,Not separately reimbursable per contract terms,$144.60 ,60,,,$79.62 ,$228.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$144.60 ,60,,,$79.62 ,$228.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$111.47 ,140,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$79.62 ,$228.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$228.95 ,95,,,$79.62 ,$228.95 ,percent of total billed charges,,95% of total billed charges,$79.62 ,100,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$99.33 ,124.753,CMS physician fee schedule,,$79.62 ,$228.95 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99024 Post-op f/u visit,8041008,CDM,983,RC,99024,HCPCS,outpatient,,,,,,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursible per contract terms,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$54.55 ,100,,,$54.55 ,$54.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursable per contract terms,,,,,$54.55 ,$54.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.55 ,$54.55 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
99174 Instrument-based ocular screening,2389206,CDM,521,RC,99174,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99201 Office/Outpatient Visit - New Patient,8041012,CDM,521,RC,99201,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$904.36 ,92,,,$36.80 ,$953.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$36.80 ,$953.51 ,case rate,,100% of clinic case rate per visit,,,,,$36.80 ,$953.51 ,other,,Not applicable. No negotiated rates per contract,$845.38 ,86,,,$36.80 ,$953.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$786.40 ,80,,,$36.80 ,$953.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$36.80 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.80 ,100,,,$36.80 ,$953.51 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$933.85 ,95,,,$36.80 ,$953.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.25 ,75,,,$36.80 ,$953.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$835.55 ,85,,,$36.80 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$953.51 ,97,,,$36.80 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$36.80 ,$953.51 ,case rate,,100% of clinic case rate per visit,$884.70 ,90,,,$36.80 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$953.51 ,97,,,$36.80 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$36.80 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$36.80 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$835.55 ,85,,,$36.80 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.70 ,90,,,$36.80 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.80 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$933.85 ,90,,,$36.80 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$36.80 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.80 ,$953.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99202 Office/Outpatient Visit - New Patient,8041013,CDM,521,RC,99202,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$904.36 ,92,,,$65.23 ,$953.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$65.23 ,$953.51 ,case rate,,100% of clinic case rate per visit,,,,,$65.23 ,$953.51 ,other,,Not applicable. No negotiated rates per contract,$845.38 ,86,,,$65.23 ,$953.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$786.40 ,80,,,$65.23 ,$953.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$65.23 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.23 ,100,,,$65.23 ,$953.51 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$933.85 ,95,,,$65.23 ,$953.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.25 ,75,,,$65.23 ,$953.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$835.55 ,85,,,$65.23 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$953.51 ,97,,,$65.23 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$65.23 ,$953.51 ,case rate,,100% of clinic case rate per visit,$884.70 ,90,,,$65.23 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$953.51 ,97,,,$65.23 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$65.23 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$65.23 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$835.55 ,85,,,$65.23 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.70 ,90,,,$65.23 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$65.23 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$933.85 ,90,,,$65.23 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$65.23 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.23 ,$953.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99203 Office/Outpatient Visit - New Patient,8041014,CDM,521,RC,99203,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$904.36 ,92,,,$96.95 ,$953.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$96.95 ,$953.51 ,case rate,,100% of clinic case rate per visit,,,,,$96.95 ,$953.51 ,other,,Not applicable. No negotiated rates per contract,$845.38 ,86,,,$96.95 ,$953.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$786.40 ,80,,,$96.95 ,$953.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$96.95 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.95 ,100,,,$96.95 ,$953.51 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$933.85 ,95,,,$96.95 ,$953.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.25 ,75,,,$96.95 ,$953.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$835.55 ,85,,,$96.95 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$953.51 ,97,,,$96.95 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$96.95 ,$953.51 ,case rate,,100% of clinic case rate per visit,$884.70 ,90,,,$96.95 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$953.51 ,97,,,$96.95 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$96.95 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$96.95 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$835.55 ,85,,,$96.95 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.70 ,90,,,$96.95 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$96.95 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$933.85 ,90,,,$96.95 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$96.95 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.95 ,$953.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99204 Office/Outpatient Visit - New Patient,8041015,CDM,521,RC,99204,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$904.36 ,92,,,$137.09 ,$953.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$137.09 ,$953.51 ,case rate,,100% of clinic case rate per visit,,,,,$137.09 ,$953.51 ,other,,Not applicable. No negotiated rates per contract,$845.38 ,86,,,$137.09 ,$953.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$786.40 ,80,,,$137.09 ,$953.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$137.09 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.09 ,100,,,$137.09 ,$953.51 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$933.85 ,95,,,$137.09 ,$953.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.25 ,75,,,$137.09 ,$953.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$835.55 ,85,,,$137.09 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$953.51 ,97,,,$137.09 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$137.09 ,$953.51 ,case rate,,100% of clinic case rate per visit,$884.70 ,90,,,$137.09 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$953.51 ,97,,,$137.09 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$137.09 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$137.09 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$835.55 ,85,,,$137.09 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.70 ,90,,,$137.09 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$137.09 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$933.85 ,90,,,$137.09 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$137.09 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$137.09 ,$953.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99205 Office/Outpatient Visit - New Patient,8041016,CDM,521,RC,99205,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$904.36 ,92,,,$174.15 ,$953.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$174.15 ,$953.51 ,case rate,,100% of clinic case rate per visit,,,,,$174.15 ,$953.51 ,other,,Not applicable. No negotiated rates per contract,$845.38 ,86,,,$174.15 ,$953.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$786.40 ,80,,,$174.15 ,$953.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$174.15 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.15 ,100,,,$174.15 ,$953.51 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$933.85 ,95,,,$174.15 ,$953.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.25 ,75,,,$174.15 ,$953.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$835.55 ,85,,,$174.15 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$953.51 ,97,,,$174.15 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$174.15 ,$953.51 ,case rate,,100% of clinic case rate per visit,$884.70 ,90,,,$174.15 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$953.51 ,97,,,$174.15 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$174.15 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$953.51 ,97,,,$174.15 ,$953.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$835.55 ,85,,,$174.15 ,$953.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.70 ,90,,,$174.15 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$174.15 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$933.85 ,90,,,$174.15 ,$953.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$174.15 ,$953.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.15 ,$953.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99211 Office/Outpatient Visit - Established Patient,8041017,CDM,521,RC,99211,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$57.04 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$53.32 ,86,,,$21.73 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$49.60 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$58.90 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.50 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$52.70 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$55.80 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.70 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.80 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.73 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99212 Office/Outpatient Visit - Established Patient,8041018,CDM,983,RC,99212,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$34.16 ,135,cms physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,135% of 2011 CMS physician fee schedule,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.88 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$54.55 ,100,,,$25.88 ,$106.40 ,fee schedule,,100% of the Blue Cross physician fee schedule,$40.88 ,100,physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.33 ,145,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,145% CMS Medicare physician fee schedule ,$106.40 ,95,,,$25.88 ,$106.40 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$25.88 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.97 ,100,,,$25.88 ,$106.40 ,fee schedule,,100% Humana physician fee schedule,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.88 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$42.60 ,100,,,$25.88 ,$106.40 ,fee schedule,,100% Midlands Choice physician fee schedule,$25.88 ,100,,,$25.88 ,$106.40 ,fee schedule,,100% Multiplan physician fee schedule,$25.88 ,100,,,$25.88 ,$106.40 ,fee schedule,,100% Multiplan physician fee schedule,$51.49 ,140,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$25.88 ,$106.40 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$106.40 ,95,,,$25.88 ,$106.40 ,percent of total billed charges,,95% of total billed charges,$36.78 ,100,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,100% CMS Medicare physician fee schedule ,$45.88 ,124.753,CMS physician fee schedule,,$25.88 ,$106.40 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99213 Office/Outpatient Visit - Established Patient,8041019,CDM,983,RC,99213,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$68.01 ,135,cms physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.74 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$89.34 ,100,,,$51.74 ,$116.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$81.20 ,100,physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$98.28 ,145,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$116.85 ,95,,,$51.74 ,$116.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$51.74 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$73.54 ,100,,,$51.74 ,$116.85 ,fee schedule,,100% Humana physician fee schedule,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.74 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$85.62 ,100,,,$51.74 ,$116.85 ,fee schedule,,100% Midlands Choice physician fee schedule,$51.74 ,100,,,$51.74 ,$116.85 ,fee schedule,,100% Multiplan physician fee schedule,$51.74 ,100,,,$51.74 ,$116.85 ,fee schedule,,100% Multiplan physician fee schedule,$94.89 ,140,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$51.74 ,$116.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$116.85 ,95,,,$51.74 ,$116.85 ,percent of total billed charges,,95% of total billed charges,$67.78 ,100,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$84.56 ,124.753,CMS physician fee schedule,,$51.74 ,$116.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99214 Office/Outpatient Visit - Established Patient,8041020,CDM,983,RC,99214,HCPCS,outpatient,,,$206.00 ,$154.50 ,,$104.17 ,135,cms physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$79.75 ,$195.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$129.28 ,100,,,$79.75 ,$195.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$124.88 ,100,physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$144.29 ,145,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$195.70 ,95,,,$79.75 ,$195.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$79.75 ,$195.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$113.18 ,100,,,$79.75 ,$195.70 ,fee schedule,,100% Humana physician fee schedule,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$79.75 ,$195.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$132.31 ,100,,,$79.75 ,$195.70 ,fee schedule,,100% Midlands Choice physician fee schedule,$79.75 ,100,,,$79.75 ,$195.70 ,fee schedule,,100% Multiplan physician fee schedule,$79.75 ,100,,,$79.75 ,$195.70 ,fee schedule,,100% Multiplan physician fee schedule,$139.31 ,140,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$79.75 ,$195.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$195.70 ,95,,,$79.75 ,$195.70 ,percent of total billed charges,,95% of total billed charges,$99.51 ,100,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$124.14 ,124.753,CMS physician fee schedule,,$79.75 ,$195.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99215 Office/Outpatient Visit - Established Patient,8041021,CDM,521,RC,99215,HCPCS,outpatient,,,$301.00 ,$225.75 ,,$276.92 ,92,,,$120.24 ,$291.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$120.24 ,$291.97 ,case rate,,100% of clinic case rate per visit,,,,,$120.24 ,$291.97 ,other,,Not applicable. No negotiated rates per contract,$258.86 ,86,,,$120.24 ,$291.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$240.80 ,80,,,$120.24 ,$291.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$120.24 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.24 ,100,,,$120.24 ,$291.97 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$285.95 ,95,,,$120.24 ,$291.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.75 ,75,,,$120.24 ,$291.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$255.85 ,85,,,$120.24 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.97 ,97,,,$120.24 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$120.24 ,$291.97 ,case rate,,100% of clinic case rate per visit,$270.90 ,90,,,$120.24 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.97 ,97,,,$120.24 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$120.24 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$120.24 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.85 ,85,,,$120.24 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.90 ,90,,,$120.24 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$120.24 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.95 ,90,,,$120.24 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$120.24 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$120.24 ,$291.97 ,other,,Not separately reimbursable per table 3 referenced in contract
99304 Initial Nursing Facility Care,8041058,CDM,525,RC,99304,HCPCS,outpatient,,,$317.00 ,$237.75 ,,$291.64 ,92,,,$59.45 ,$307.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$59.45 ,$307.49 ,case rate,,100% of clinic case rate per visit,,,,,$59.45 ,$307.49 ,other,,Not applicable. No negotiated rates per contract,$272.62 ,86,,,$59.45 ,$307.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$253.60 ,80,,,$59.45 ,$307.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$59.45 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.45 ,100,,,$59.45 ,$307.49 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$301.15 ,95,,,$59.45 ,$307.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.75 ,75,,,$59.45 ,$307.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$269.45 ,85,,,$59.45 ,$307.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.49 ,97,,,$59.45 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$59.45 ,$307.49 ,case rate,,100% of clinic case rate per visit,$285.30 ,90,,,$59.45 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.49 ,97,,,$59.45 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.49 ,97,,,$59.45 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.49 ,97,,,$59.45 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.45 ,85,,,$59.45 ,$307.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$285.30 ,90,,,$59.45 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$59.45 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.15 ,90,,,$59.45 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$59.45 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$59.45 ,$307.49 ,other,,Not separately reimbursable per table 3 referenced in contract
99305 Initial Nursing Facility Care,8041059,CDM,521,RC,99305,HCPCS,outpatient,,,$440.00 ,$330.00 ,,$404.80 ,92,,,$83.02 ,$426.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$83.02 ,$426.80 ,case rate,,100% of clinic case rate per visit,,,,,$83.02 ,$426.80 ,other,,Not applicable. No negotiated rates per contract,$378.40 ,86,,,$83.02 ,$426.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$352.00 ,80,,,$83.02 ,$426.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$83.02 ,$426.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.02 ,100,,,$83.02 ,$426.80 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$418.00 ,95,,,$83.02 ,$426.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.00 ,75,,,$83.02 ,$426.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$374.00 ,85,,,$83.02 ,$426.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$426.80 ,97,,,$83.02 ,$426.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$83.02 ,$426.80 ,case rate,,100% of clinic case rate per visit,$396.00 ,90,,,$83.02 ,$426.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$426.80 ,97,,,$83.02 ,$426.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$426.80 ,97,,,$83.02 ,$426.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$426.80 ,97,,,$83.02 ,$426.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$374.00 ,85,,,$83.02 ,$426.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$396.00 ,90,,,$83.02 ,$426.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$83.02 ,$426.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$418.00 ,90,,,$83.02 ,$426.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$83.02 ,$426.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.02 ,$426.80 ,other,,Not separately reimbursable per table 3 referenced in contract
99306 Initial Nursing Facility Care,8041060,CDM,525,RC,99306,HCPCS,outpatient,,,$563.00 ,$422.25 ,,$517.96 ,92,,,$106.59 ,$546.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$106.59 ,$546.11 ,case rate,,100% of clinic case rate per visit,,,,,$106.59 ,$546.11 ,other,,Not applicable. No negotiated rates per contract,$484.18 ,86,,,$106.59 ,$546.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$450.40 ,80,,,$106.59 ,$546.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$106.59 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.59 ,100,,,$106.59 ,$546.11 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$534.85 ,95,,,$106.59 ,$546.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$422.25 ,75,,,$106.59 ,$546.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$478.55 ,85,,,$106.59 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$546.11 ,97,,,$106.59 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$106.59 ,$546.11 ,case rate,,100% of clinic case rate per visit,$506.70 ,90,,,$106.59 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$546.11 ,97,,,$106.59 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$106.59 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$106.59 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$478.55 ,85,,,$106.59 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$506.70 ,90,,,$106.59 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$106.59 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.85 ,90,,,$106.59 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$106.59 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$106.59 ,$546.11 ,other,,Not separately reimbursable per table 3 referenced in contract
99307 Subsequent Nursing Facility Care,8041061,CDM,525,RC,99307,HCPCS,outpatient,,,$156.00 ,$117.00 ,,$143.52 ,92,,,$29.40 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$29.40 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$29.40 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$134.16 ,86,,,$29.40 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.80 ,80,,,$29.40 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$29.40 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.40 ,100,,,$29.40 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$148.20 ,95,,,$29.40 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.00 ,75,,,$29.40 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.60 ,85,,,$29.40 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.32 ,97,,,$29.40 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$29.40 ,$197.64 ,case rate,,100% of clinic case rate per visit,$140.40 ,90,,,$29.40 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.32 ,97,,,$29.40 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$29.40 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$29.40 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.60 ,85,,,$29.40 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.40 ,90,,,$29.40 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$29.40 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.20 ,90,,,$29.40 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$29.40 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.40 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99308 Subsequent Nursing Facility Care,8041062,CDM,525,RC,99308,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$44.96 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$44.96 ,$226.01 ,case rate,,100% of clinic case rate per visit,,,,,$44.96 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$200.38 ,86,,,$44.96 ,$226.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.40 ,80,,,$44.96 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$44.96 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.96 ,100,,,$44.96 ,$226.01 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$221.35 ,95,,,$44.96 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$44.96 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$44.96 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$44.96 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$44.96 ,$226.01 ,case rate,,100% of clinic case rate per visit,$209.70 ,90,,,$44.96 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$44.96 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$44.96 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$44.96 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$44.96 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$44.96 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$44.96 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$44.96 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$44.96 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.96 ,$226.01 ,other,,Not separately reimbursable per table 3 referenced in contract
99309 Subsequent Nursing Facility Care,8041063,CDM,525,RC,99309,HCPCS,outpatient,,,$309.00 ,$231.75 ,,$284.28 ,92,,,$59.60 ,$299.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$59.60 ,$299.73 ,case rate,,100% of clinic case rate per visit,,,,,$59.60 ,$299.73 ,other,,Not applicable. No negotiated rates per contract,$265.74 ,86,,,$59.60 ,$299.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$247.20 ,80,,,$59.60 ,$299.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$59.60 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.60 ,100,,,$59.60 ,$299.73 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$293.55 ,95,,,$59.60 ,$299.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.75 ,75,,,$59.60 ,$299.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$262.65 ,85,,,$59.60 ,$299.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$299.73 ,97,,,$59.60 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$59.60 ,$299.73 ,case rate,,100% of clinic case rate per visit,$278.10 ,90,,,$59.60 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.73 ,97,,,$59.60 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.73 ,97,,,$59.60 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.73 ,97,,,$59.60 ,$299.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.65 ,85,,,$59.60 ,$299.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$278.10 ,90,,,$59.60 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$59.60 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.55 ,90,,,$59.60 ,$299.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$59.60 ,$299.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$59.60 ,$299.73 ,other,,Not separately reimbursable per table 3 referenced in contract
99310 Subsequent Nursing Facility Care,8041064,CDM,521,RC,99310,HCPCS,outpatient,,,$459.00 ,$344.25 ,,$422.28 ,92,,,$197.64 ,$445.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$445.23 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$445.23 ,other,,Not applicable. No negotiated rates per contract,$394.74 ,86,,,$197.64 ,$445.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$367.20 ,80,,,$197.64 ,$445.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$436.05 ,95,,,$197.64 ,$445.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$436.05 ,95,,,$197.64 ,$445.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$344.25 ,75,,,$197.64 ,$445.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$390.15 ,85,,,$197.64 ,$445.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$445.23 ,case rate,,100% of clinic case rate per visit,$413.10 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$445.23 ,97,,,$197.64 ,$445.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.15 ,85,,,$197.64 ,$445.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$413.10 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$436.05 ,90,,,$197.64 ,$445.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$445.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$445.23 ,other,,Not separately reimbursable per table 3 referenced in contract
99315 Nursing Facility Discharge,8041065,CDM,525,RC,99315,HCPCS,outpatient,,,$246.00 ,$184.50 ,,$226.32 ,92,,,$42.98 ,$238.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$42.98 ,$238.62 ,case rate,,100% of clinic case rate per visit,,,,,$42.98 ,$238.62 ,other,,Not applicable. No negotiated rates per contract,$211.56 ,86,,,$42.98 ,$238.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$196.80 ,80,,,$42.98 ,$238.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.98 ,100,,,$42.98 ,$238.62 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$233.70 ,95,,,$42.98 ,$238.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.50 ,75,,,$42.98 ,$238.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$209.10 ,85,,,$42.98 ,$238.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$42.98 ,$238.62 ,case rate,,100% of clinic case rate per visit,$221.40 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.10 ,85,,,$42.98 ,$238.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$221.40 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.70 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.98 ,$238.62 ,other,,Not separately reimbursable per table 3 referenced in contract
99315 Nursing Facility Discharge,9216942,CDM,525,RC,99315,HCPCS,outpatient,,,$246.00 ,$184.50 ,,$226.32 ,92,,,$42.98 ,$238.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$42.98 ,$238.62 ,case rate,,100% of clinic case rate per visit,,,,,$42.98 ,$238.62 ,other,,Not applicable. No negotiated rates per contract,$211.56 ,86,,,$42.98 ,$238.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$196.80 ,80,,,$42.98 ,$238.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.98 ,100,,,$42.98 ,$238.62 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$233.70 ,95,,,$42.98 ,$238.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.50 ,75,,,$42.98 ,$238.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$209.10 ,85,,,$42.98 ,$238.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$42.98 ,$238.62 ,case rate,,100% of clinic case rate per visit,$221.40 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.62 ,97,,,$42.98 ,$238.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.10 ,85,,,$42.98 ,$238.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$221.40 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.70 ,90,,,$42.98 ,$238.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.98 ,$238.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.98 ,$238.62 ,other,,Not separately reimbursable per table 3 referenced in contract
99316 Nursing Facility Discharge,8041066,CDM,525,RC,99316,HCPCS,outpatient,,,$362.00 ,$271.50 ,,$333.04 ,92,,,$56.11 ,$351.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$56.11 ,$351.14 ,case rate,,100% of clinic case rate per visit,,,,,$56.11 ,$351.14 ,other,,Not applicable. No negotiated rates per contract,$311.32 ,86,,,$56.11 ,$351.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$289.60 ,80,,,$56.11 ,$351.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.11 ,100,,,$56.11 ,$351.14 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$343.90 ,95,,,$56.11 ,$351.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.50 ,75,,,$56.11 ,$351.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$307.70 ,85,,,$56.11 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$56.11 ,$351.14 ,case rate,,100% of clinic case rate per visit,$325.80 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.70 ,85,,,$56.11 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$325.80 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$343.90 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.11 ,$351.14 ,other,,Not separately reimbursable per table 3 referenced in contract
99316 Nursing Facility Discharge,9216943,CDM,525,RC,99316,HCPCS,outpatient,,,$362.00 ,$271.50 ,,$333.04 ,92,,,$56.11 ,$351.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$56.11 ,$351.14 ,case rate,,100% of clinic case rate per visit,,,,,$56.11 ,$351.14 ,other,,Not applicable. No negotiated rates per contract,$311.32 ,86,,,$56.11 ,$351.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$289.60 ,80,,,$56.11 ,$351.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.11 ,100,,,$56.11 ,$351.14 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$343.90 ,95,,,$56.11 ,$351.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.50 ,75,,,$56.11 ,$351.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$307.70 ,85,,,$56.11 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$56.11 ,$351.14 ,case rate,,100% of clinic case rate per visit,$325.80 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$56.11 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.70 ,85,,,$56.11 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$325.80 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$343.90 ,90,,,$56.11 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$56.11 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.11 ,$351.14 ,other,,Not separately reimbursable per table 3 referenced in contract
99318 Annual Nursing Facility Assessment,8041067,CDM,525,RC,99318,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99325 Domicillary/Rest Home,8041069,CDM,525,RC,99325,HCPCS,outpatient,,,$521.00 ,$390.75 ,,$479.32 ,92,,,$197.64 ,$505.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$505.37 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$505.37 ,other,,Not applicable. No negotiated rates per contract,$448.06 ,86,,,$197.64 ,$505.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$416.80 ,80,,,$197.64 ,$505.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.95 ,95,,,$197.64 ,$505.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$494.95 ,95,,,$197.64 ,$505.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.75 ,75,,,$197.64 ,$505.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$442.85 ,85,,,$197.64 ,$505.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$505.37 ,case rate,,100% of clinic case rate per visit,$468.90 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.85 ,85,,,$197.64 ,$505.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$468.90 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.95 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$505.37 ,other,,Not separately reimbursable per table 3 referenced in contract
99334 Domicillary/Rest Home,8041073,CDM,521,RC,99334,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99335 Domicillary/Rest Home,8041074,CDM,525,RC,99335,HCPCS,outpatient,,,$521.00 ,$390.75 ,,$479.32 ,92,,,$197.64 ,$505.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$505.37 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$505.37 ,other,,Not applicable. No negotiated rates per contract,$448.06 ,86,,,$197.64 ,$505.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$416.80 ,80,,,$197.64 ,$505.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.95 ,95,,,$197.64 ,$505.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$494.95 ,95,,,$197.64 ,$505.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.75 ,75,,,$197.64 ,$505.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$442.85 ,85,,,$197.64 ,$505.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$505.37 ,case rate,,100% of clinic case rate per visit,$468.90 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.37 ,97,,,$197.64 ,$505.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.85 ,85,,,$197.64 ,$505.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$468.90 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.95 ,90,,,$197.64 ,$505.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$505.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$505.37 ,other,,Not separately reimbursable per table 3 referenced in contract
99336 Domicillary/Rest Home,8041075,CDM,521,RC,99336,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99337 Domicillary/Rest Home,8041076,CDM,521,RC,99337,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99341 Home Visit,8041077,CDM,522,RC,99341,HCPCS,outpatient,,,,,,,,,,$40.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$40.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$40.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$40.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$40.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$40.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$40.00 ,100,,,$40.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$40.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$40.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$40.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$40.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$40.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$40.00 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99342 Home Visit,8041078,CDM,522,RC,99342,HCPCS,outpatient,,,,,,,,,,$74.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$74.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$74.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$74.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$74.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$74.00 ,100,,,$74.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$74.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$74.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$74.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$74.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$74.00 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99343 Home Visit,8041079,CDM,522,RC,99343,HCPCS,outpatient,,,,,,,,,,$93.52 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$93.52 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$93.52 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$93.52 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$93.52 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$93.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$93.52 ,100,,,$93.52 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$93.52 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$93.52 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$93.52 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$93.52 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$93.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$93.52 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99347 Home Visit,8041082,CDM,522,RC,99347,HCPCS,outpatient,,,,,,,,,,$39.02 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$39.02 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$39.02 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$39.02 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$39.02 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$39.02 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$39.02 ,100,,,$39.02 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$39.02 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$39.02 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$39.02 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$39.02 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$39.02 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$39.02 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99348 Home Visit,8041083,CDM,522,RC,99348,HCPCS,outpatient,,,,,,,,,,$74.00 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$74.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$74.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$74.00 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$74.00 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$74.00 ,100,,,$74.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$74.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$74.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$74.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$74.00 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$74.00 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$74.00 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99349 Home Visit,8041084,CDM,522,RC,99349,HCPCS,outpatient,,,,,,,,,,$85.52 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$85.52 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$85.52 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$85.52 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$85.52 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$85.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$85.52 ,100,,,$85.52 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,,,,,$85.52 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$85.52 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$85.52 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$85.52 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$85.52 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$85.52 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99366 Medical Team Conference,8041093,CDM,521,RC,99366,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99381 Preventive Evaluation,8041101,CDM,521,RC,99381,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$229.08 ,92,,,$186.75 ,$241.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$186.75 ,$241.53 ,case rate,,100% of clinic case rate per visit,,,,,$186.75 ,$241.53 ,other,,Not applicable. No negotiated rates per contract,$214.14 ,86,,,$186.75 ,$241.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$199.20 ,80,,,$186.75 ,$241.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,95,,,$186.75 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.55 ,95,,,$186.75 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.75 ,75,,,$186.75 ,$241.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.65 ,85,,,$186.75 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$186.75 ,$241.53 ,case rate,,100% of clinic case rate per visit,$224.10 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.65 ,85,,,$186.75 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$224.10 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$186.75 ,$241.53 ,other,,Not separately reimbursable per table 3 referenced in contract
99382 Preventive Evaluation,8041102,CDM,521,RC,99382,HCPCS,outpatient,,,$267.00 ,$200.25 ,,$245.64 ,92,,,$197.64 ,$258.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$258.99 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$258.99 ,other,,Not applicable. No negotiated rates per contract,$229.62 ,86,,,$197.64 ,$258.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$213.60 ,80,,,$197.64 ,$258.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$258.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$253.65 ,95,,,$197.64 ,$258.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$253.65 ,95,,,$197.64 ,$258.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.25 ,75,,,$197.64 ,$258.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$226.95 ,85,,,$197.64 ,$258.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$258.99 ,97,,,$197.64 ,$258.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$258.99 ,case rate,,100% of clinic case rate per visit,$240.30 ,90,,,$197.64 ,$258.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$258.99 ,97,,,$197.64 ,$258.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.99 ,97,,,$197.64 ,$258.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.99 ,97,,,$197.64 ,$258.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.95 ,85,,,$197.64 ,$258.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$240.30 ,90,,,$197.64 ,$258.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$258.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$253.65 ,90,,,$197.64 ,$258.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$258.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$258.99 ,other,,Not separately reimbursable per table 3 referenced in contract
99383 Preventive Evaluation,8041103,CDM,521,RC,99383,HCPCS,outpatient,,,$283.00 ,$212.25 ,,$260.36 ,92,,,$197.64 ,$274.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$274.51 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$274.51 ,other,,Not applicable. No negotiated rates per contract,$243.38 ,86,,,$197.64 ,$274.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$226.40 ,80,,,$197.64 ,$274.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$274.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.85 ,95,,,$197.64 ,$274.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$268.85 ,95,,,$197.64 ,$274.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.25 ,75,,,$197.64 ,$274.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$240.55 ,85,,,$197.64 ,$274.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.51 ,97,,,$197.64 ,$274.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$274.51 ,case rate,,100% of clinic case rate per visit,$254.70 ,90,,,$197.64 ,$274.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$274.51 ,97,,,$197.64 ,$274.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.51 ,97,,,$197.64 ,$274.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.51 ,97,,,$197.64 ,$274.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.55 ,85,,,$197.64 ,$274.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.70 ,90,,,$197.64 ,$274.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$274.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.85 ,90,,,$197.64 ,$274.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$274.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$274.51 ,other,,Not separately reimbursable per table 3 referenced in contract
99383S Preventive Evaluation,8995470,CDM,521,RC,99383,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99384 Preventive Evaluation,8041104,CDM,521,RC,99384,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99384 Preventive checkup NEW PT 12-17 YRS w/Female exam,9025417,CDM,521,RC,99384,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99385 Preventive Evaluation,8041105,CDM,521,RC,99385,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99385 Preventive checkup,9025416,CDM,521,RC,52199,HCPCS,outpatient,,,$337.00 ,$252.75 ,,$310.04 ,92,,,$197.64 ,$326.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$326.89 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$326.89 ,other,,Not applicable. No negotiated rates per contract,$289.82 ,86,,,$197.64 ,$326.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$269.60 ,80,,,$197.64 ,$326.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.15 ,95,,,$197.64 ,$326.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$320.15 ,95,,,$197.64 ,$326.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$252.75 ,75,,,$197.64 ,$326.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$286.45 ,85,,,$197.64 ,$326.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$326.89 ,97,,,$197.64 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$326.89 ,case rate,,100% of clinic case rate per visit,$303.30 ,90,,,$197.64 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$326.89 ,97,,,$197.64 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.89 ,97,,,$197.64 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.89 ,97,,,$197.64 ,$326.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.45 ,85,,,$197.64 ,$326.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$303.30 ,90,,,$197.64 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.15 ,90,,,$197.64 ,$326.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$326.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$326.89 ,other,,Not separately reimbursable per table 3 referenced in contract
99386 Preventive Evaluation,8041106,CDM,521,RC,99386,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99386 Preventive checkup,9025418,CDM,521,RC,52199,HCPCS,outpatient,,,$411.00 ,$308.25 ,,$378.12 ,92,,,$197.64 ,$398.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$398.67 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$398.67 ,other,,Not applicable. No negotiated rates per contract,$353.46 ,86,,,$197.64 ,$398.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$328.80 ,80,,,$197.64 ,$398.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$398.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$390.45 ,95,,,$197.64 ,$398.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.45 ,95,,,$197.64 ,$398.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$308.25 ,75,,,$197.64 ,$398.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$349.35 ,85,,,$197.64 ,$398.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$398.67 ,97,,,$197.64 ,$398.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$398.67 ,case rate,,100% of clinic case rate per visit,$369.90 ,90,,,$197.64 ,$398.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.67 ,97,,,$197.64 ,$398.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.67 ,97,,,$197.64 ,$398.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.67 ,97,,,$197.64 ,$398.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.35 ,85,,,$197.64 ,$398.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$369.90 ,90,,,$197.64 ,$398.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$398.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$390.45 ,90,,,$197.64 ,$398.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$398.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$398.67 ,other,,Not separately reimbursable per table 3 referenced in contract
99387 Preventive Evaluation,8041107,CDM,521,RC,99387,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99391 Preventive Evaluation,8041108,CDM,521,RC,99391,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99392 Preventive Evaluation,8041109,CDM,521,RC,99392,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99393 Preventive Evaluation,8041110,CDM,521,RC,99393,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99394 Preventive Evaluation,8041111,CDM,521,RC,99394,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99394F Preventive Evaluation,8985565,CDM,521,RC,52199,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99394S Preventive Evaluation,8995471,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99395 Preventive Evaluation,8041112,CDM,521,RC,99395,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99395F Preventive Evaluation,8985569,CDM,521,RC,52199,HCPCS,outpatient,,,$314.00 ,$235.50 ,,$288.88 ,92,,,$197.64 ,$304.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$304.58 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$304.58 ,other,,Not applicable. No negotiated rates per contract,$270.04 ,86,,,$197.64 ,$304.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$251.20 ,80,,,$197.64 ,$304.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$304.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.30 ,95,,,$197.64 ,$304.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.30 ,95,,,$197.64 ,$304.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$235.50 ,75,,,$197.64 ,$304.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$266.90 ,85,,,$197.64 ,$304.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$304.58 ,97,,,$197.64 ,$304.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$304.58 ,case rate,,100% of clinic case rate per visit,$282.60 ,90,,,$197.64 ,$304.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$304.58 ,97,,,$197.64 ,$304.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.58 ,97,,,$197.64 ,$304.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.58 ,97,,,$197.64 ,$304.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.90 ,85,,,$197.64 ,$304.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$282.60 ,90,,,$197.64 ,$304.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$304.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.30 ,90,,,$197.64 ,$304.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$304.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$304.58 ,other,,Not separately reimbursable per table 3 referenced in contract
99395S Preventive Evaluation,8995472,CDM,521,RC,,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99396 Preventive Evaluation,8041113,CDM,521,RC,99396,HCPCS,outpatient,,,$318.00 ,$238.50 ,,$292.56 ,92,,,$197.64 ,$308.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$308.46 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$308.46 ,other,,Not applicable. No negotiated rates per contract,$273.48 ,86,,,$197.64 ,$308.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.40 ,80,,,$197.64 ,$308.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,95,,,$197.64 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.10 ,95,,,$197.64 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.50 ,75,,,$197.64 ,$308.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.30 ,85,,,$197.64 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.46 ,97,,,$197.64 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$308.46 ,case rate,,100% of clinic case rate per visit,$286.20 ,90,,,$197.64 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.46 ,97,,,$197.64 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$197.64 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$197.64 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.30 ,85,,,$197.64 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.20 ,90,,,$197.64 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,90,,,$197.64 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$308.46 ,other,,Not separately reimbursable per table 3 referenced in contract
99396F Preventive Evaluation,8985572,CDM,521,RC,52199,HCPCS,outpatient,,,$341.00 ,$255.75 ,,$313.72 ,92,,,$197.64 ,$330.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$330.77 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$330.77 ,other,,Not applicable. No negotiated rates per contract,$293.26 ,86,,,$197.64 ,$330.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$272.80 ,80,,,$197.64 ,$330.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,95,,,$197.64 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$323.95 ,95,,,$197.64 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.75 ,75,,,$197.64 ,$330.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$289.85 ,85,,,$197.64 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$330.77 ,97,,,$197.64 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$330.77 ,case rate,,100% of clinic case rate per visit,$306.90 ,90,,,$197.64 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$330.77 ,97,,,$197.64 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$197.64 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$197.64 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.85 ,85,,,$197.64 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.90 ,90,,,$197.64 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,90,,,$197.64 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$330.77 ,other,,Not separately reimbursable per table 3 referenced in contract
99397 Preventive Evaluation,8041114,CDM,521,RC,99397,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99397F Preventive Evaluation,8985575,CDM,521,RC,52199,HCPCS,outpatient,,,$363.00 ,$272.25 ,,$333.96 ,92,,,$197.64 ,$352.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$352.11 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$352.11 ,other,,Not applicable. No negotiated rates per contract,$312.18 ,86,,,$197.64 ,$352.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$290.40 ,80,,,$197.64 ,$352.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$352.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.85 ,95,,,$197.64 ,$352.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$344.85 ,95,,,$197.64 ,$352.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.25 ,75,,,$197.64 ,$352.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$308.55 ,85,,,$197.64 ,$352.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$352.11 ,97,,,$197.64 ,$352.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$352.11 ,case rate,,100% of clinic case rate per visit,$326.70 ,90,,,$197.64 ,$352.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$352.11 ,97,,,$197.64 ,$352.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$352.11 ,97,,,$197.64 ,$352.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$352.11 ,97,,,$197.64 ,$352.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.55 ,85,,,$197.64 ,$352.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$326.70 ,90,,,$197.64 ,$352.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$352.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.85 ,90,,,$197.64 ,$352.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$352.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$352.11 ,other,,Not separately reimbursable per table 3 referenced in contract
99406 Smoking/Tobacco Cessation Counseling; 3-10 Min,8041119,CDM,521,RC,99406,HCPCS,outpatient,,,$59.00 ,$44.25 ,,$54.28 ,92,,,$44.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$44.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$44.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$50.74 ,86,,,$44.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.20 ,80,,,$44.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$44.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.05 ,95,,,$44.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.05 ,95,,,$44.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.25 ,75,,,$44.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.15 ,85,,,$44.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.23 ,97,,,$44.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$44.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$53.10 ,90,,,$44.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.23 ,97,,,$44.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.23 ,97,,,$44.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.23 ,97,,,$44.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.15 ,85,,,$44.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.10 ,90,,,$44.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$44.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.05 ,90,,,$44.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$44.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99407 Smoking/Tobacco Cessation Counseling; 11+ Min,8041120,CDM,521,RC,99407,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99408 Alcohol/Substance Abuse Structured Screen; 15-30 Min,8041121,CDM,521,RC,99408,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99417 PROLONG OFFICE E/M EA 15 MIN,9254003,CDM,521,RC,99417,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99443 Telephone Visit - Established Patient; 21-30 Min,8041127,CDM,521,RC,99443,HCPCS,outpatient,,,$167.00 ,$125.25 ,,$153.64 ,92,,,$125.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$125.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$125.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$143.62 ,86,,,$125.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$133.60 ,80,,,$125.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$125.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,95,,,$125.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.65 ,95,,,$125.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.25 ,75,,,$125.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.95 ,85,,,$125.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.99 ,97,,,$125.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$125.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$150.30 ,90,,,$125.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.99 ,97,,,$125.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$125.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$125.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.95 ,85,,,$125.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.30 ,90,,,$125.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$125.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,90,,,$125.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$125.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$125.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99450 Basic Life or Disability Exam,8041129,CDM,521,RC,99450,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99455 Work Related or Medical Disability Exam,8041130,CDM,521,RC,99455,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99490 Chronic care management services,8550290,CDM,521,RC,99490,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99495 Transitional Care Management,8041146,CDM,521,RC,99495,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99496 Transitional Care Management,8041147,CDM,521,RC,99496,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
99497 Advance Care Planning,8041148,CDM,521,RC,99497,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$43.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$43.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$43.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$49.88 ,86,,,$43.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$43.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$43.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$43.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$43.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$43.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$43.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$43.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$43.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$52.20 ,90,,,$43.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$43.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$43.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$43.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$43.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$43.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$43.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$43.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$43.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99498 Advance Care Planning,8041149,CDM,521,RC,99498,HCPCS,outpatient,,,$156.00 ,$117.00 ,,$143.52 ,92,,,$117.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$117.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$117.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$134.16 ,86,,,$117.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.80 ,80,,,$117.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$117.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.20 ,95,,,$117.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.20 ,95,,,$117.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.00 ,75,,,$117.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.60 ,85,,,$117.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.32 ,97,,,$117.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$117.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$140.40 ,90,,,$117.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.32 ,97,,,$117.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$117.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.32 ,97,,,$117.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.60 ,85,,,$117.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.40 ,90,,,$117.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$117.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.20 ,90,,,$117.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$117.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
DOT Physical,8238946,CDM,521,RC,,HCPCS,outpatient,,,$99.00 ,$74.25 ,,$91.08 ,92,,,$74.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$74.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$74.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$85.14 ,86,,,$74.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$79.20 ,80,,,$74.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$74.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.05 ,95,,,$74.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.05 ,95,,,$74.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.25 ,75,,,$74.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$84.15 ,85,,,$74.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.03 ,97,,,$74.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$74.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$89.10 ,90,,,$74.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.03 ,97,,,$74.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.03 ,97,,,$74.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.03 ,97,,,$74.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.15 ,85,,,$74.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.10 ,90,,,$74.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$74.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.05 ,90,,,$74.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$74.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$74.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
G0071 Online digital eval,8873578,CDM,521,RC,G0071,HCPCS,outpatient,,,$72.00 ,$54.00 ,,$66.24 ,92,,,$54.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$54.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$54.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$61.92 ,86,,,$54.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.60 ,80,,,$54.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$54.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,95,,,$54.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.40 ,95,,,$54.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.00 ,75,,,$54.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.20 ,85,,,$54.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.84 ,97,,,$54.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$54.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$64.80 ,90,,,$54.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.84 ,97,,,$54.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$54.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$54.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.20 ,85,,,$54.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.80 ,90,,,$54.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$54.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$54.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$54.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$54.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination,8041152,CDM,521,RC,G0101,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
G0402 Initial preventive physical (Welcome to Medicare),8041166,CDM,521,RC,G0402,HCPCS,outpatient,,,$286.00 ,$214.50 ,,$263.12 ,92,,,$197.64 ,$277.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$277.42 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$277.42 ,other,,Not applicable. No negotiated rates per contract,$245.96 ,86,,,$197.64 ,$277.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$228.80 ,80,,,$197.64 ,$277.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.70 ,95,,,$197.64 ,$277.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.70 ,95,,,$197.64 ,$277.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.50 ,75,,,$197.64 ,$277.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$243.10 ,85,,,$197.64 ,$277.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.42 ,97,,,$197.64 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$277.42 ,case rate,,100% of clinic case rate per visit,$257.40 ,90,,,$197.64 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.42 ,97,,,$197.64 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.42 ,97,,,$197.64 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.42 ,97,,,$197.64 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.10 ,85,,,$197.64 ,$277.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.40 ,90,,,$197.64 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.70 ,90,,,$197.64 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$277.42 ,other,,Not separately reimbursable per table 3 referenced in contract
G0436 Smoking and tobacco cessation counseling; intermediate,8041170,CDM,521,RC,G0436,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
G0437 Smoking and tobacco cessation counseling; intensive,8041171,CDM,521,RC,G0437,HCPCS,outpatient,,,$56.00 ,$42.00 ,,$51.52 ,92,,,$42.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$42.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$42.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$48.16 ,86,,,$42.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$44.80 ,80,,,$42.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$42.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,95,,,$42.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.20 ,95,,,$42.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.00 ,75,,,$42.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.60 ,85,,,$42.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.32 ,97,,,$42.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$42.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$50.40 ,90,,,$42.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.32 ,97,,,$42.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$42.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$42.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.60 ,85,,,$42.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.40 ,90,,,$42.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,90,,,$42.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$42.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
G0438 Annual wellness visit; includes a personalized prevention plan of service,8041172,CDM,521,RC,G0438,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$197.64 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$275.48 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$244.24 ,86,,,$197.64 ,$275.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.20 ,80,,,$197.64 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$197.64 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$197.64 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$197.64 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$197.64 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$275.48 ,case rate,,100% of clinic case rate per visit,$255.60 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$197.64 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$197.64 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$197.64 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$275.48 ,other,,Not separately reimbursable per table 3 referenced in contract
G0444 Annual depression screening; 15 min,8041176,CDM,521,RC,G0444,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
G0447 Obesity Counseling; 15 min,8041179,CDM,521,RC,G0447,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
G2025 Telemedicine,8890323,CDM,521,RC,G2025,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$92.25 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$92.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$92.25 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$92.25 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$92.25 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$92.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$92.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$92.25 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$92.25 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$92.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$92.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$92.25 ,$197.64 ,case rate,,100% of clinic case rate per visit,$110.70 ,90,,,$92.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.31 ,97,,,$92.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$92.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$92.25 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$92.25 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$92.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$92.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$92.25 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$92.25 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$92.25 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
Q0091 Obtaining screen pap smear,9057787,CDM,521,RC,Q0091,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$70.50 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$70.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$70.50 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$80.84 ,86,,,$70.50 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$75.20 ,80,,,$70.50 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$70.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$70.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$70.50 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$70.50 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$70.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$70.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$70.50 ,$197.64 ,case rate,,100% of clinic case rate per visit,$84.60 ,90,,,$70.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$70.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$70.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$70.50 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$70.50 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$70.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$70.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$70.50 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$70.50 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.50 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
Sports Physical,8238947,CDM,521,RC,99213,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$52.82 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$52.82 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$52.82 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$101.48 ,86,,,$52.82 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$94.40 ,80,,,$52.82 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$52.82 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.82 ,100,,,$52.82 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$112.10 ,95,,,$52.82 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$52.82 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$52.82 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$52.82 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$52.82 ,$197.64 ,case rate,,100% of clinic case rate per visit,$106.20 ,90,,,$52.82 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$52.82 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$52.82 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$52.82 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$52.82 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$52.82 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$52.82 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$52.82 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$52.82 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.82 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
88304 Gross & Micro Level III,8196780,CDM,310,RC,88304,HCPCS,outpatient,,,$163.00 ,$122.25 ,,$149.96 ,92,,,$89.65 ,$158.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.65 ,55,,,$89.65 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$89.65 ,$158.11 ,other,,Not applicable. No negotiated rates per contract,$140.18 ,86,,,$89.65 ,$158.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$130.40 ,80,,,$89.65 ,$158.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.65 ,55,,,$89.65 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,95,,,$89.65 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$154.85 ,95,,,$89.65 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.25 ,75,,,$89.65 ,$158.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$138.55 ,85,,,$89.65 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$158.11 ,97,,,$89.65 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.65 ,55,,,$89.65 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.70 ,90,,,$89.65 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.11 ,97,,,$89.65 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$89.65 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$89.65 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.55 ,85,,,$89.65 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.70 ,90,,,$89.65 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$89.65 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,90,,,$89.65 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$89.65 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.59 ,93,,,$89.65 ,$158.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT/INR,8952673,CDM,305,RC,85610,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$1.89 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.89 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$1.89 ,44,,,$1.89 ,$56.26 ,fee schedule,,44% of CMS Medicare lab fee schedule,$46.40 ,80,,,$1.89 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$1.89 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$1.89 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.Chlamydia Trachomatis,8713343,CDM,306,RC,87491,HCPCS,outpatient,,,$164.00 ,$123.00 ,,$150.88 ,92,,,$15.44 ,$159.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$159.08 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$159.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$131.20 ,80,,,$15.44 ,$159.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,95,,,$15.44 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$155.80 ,95,,,$15.44 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.00 ,75,,,$15.44 ,$159.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.40 ,85,,,$15.44 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.60 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.40 ,85,,,$15.44 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.60 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.52 ,93,,,$15.44 ,$159.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.GTT 1 HR,8046175,CDM,300,RC,82950,HCPCS,outpatient,,,$59.00 ,$44.25 ,,$54.28 ,92,,,$2.09 ,$57.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.45 ,55,,,$2.09 ,$57.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.09 ,$57.23 ,other,,Not applicable. No negotiated rates per contract,$2.09 ,44,,,$2.09 ,$57.23 ,fee schedule,,44% of CMS Medicare lab fee schedule,$47.20 ,80,,,$2.09 ,$57.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.45 ,55,,,$2.09 ,$57.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.05 ,95,,,$2.09 ,$57.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.05 ,95,,,$2.09 ,$57.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.25 ,75,,,$2.09 ,$57.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.15 ,85,,,$2.09 ,$57.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.23 ,97,,,$2.09 ,$57.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.45 ,55,,,$2.09 ,$57.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.10 ,90,,,$2.09 ,$57.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.23 ,97,,,$2.09 ,$57.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.23 ,97,,,$2.09 ,$57.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.23 ,97,,,$2.09 ,$57.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.15 ,85,,,$2.09 ,$57.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.10 ,90,,,$2.09 ,$57.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.45 ,55,,,$2.09 ,$57.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.05 ,90,,,$2.09 ,$57.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.45 ,55,,,$2.09 ,$57.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.87 ,93,,,$2.09 ,$57.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.Glucose Fasting,8046181,CDM,304,RC,82947,HCPCS,outpatient,,,$35.00 ,$26.25 ,,$32.20 ,92,,,$1.73 ,$33.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.73 ,$33.95 ,other,,Not applicable. No negotiated rates per contract,$1.73 ,44,,,$1.73 ,$33.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$28.00 ,80,,,$1.73 ,$33.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,95,,,$1.73 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.25 ,95,,,$1.73 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.25 ,75,,,$1.73 ,$33.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.75 ,85,,,$1.73 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.75 ,85,,,$1.73 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.50 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.55 ,93,,,$1.73 ,$33.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.HCV RNA,8042799,CDM,306,RC,87522,HCPCS,outpatient,,,$892.00 ,$669.00 ,,$820.64 ,92,,,$18.85 ,$865.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.85 ,$865.24 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$865.24 ,fee schedule,,44% of CMS Medicare lab fee schedule,$713.60 ,80,,,$18.85 ,$865.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,95,,,$18.85 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$847.40 ,95,,,$18.85 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$669.00 ,75,,,$18.85 ,$865.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$758.20 ,85,,,$18.85 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$802.80 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$758.20 ,85,,,$18.85 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$802.80 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$829.56 ,93,,,$18.85 ,$865.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.ID Organism HBL,8836663,CDM,306,RC,87077,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$57.04 ,92,,,$3.56 ,$60.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.10 ,55,,,$3.56 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.56 ,$60.14 ,other,,Not applicable. No negotiated rates per contract,$3.56 ,44,,,$3.56 ,$60.14 ,fee schedule,,44% of CMS Medicare lab fee schedule,$49.60 ,80,,,$3.56 ,$60.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.10 ,55,,,$3.56 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,95,,,$3.56 ,$60.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.90 ,95,,,$3.56 ,$60.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.50 ,75,,,$3.56 ,$60.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$52.70 ,85,,,$3.56 ,$60.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.14 ,97,,,$3.56 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.10 ,55,,,$3.56 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.80 ,90,,,$3.56 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.14 ,97,,,$3.56 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$3.56 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$3.56 ,$60.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.70 ,85,,,$3.56 ,$60.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.80 ,90,,,$3.56 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.10 ,55,,,$3.56 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,90,,,$3.56 ,$60.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.10 ,55,,,$3.56 ,$60.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.66 ,93,,,$3.56 ,$60.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.Manual Differential (YUMA),8687300,CDM,305,RC,85007,HCPCS,outpatient,,,$86.00 ,$64.50 ,,$79.12 ,92,,,$1.67 ,$83.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.30 ,55,,,$1.67 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.67 ,$83.42 ,other,,Not applicable. No negotiated rates per contract,$1.67 ,44,,,$1.67 ,$83.42 ,fee schedule,,44% of CMS Medicare lab fee schedule,$68.80 ,80,,,$1.67 ,$83.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.30 ,55,,,$1.67 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,95,,,$1.67 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.70 ,95,,,$1.67 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.50 ,75,,,$1.67 ,$83.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.10 ,85,,,$1.67 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.42 ,97,,,$1.67 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.30 ,55,,,$1.67 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.40 ,90,,,$1.67 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.42 ,97,,,$1.67 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$1.67 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$1.67 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.10 ,85,,,$1.67 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.40 ,90,,,$1.67 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$1.67 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,90,,,$1.67 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$1.67 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.98 ,93,,,$1.67 ,$83.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.Neisseria Gonorrhoeae,8713344,CDM,306,RC,87591,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
.P190 BCR ABL1 QST,8713377,CDM,310,RC,81207,HCPCS,outpatient,,,$669.00 ,$501.75 ,,$615.48 ,92,,,$63.73 ,$648.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.95 ,55,,,$63.73 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.73 ,$648.93 ,other,,Not applicable. No negotiated rates per contract,$63.73 ,44,,,$63.73 ,$648.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,$535.20 ,80,,,$63.73 ,$648.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.95 ,55,,,$63.73 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,95,,,$63.73 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$635.55 ,95,,,$63.73 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.75 ,75,,,$63.73 ,$648.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$568.65 ,85,,,$63.73 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$648.93 ,97,,,$63.73 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.95 ,55,,,$63.73 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$602.10 ,90,,,$63.73 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$648.93 ,97,,,$63.73 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$63.73 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$63.73 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.65 ,85,,,$63.73 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.10 ,90,,,$63.73 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$63.73 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,90,,,$63.73 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$63.73 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$622.17 ,93,,,$63.73 ,$648.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.P210 BCR ABL1 QST,8713378,CDM,310,RC,81206,HCPCS,outpatient,,,$669.00 ,$501.75 ,,$615.48 ,92,,,$72.14 ,$648.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.14 ,$648.93 ,other,,Not applicable. No negotiated rates per contract,$72.14 ,44,,,$72.14 ,$648.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,$535.20 ,80,,,$72.14 ,$648.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.75 ,75,,,$72.14 ,$648.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$622.17 ,93,,,$72.14 ,$648.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.P210 BCR-ABL1 QST,8414359,CDM,310,RC,81206,HCPCS,outpatient,,,$669.00 ,$501.75 ,,$615.48 ,92,,,$72.14 ,$648.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.14 ,$648.93 ,other,,Not applicable. No negotiated rates per contract,$72.14 ,44,,,$72.14 ,$648.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,$535.20 ,80,,,$72.14 ,$648.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.75 ,75,,,$72.14 ,$648.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$622.17 ,93,,,$72.14 ,$648.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.Susceptibility HBL,8836671,CDM,306,RC,87186,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$3.81 ,$187.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.15 ,55,,,$3.81 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.81 ,$187.21 ,other,,Not applicable. No negotiated rates per contract,$3.81 ,44,,,$3.81 ,$187.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$154.40 ,80,,,$3.81 ,$187.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.15 ,55,,,$3.81 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$3.81 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$3.81 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$3.81 ,$187.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$3.81 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$3.81 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.15 ,55,,,$3.81 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.70 ,90,,,$3.81 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$3.81 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$3.81 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$3.81 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$3.81 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$3.81 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$3.81 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$3.81 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$3.81 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.49 ,93,,,$3.81 ,$187.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
88312 AP Bill Special stains group 1,8816029,CDM,312,RC,88312,HCPCS,outpatient,,,$161.00 ,$120.75 ,,$148.12 ,92,,,$88.55 ,$156.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$88.55 ,55,,,$88.55 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$88.55 ,$156.17 ,other,,Not applicable. No negotiated rates per contract,$138.46 ,86,,,$88.55 ,$156.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$128.80 ,80,,,$88.55 ,$156.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$88.55 ,55,,,$88.55 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.95 ,95,,,$88.55 ,$156.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.95 ,95,,,$88.55 ,$156.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.75 ,75,,,$88.55 ,$156.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$136.85 ,85,,,$88.55 ,$156.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.17 ,97,,,$88.55 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.55 ,55,,,$88.55 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.90 ,90,,,$88.55 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.17 ,97,,,$88.55 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.17 ,97,,,$88.55 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.17 ,97,,,$88.55 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.85 ,85,,,$88.55 ,$156.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.90 ,90,,,$88.55 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.55 ,55,,,$88.55 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.95 ,90,,,$88.55 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.55 ,55,,,$88.55 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.73 ,93,,,$88.55 ,$156.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AC/HS QST,8743283,CDM,300,RC,86406,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$4.68 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$4.68 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.68 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$4.68 ,44,,,$4.68 ,$393.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$324.80 ,80,,,$4.68 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$4.68 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$4.68 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$4.68 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$4.68 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$4.68 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$4.68 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$4.68 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$4.68 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$4.68 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$4.68 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$4.68 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$4.68 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$4.68 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$4.68 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$4.68 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$4.68 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$4.68 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ACTH,8042420,CDM,300,RC,82024,HCPCS,outpatient,,,,,,,,,,$16.99 ,$16.99 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$16.99 ,$16.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$16.99 ,$16.99 ,other,,Not applicable. No negotiated rates per contract,$16.99 ,44,,,$16.99 ,$16.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$16.99 ,$16.99 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$16.99 ,$16.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$16.99 ,$16.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$16.99 ,$16.99 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$16.99 ,$16.99 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$16.99 ,$16.99 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$16.99 ,$16.99 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
AFB Culture/Smear (Stain) HBL,8836654,CDM,306,RC,87206,HCPCS,outpatient,,,$95.00 ,$71.25 ,,$87.40 ,92,,,$2.37 ,$92.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.25 ,55,,,$2.37 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.37 ,$92.15 ,other,,Not applicable. No negotiated rates per contract,$2.37 ,44,,,$2.37 ,$92.15 ,fee schedule,,44% of CMS Medicare lab fee schedule,$76.00 ,80,,,$2.37 ,$92.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.25 ,55,,,$2.37 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.25 ,95,,,$2.37 ,$92.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.25 ,95,,,$2.37 ,$92.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.25 ,75,,,$2.37 ,$92.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$80.75 ,85,,,$2.37 ,$92.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.15 ,97,,,$2.37 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.25 ,55,,,$2.37 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,90,,,$2.37 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.15 ,97,,,$2.37 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.15 ,97,,,$2.37 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.15 ,97,,,$2.37 ,$92.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.75 ,85,,,$2.37 ,$92.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.50 ,90,,,$2.37 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.25 ,55,,,$2.37 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.25 ,90,,,$2.37 ,$92.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.25 ,55,,,$2.37 ,$92.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,93,,,$2.37 ,$92.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANA Multiplex w/ Reflex to dsDNA QST,8713351,CDM,302,RC,86038,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$5.32 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.32 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$5.32 ,44,,,$5.32 ,$122.22 ,fee schedule,,44% of CMS Medicare lab fee schedule,$100.80 ,80,,,$5.32 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$5.32 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$5.32 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$5.32 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$5.32 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$5.32 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$5.32 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANA Multiplex w/Reflex 11 Ab Cascade QST,8713345,CDM,302,RC,86038,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$5.32 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.32 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$5.32 ,44,,,$5.32 ,$122.22 ,fee schedule,,44% of CMS Medicare lab fee schedule,$100.80 ,80,,,$5.32 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$5.32 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$5.32 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$5.32 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$5.32 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$5.32 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$5.32 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$5.32 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$5.32 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$5.32 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANA Screen,8743212,CDM,302,RC,86038,HCPCS,outpatient,,,,,,,,,,$5.32 ,$5.32 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.32 ,$5.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.32 ,$5.32 ,other,,Not applicable. No negotiated rates per contract,$5.32 ,44,,,$5.32 ,$5.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.32 ,$5.32 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.32 ,$5.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.32 ,$5.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.32 ,$5.32 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.32 ,$5.32 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.32 ,$5.32 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.32 ,$5.32 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ANCA Screen With Reflex To Titer QST,8042696,CDM,300,RC,86021,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$6.62 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$6.62 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.62 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$6.62 ,44,,,$6.62 ,$64.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,$53.60 ,80,,,$6.62 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$6.62 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$6.62 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$6.62 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$6.62 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$6.62 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$6.62 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$6.62 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$6.62 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$6.62 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$6.62 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$6.62 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$6.62 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$6.62 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$6.62 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$6.62 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$6.62 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$6.62 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Acetaminophen Level,1503764,CDM,301,RC,80143,HCPCS,outpatient,,,$256.00 ,$192.00 ,,$235.52 ,92,,,$8.20 ,$248.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$140.80 ,55,,,$8.20 ,$248.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.20 ,$248.32 ,other,,Not applicable. No negotiated rates per contract,$8.20 ,44,,,$8.20 ,$248.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,$204.80 ,80,,,$8.20 ,$248.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$140.80 ,55,,,$8.20 ,$248.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.20 ,95,,,$8.20 ,$248.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.20 ,95,,,$8.20 ,$248.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.00 ,75,,,$8.20 ,$248.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$217.60 ,85,,,$8.20 ,$248.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$248.32 ,97,,,$8.20 ,$248.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.80 ,55,,,$8.20 ,$248.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.40 ,90,,,$8.20 ,$248.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.32 ,97,,,$8.20 ,$248.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.32 ,97,,,$8.20 ,$248.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.32 ,97,,,$8.20 ,$248.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.60 ,85,,,$8.20 ,$248.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$230.40 ,90,,,$8.20 ,$248.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.80 ,55,,,$8.20 ,$248.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.20 ,90,,,$8.20 ,$248.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.80 ,55,,,$8.20 ,$248.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.08 ,93,,,$8.20 ,$248.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Acetylcholine Receptor Binding Ab QST,8042419,CDM,301,RC,83519,HCPCS,outpatient,,,$725.00 ,$543.75 ,,$667.00 ,92,,,$8.10 ,$703.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.10 ,$703.25 ,other,,Not applicable. No negotiated rates per contract,$8.10 ,44,,,$8.10 ,$703.25 ,fee schedule,,44% of CMS Medicare lab fee schedule,$580.00 ,80,,,$8.10 ,$703.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$688.75 ,95,,,$8.10 ,$703.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$688.75 ,95,,,$8.10 ,$703.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.75 ,75,,,$8.10 ,$703.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$616.25 ,85,,,$8.10 ,$703.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.50 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$616.25 ,85,,,$8.10 ,$703.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$652.50 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$688.75 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.25 ,93,,,$8.10 ,$703.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Actin (Smooth Muscle) Ab (IgG) QST,8042357,CDM,301,RC,83516,HCPCS,outpatient,,,$335.00 ,$251.25 ,,$308.20 ,92,,,$5.07 ,$324.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.07 ,$324.95 ,other,,Not applicable. No negotiated rates per contract,$5.07 ,44,,,$5.07 ,$324.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$268.00 ,80,,,$5.07 ,$324.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.25 ,75,,,$5.07 ,$324.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.55 ,93,,,$5.07 ,$324.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Actin (Smooth Muscle) Ab (IgG) QST,8743214,CDM,302,RC,86255,HCPCS,outpatient,,,$97.00 ,$72.75 ,,$89.24 ,92,,,$5.30 ,$94.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.30 ,$94.09 ,other,,Not applicable. No negotiated rates per contract,$5.30 ,44,,,$5.30 ,$94.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,$77.60 ,80,,,$5.30 ,$94.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,95,,,$5.30 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.15 ,95,,,$5.30 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.75 ,75,,,$5.30 ,$94.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$82.45 ,85,,,$5.30 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.30 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,85,,,$5.30 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.30 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.21 ,93,,,$5.30 ,$94.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Acute Hepatitis Panel w/Rfx to Confirm. QST,8147206,CDM,301,RC,80074,HCPCS,outpatient,,,$343.00 ,$257.25 ,,$315.56 ,92,,,$20.96 ,$332.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$188.65 ,55,,,$20.96 ,$332.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.96 ,$332.71 ,other,,Not applicable. No negotiated rates per contract,$20.96 ,44,,,$20.96 ,$332.71 ,fee schedule,,44% of CMS Medicare lab fee schedule,$274.40 ,80,,,$20.96 ,$332.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$188.65 ,55,,,$20.96 ,$332.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$325.85 ,95,,,$20.96 ,$332.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$325.85 ,95,,,$20.96 ,$332.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.25 ,75,,,$20.96 ,$332.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$291.55 ,85,,,$20.96 ,$332.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$332.71 ,97,,,$20.96 ,$332.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.65 ,55,,,$20.96 ,$332.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.70 ,90,,,$20.96 ,$332.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.71 ,97,,,$20.96 ,$332.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.71 ,97,,,$20.96 ,$332.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.71 ,97,,,$20.96 ,$332.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.55 ,85,,,$20.96 ,$332.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.70 ,90,,,$20.96 ,$332.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.65 ,55,,,$20.96 ,$332.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$325.85 ,90,,,$20.96 ,$332.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.65 ,55,,,$20.96 ,$332.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.99 ,93,,,$20.96 ,$332.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alanine Aminotransferase,633632,CDM,301,RC,84460,HCPCS,outpatient,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$2.33 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$2.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.33 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$2.33 ,44,,,$2.33 ,$117.37 ,fee schedule,,44% of CMS Medicare lab fee schedule,$96.80 ,80,,,$2.33 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$2.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$2.33 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$2.33 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$2.33 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$2.33 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$2.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$2.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$2.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$2.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$2.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$2.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$2.33 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$2.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$2.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$2.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$2.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$2.33 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Albumin Level,1620877,CDM,301,RC,82040,HCPCS,outpatient,,,$103.00 ,$77.25 ,,$94.76 ,92,,,$2.18 ,$99.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.65 ,55,,,$2.18 ,$99.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.18 ,$99.91 ,other,,Not applicable. No negotiated rates per contract,$2.18 ,44,,,$2.18 ,$99.91 ,fee schedule,,44% of CMS Medicare lab fee schedule,$82.40 ,80,,,$2.18 ,$99.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.65 ,55,,,$2.18 ,$99.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.85 ,95,,,$2.18 ,$99.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$97.85 ,95,,,$2.18 ,$99.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.25 ,75,,,$2.18 ,$99.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$87.55 ,85,,,$2.18 ,$99.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.91 ,97,,,$2.18 ,$99.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.65 ,55,,,$2.18 ,$99.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.70 ,90,,,$2.18 ,$99.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.91 ,97,,,$2.18 ,$99.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.91 ,97,,,$2.18 ,$99.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.91 ,97,,,$2.18 ,$99.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.55 ,85,,,$2.18 ,$99.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.70 ,90,,,$2.18 ,$99.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.65 ,55,,,$2.18 ,$99.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.85 ,90,,,$2.18 ,$99.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.65 ,55,,,$2.18 ,$99.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.79 ,93,,,$2.18 ,$99.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alcohol Level,1503765,CDM,301,RC,80320,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$98.45 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$98.45 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$98.45 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$153.94 ,86,,,$98.45 ,$173.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$143.20 ,80,,,$98.45 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$98.45 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$98.45 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$98.45 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$98.45 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$98.45 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$98.45 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$98.45 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$98.45 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$98.45 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$98.45 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$98.45 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$98.45 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$98.45 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$98.45 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$98.45 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$98.45 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$98.45 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Aldosterone,8227455,CDM,301,RC,82088,HCPCS,outpatient,,,,,,,,,,$17.93 ,$17.93 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$17.93 ,$17.93 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$17.93 ,$17.93 ,other,,Not applicable. No negotiated rates per contract,$17.93 ,44,,,$17.93 ,$17.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$17.93 ,$17.93 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$17.93 ,$17.93 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$17.93 ,$17.93 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$17.93 ,$17.93 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$17.93 ,$17.93 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$17.93 ,$17.93 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$17.93 ,$17.93 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Aldosterone,8042391,CDM,301,RC,82088,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$210.68 ,92,,,$17.93 ,$222.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$125.95 ,55,,,$17.93 ,$222.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.93 ,$222.13 ,other,,Not applicable. No negotiated rates per contract,$17.93 ,44,,,$17.93 ,$222.13 ,fee schedule,,44% of CMS Medicare lab fee schedule,$183.20 ,80,,,$17.93 ,$222.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$125.95 ,55,,,$17.93 ,$222.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$217.55 ,95,,,$17.93 ,$222.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.55 ,95,,,$17.93 ,$222.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.75 ,75,,,$17.93 ,$222.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$194.65 ,85,,,$17.93 ,$222.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$222.13 ,97,,,$17.93 ,$222.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.95 ,55,,,$17.93 ,$222.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.10 ,90,,,$17.93 ,$222.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.13 ,97,,,$17.93 ,$222.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.13 ,97,,,$17.93 ,$222.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.13 ,97,,,$17.93 ,$222.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$194.65 ,85,,,$17.93 ,$222.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$206.10 ,90,,,$17.93 ,$222.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.95 ,55,,,$17.93 ,$222.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$217.55 ,90,,,$17.93 ,$222.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.95 ,55,,,$17.93 ,$222.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.97 ,93,,,$17.93 ,$222.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alkaline Phosphatase,1620878,CDM,301,RC,84075,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$2.28 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$2.28 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$50.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,$41.60 ,80,,,$2.28 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$2.28 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$2.28 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$2.28 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$2.28 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$2.28 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$2.28 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$2.28 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$2.28 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$2.28 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$2.28 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$2.28 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$2.28 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$2.28 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$2.28 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$2.28 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$2.28 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$2.28 ,$50.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alpha Fetoprotein,8042434,CDM,301,RC,82105,HCPCS,outpatient,,,$130.00 ,$97.50 ,,$119.60 ,92,,,$7.38 ,$126.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$71.50 ,55,,,$7.38 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.38 ,$126.10 ,other,,Not applicable. No negotiated rates per contract,$7.38 ,44,,,$7.38 ,$126.10 ,fee schedule,,44% of CMS Medicare lab fee schedule,$104.00 ,80,,,$7.38 ,$126.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$71.50 ,55,,,$7.38 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,95,,,$7.38 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.50 ,95,,,$7.38 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$97.50 ,75,,,$7.38 ,$126.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$110.50 ,85,,,$7.38 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.10 ,97,,,$7.38 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.50 ,55,,,$7.38 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.00 ,90,,,$7.38 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.10 ,97,,,$7.38 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$7.38 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$7.38 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.50 ,85,,,$7.38 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.00 ,90,,,$7.38 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$7.38 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,90,,,$7.38 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$7.38 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.90 ,93,,,$7.38 ,$126.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alpha-1-Antitrypsin Qn QST,8042433,CDM,301,RC,82103,HCPCS,outpatient,,,$149.00 ,$111.75 ,,$137.08 ,92,,,$5.91 ,$144.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.95 ,55,,,$5.91 ,$144.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.91 ,$144.53 ,other,,Not applicable. No negotiated rates per contract,$5.91 ,44,,,$5.91 ,$144.53 ,fee schedule,,44% of CMS Medicare lab fee schedule,$119.20 ,80,,,$5.91 ,$144.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.95 ,55,,,$5.91 ,$144.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.55 ,95,,,$5.91 ,$144.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.55 ,95,,,$5.91 ,$144.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.75 ,75,,,$5.91 ,$144.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.65 ,85,,,$5.91 ,$144.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.53 ,97,,,$5.91 ,$144.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.95 ,55,,,$5.91 ,$144.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.10 ,90,,,$5.91 ,$144.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.53 ,97,,,$5.91 ,$144.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.53 ,97,,,$5.91 ,$144.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.53 ,97,,,$5.91 ,$144.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.65 ,85,,,$5.91 ,$144.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.10 ,90,,,$5.91 ,$144.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.95 ,55,,,$5.91 ,$144.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.55 ,90,,,$5.91 ,$144.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.95 ,55,,,$5.91 ,$144.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.57 ,93,,,$5.91 ,$144.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Alpha-Fetoprotein (AFP) And AFP-L3 QST,8223179,CDM,301,RC,82107,HCPCS,outpatient,,,$161.00 ,$120.75 ,,$148.12 ,92,,,$28.34 ,$156.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$88.55 ,55,,,$28.34 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.34 ,$156.17 ,other,,Not applicable. No negotiated rates per contract,$28.34 ,44,,,$28.34 ,$156.17 ,fee schedule,,44% of CMS Medicare lab fee schedule,$128.80 ,80,,,$28.34 ,$156.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$88.55 ,55,,,$28.34 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.95 ,95,,,$28.34 ,$156.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.95 ,95,,,$28.34 ,$156.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.75 ,75,,,$28.34 ,$156.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$136.85 ,85,,,$28.34 ,$156.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.17 ,97,,,$28.34 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.55 ,55,,,$28.34 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.90 ,90,,,$28.34 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.17 ,97,,,$28.34 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.17 ,97,,,$28.34 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.17 ,97,,,$28.34 ,$156.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.85 ,85,,,$28.34 ,$156.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.90 ,90,,,$28.34 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.55 ,55,,,$28.34 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.95 ,90,,,$28.34 ,$156.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.55 ,55,,,$28.34 ,$156.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.73 ,93,,,$28.34 ,$156.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ammonia (P) QST,8147210,CDM,300,RC,82140,HCPCS,outpatient,,,$85.00 ,$63.75 ,,$78.20 ,92,,,$6.41 ,$82.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.75 ,55,,,$6.41 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.41 ,$82.45 ,other,,Not applicable. No negotiated rates per contract,$6.41 ,44,,,$6.41 ,$82.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,$68.00 ,80,,,$6.41 ,$82.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.75 ,55,,,$6.41 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,95,,,$6.41 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.75 ,95,,,$6.41 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.75 ,75,,,$6.41 ,$82.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.25 ,85,,,$6.41 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.45 ,97,,,$6.41 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.75 ,55,,,$6.41 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.50 ,90,,,$6.41 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.45 ,97,,,$6.41 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$6.41 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$6.41 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.25 ,85,,,$6.41 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.50 ,90,,,$6.41 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$6.41 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,90,,,$6.41 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$6.41 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.05 ,93,,,$6.41 ,$82.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Amnisure ROM,8045318,CDM,301,RC,84112,HCPCS,outpatient,,,$301.00 ,$225.75 ,,$276.92 ,92,,,$43.17 ,$291.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$165.55 ,55,,,$43.17 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.17 ,$291.97 ,other,,Not applicable. No negotiated rates per contract,$43.17 ,44,,,$43.17 ,$291.97 ,fee schedule,,44% of CMS Medicare lab fee schedule,$240.80 ,80,,,$43.17 ,$291.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$165.55 ,55,,,$43.17 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.95 ,95,,,$43.17 ,$291.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$285.95 ,95,,,$43.17 ,$291.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.75 ,75,,,$43.17 ,$291.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$255.85 ,85,,,$43.17 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.97 ,97,,,$43.17 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.55 ,55,,,$43.17 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.90 ,90,,,$43.17 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.97 ,97,,,$43.17 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$43.17 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.97 ,97,,,$43.17 ,$291.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.85 ,85,,,$43.17 ,$291.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.90 ,90,,,$43.17 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.55 ,55,,,$43.17 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.95 ,90,,,$43.17 ,$291.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.55 ,55,,,$43.17 ,$291.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$279.93 ,93,,,$43.17 ,$291.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Amylase Level,631567,CDM,301,RC,82150,HCPCS,outpatient,,,$77.00 ,$57.75 ,,$70.84 ,92,,,$2.85 ,$74.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.35 ,55,,,$2.85 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$74.69 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$74.69 ,fee schedule,,44% of CMS Medicare lab fee schedule,$61.60 ,80,,,$2.85 ,$74.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.35 ,55,,,$2.85 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,95,,,$2.85 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.15 ,95,,,$2.85 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.75 ,75,,,$2.85 ,$74.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.45 ,85,,,$2.85 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.69 ,97,,,$2.85 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.35 ,55,,,$2.85 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.30 ,90,,,$2.85 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.69 ,97,,,$2.85 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$2.85 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$2.85 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,85,,,$2.85 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.30 ,90,,,$2.85 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$2.85 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,90,,,$2.85 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$2.85 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.61 ,93,,,$2.85 ,$74.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Anaerobic Culture HBL,8836655,CDM,306,RC,87075,HCPCS,outpatient,,,$200.00 ,$150.00 ,,$184.00 ,92,,,$4.17 ,$194.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$110.00 ,55,,,$4.17 ,$194.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.17 ,$194.00 ,other,,Not applicable. No negotiated rates per contract,$4.17 ,44,,,$4.17 ,$194.00 ,fee schedule,,44% of CMS Medicare lab fee schedule,$160.00 ,80,,,$4.17 ,$194.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$110.00 ,55,,,$4.17 ,$194.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.00 ,95,,,$4.17 ,$194.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.00 ,95,,,$4.17 ,$194.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$150.00 ,75,,,$4.17 ,$194.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$170.00 ,85,,,$4.17 ,$194.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$194.00 ,97,,,$4.17 ,$194.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.00 ,55,,,$4.17 ,$194.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.00 ,90,,,$4.17 ,$194.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$194.00 ,97,,,$4.17 ,$194.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$194.00 ,97,,,$4.17 ,$194.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$194.00 ,97,,,$4.17 ,$194.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$170.00 ,85,,,$4.17 ,$194.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.00 ,90,,,$4.17 ,$194.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.00 ,55,,,$4.17 ,$194.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.00 ,90,,,$4.17 ,$194.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.00 ,55,,,$4.17 ,$194.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.00 ,93,,,$4.17 ,$194.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Angiotensin-1-Converting Enzyme QST,8042692,CDM,300,RC,82164,HCPCS,outpatient,,,$398.00 ,$298.50 ,,$366.16 ,92,,,$6.42 ,$386.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.90 ,55,,,$6.42 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.42 ,$386.06 ,other,,Not applicable. No negotiated rates per contract,$6.42 ,44,,,$6.42 ,$386.06 ,fee schedule,,44% of CMS Medicare lab fee schedule,$318.40 ,80,,,$6.42 ,$386.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.90 ,55,,,$6.42 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,95,,,$6.42 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.10 ,95,,,$6.42 ,$386.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.50 ,75,,,$6.42 ,$386.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.30 ,85,,,$6.42 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.06 ,97,,,$6.42 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.90 ,55,,,$6.42 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.20 ,90,,,$6.42 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$386.06 ,97,,,$6.42 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$6.42 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.06 ,97,,,$6.42 ,$386.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.30 ,85,,,$6.42 ,$386.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.20 ,90,,,$6.42 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$6.42 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.10 ,90,,,$6.42 ,$386.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.90 ,55,,,$6.42 ,$386.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.14 ,93,,,$6.42 ,$386.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Arsenic,8042462,CDM,301,RC,82175,HCPCS,outpatient,,,$87.00 ,$65.25 ,,$80.04 ,92,,,$8.35 ,$84.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.85 ,55,,,$8.35 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.35 ,$84.39 ,other,,Not applicable. No negotiated rates per contract,$8.35 ,44,,,$8.35 ,$84.39 ,fee schedule,,44% of CMS Medicare lab fee schedule,$69.60 ,80,,,$8.35 ,$84.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.85 ,55,,,$8.35 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,95,,,$8.35 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.65 ,95,,,$8.35 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.25 ,75,,,$8.35 ,$84.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.95 ,85,,,$8.35 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.39 ,97,,,$8.35 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.85 ,55,,,$8.35 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$8.35 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.39 ,97,,,$8.35 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$8.35 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$8.35 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.95 ,85,,,$8.35 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.30 ,90,,,$8.35 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$8.35 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,90,,,$8.35 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$8.35 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,93,,,$8.35 ,$84.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Arsenic,8422354,CDM,301,RC,82175,HCPCS,outpatient,,,,,,,,,,$8.35 ,$8.35 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.35 ,$8.35 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.35 ,$8.35 ,other,,Not applicable. No negotiated rates per contract,$8.35 ,44,,,$8.35 ,$8.35 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.35 ,$8.35 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.35 ,$8.35 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.35 ,$8.35 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.35 ,$8.35 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.35 ,$8.35 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.35 ,$8.35 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.35 ,$8.35 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Aspartate Aminotransferase,633633,CDM,301,RC,84450,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$2.28 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$114.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$94.40 ,80,,,$2.28 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$2.28 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$2.28 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$2.28 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$2.28 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$2.28 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$2.28 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Atopobium Vaginae QST,8611505,CDM,306,RC,87799,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$18.85 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.85 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$18.85 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$18.85 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$18.85 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Auto Diff,633875,CDM,305,RC,85004,HCPCS,outpatient,,,$51.00 ,$38.25 ,,$46.92 ,92,,,$2.85 ,$49.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.05 ,55,,,$2.85 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$49.47 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$49.47 ,fee schedule,,44% of CMS Medicare lab fee schedule,$40.80 ,80,,,$2.85 ,$49.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.05 ,55,,,$2.85 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,95,,,$2.85 ,$49.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.45 ,95,,,$2.85 ,$49.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.25 ,75,,,$2.85 ,$49.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.35 ,85,,,$2.85 ,$49.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.47 ,97,,,$2.85 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,55,,,$2.85 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.90 ,90,,,$2.85 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.47 ,97,,,$2.85 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$2.85 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$2.85 ,$49.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.35 ,85,,,$2.85 ,$49.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.90 ,90,,,$2.85 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$2.85 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,90,,,$2.85 ,$49.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$2.85 ,$49.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.43 ,93,,,$2.85 ,$49.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
B-hCG Quantitative,633663,CDM,301,RC,84702,HCPCS,outpatient,,,$219.00 ,$164.25 ,,$201.48 ,92,,,$6.62 ,$212.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$120.45 ,55,,,$6.62 ,$212.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.62 ,$212.43 ,other,,Not applicable. No negotiated rates per contract,$6.62 ,44,,,$6.62 ,$212.43 ,fee schedule,,44% of CMS Medicare lab fee schedule,$175.20 ,80,,,$6.62 ,$212.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$120.45 ,55,,,$6.62 ,$212.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.05 ,95,,,$6.62 ,$212.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.05 ,95,,,$6.62 ,$212.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$164.25 ,75,,,$6.62 ,$212.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$186.15 ,85,,,$6.62 ,$212.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.43 ,97,,,$6.62 ,$212.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.45 ,55,,,$6.62 ,$212.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.10 ,90,,,$6.62 ,$212.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$212.43 ,97,,,$6.62 ,$212.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.43 ,97,,,$6.62 ,$212.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.43 ,97,,,$6.62 ,$212.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.15 ,85,,,$6.62 ,$212.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.10 ,90,,,$6.62 ,$212.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.45 ,55,,,$6.62 ,$212.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.05 ,90,,,$6.62 ,$212.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.45 ,55,,,$6.62 ,$212.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.67 ,93,,,$6.62 ,$212.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BCR-ABL1 Gene Rearrangement,8414361,CDM,310,RC,81206,HCPCS,outpatient,,,$669.00 ,$501.75 ,,$615.48 ,92,,,$72.14 ,$648.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.14 ,$648.93 ,other,,Not applicable. No negotiated rates per contract,$72.14 ,44,,,$72.14 ,$648.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,$535.20 ,80,,,$72.14 ,$648.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$635.55 ,95,,,$72.14 ,$648.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.75 ,75,,,$72.14 ,$648.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$648.93 ,97,,,$72.14 ,$648.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$568.65 ,85,,,$72.14 ,$648.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.10 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$635.55 ,90,,,$72.14 ,$648.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.95 ,55,,,$72.14 ,$648.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$622.17 ,93,,,$72.14 ,$648.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRCavantage,8414387,CDM,305,RC,81162,HCPCS,outpatient,,,,,,,,,,$802.95 ,$802.95 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$802.95 ,$802.95 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$802.95 ,$802.95 ,other,,Not applicable. No negotiated rates per contract,$802.95 ,44,,,$802.95 ,$802.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$802.95 ,$802.95 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$802.95 ,$802.95 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$802.95 ,$802.95 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$802.95 ,$802.95 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$802.95 ,$802.95 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$802.95 ,$802.95 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$802.95 ,$802.95 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BUN and Creatinine,8337923,CDM,301,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Bacterial Vaginosis\Vaginitis Panel (BD) HBL,10043757,CDM,306,RC,87480,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$8.82 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.82 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$8.82 ,44,,,$8.82 ,$114.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$94.40 ,80,,,$8.82 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$8.82 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$8.82 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$8.82 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$8.82 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$8.82 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$8.82 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$8.82 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Basic Metabolic Panel,633628,CDM,301,RC,80048,HCPCS,outpatient,,,$187.00 ,$140.25 ,,$172.04 ,92,,,$3.72 ,$181.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.85 ,55,,,$3.72 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.72 ,$181.39 ,other,,Not applicable. No negotiated rates per contract,$3.72 ,44,,,$3.72 ,$181.39 ,fee schedule,,44% of CMS Medicare lab fee schedule,$149.60 ,80,,,$3.72 ,$181.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.85 ,55,,,$3.72 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,95,,,$3.72 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.65 ,95,,,$3.72 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.25 ,75,,,$3.72 ,$181.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.95 ,85,,,$3.72 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.39 ,97,,,$3.72 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,55,,,$3.72 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.30 ,90,,,$3.72 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.39 ,97,,,$3.72 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$3.72 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$3.72 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.95 ,85,,,$3.72 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.30 ,90,,,$3.72 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$3.72 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,90,,,$3.72 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$3.72 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.91 ,93,,,$3.72 ,$181.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Beta 2 Microglobulin QST,8042722,CDM,301,RC,82232,HCPCS,outpatient,,,$418.00 ,$313.50 ,,$384.56 ,92,,,$7.12 ,$405.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$229.90 ,55,,,$7.12 ,$405.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.12 ,$405.46 ,other,,Not applicable. No negotiated rates per contract,$7.12 ,44,,,$7.12 ,$405.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$334.40 ,80,,,$7.12 ,$405.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$229.90 ,55,,,$7.12 ,$405.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$397.10 ,95,,,$7.12 ,$405.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$397.10 ,95,,,$7.12 ,$405.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$313.50 ,75,,,$7.12 ,$405.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$355.30 ,85,,,$7.12 ,$405.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$405.46 ,97,,,$7.12 ,$405.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.90 ,55,,,$7.12 ,$405.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.20 ,90,,,$7.12 ,$405.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$405.46 ,97,,,$7.12 ,$405.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$405.46 ,97,,,$7.12 ,$405.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$405.46 ,97,,,$7.12 ,$405.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$355.30 ,85,,,$7.12 ,$405.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$376.20 ,90,,,$7.12 ,$405.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$229.90 ,55,,,$7.12 ,$405.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$397.10 ,90,,,$7.12 ,$405.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$229.90 ,55,,,$7.12 ,$405.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.74 ,93,,,$7.12 ,$405.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Beta hCG Quantitative,633665,CDM,301,RC,84702,HCPCS,outpatient,,,$211.00 ,$158.25 ,,$194.12 ,92,,,$6.62 ,$204.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.05 ,55,,,$6.62 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.62 ,$204.67 ,other,,Not applicable. No negotiated rates per contract,$6.62 ,44,,,$6.62 ,$204.67 ,fee schedule,,44% of CMS Medicare lab fee schedule,$168.80 ,80,,,$6.62 ,$204.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.05 ,55,,,$6.62 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,95,,,$6.62 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.45 ,95,,,$6.62 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.25 ,75,,,$6.62 ,$204.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.35 ,85,,,$6.62 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.67 ,97,,,$6.62 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.05 ,55,,,$6.62 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.90 ,90,,,$6.62 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.67 ,97,,,$6.62 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$6.62 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$6.62 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.35 ,85,,,$6.62 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.90 ,90,,,$6.62 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$6.62 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,90,,,$6.62 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$6.62 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.23 ,93,,,$6.62 ,$204.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bili Total,633672,CDM,301,RC,82247,HCPCS,outpatient,,,$101.00 ,$75.75 ,,$92.92 ,92,,,$2.21 ,$97.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.21 ,$97.97 ,other,,Not applicable. No negotiated rates per contract,$2.21 ,44,,,$2.21 ,$97.97 ,fee schedule,,44% of CMS Medicare lab fee schedule,$80.80 ,80,,,$2.21 ,$97.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,95,,,$2.21 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.95 ,95,,,$2.21 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.75 ,75,,,$2.21 ,$97.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.85 ,85,,,$2.21 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.90 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.85 ,85,,,$2.21 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.90 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.93 ,93,,,$2.21 ,$97.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bilirubin Direct,4240528,CDM,301,RC,82248,HCPCS,outpatient,,,$101.00 ,$75.75 ,,$92.92 ,92,,,$2.21 ,$97.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.21 ,$97.97 ,other,,Not applicable. No negotiated rates per contract,$2.21 ,44,,,$2.21 ,$97.97 ,fee schedule,,44% of CMS Medicare lab fee schedule,$80.80 ,80,,,$2.21 ,$97.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,95,,,$2.21 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.95 ,95,,,$2.21 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.75 ,75,,,$2.21 ,$97.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.85 ,85,,,$2.21 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.90 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$2.21 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.85 ,85,,,$2.21 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.90 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,90,,,$2.21 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$2.21 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.93 ,93,,,$2.21 ,$97.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88173 Cyto FNA Interp,8196790,CDM,310,RC,88173,HCPCS,outpatient,,,$405.00 ,$303.75 ,,$372.60 ,92,,,$222.75 ,$392.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.75 ,$392.85 ,other,,Not applicable. No negotiated rates per contract,$348.30 ,86,,,$222.75 ,$392.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.00 ,80,,,$222.75 ,$392.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.75 ,75,,,$222.75 ,$392.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.65 ,93,,,$222.75 ,$392.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88271 Cytogenics Molecular,8196788,CDM,310,RC,88271,HCPCS,outpatient,,,$292.00 ,$219.00 ,,$268.64 ,92,,,$9.42 ,$283.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.60 ,55,,,$9.42 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.42 ,$283.24 ,other,,Not applicable. No negotiated rates per contract,$9.42 ,44,,,$9.42 ,$283.24 ,fee schedule,,44% of CMS Medicare lab fee schedule,$233.60 ,80,,,$9.42 ,$283.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.60 ,55,,,$9.42 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,95,,,$9.42 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.40 ,95,,,$9.42 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.00 ,75,,,$9.42 ,$283.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$248.20 ,85,,,$9.42 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.24 ,97,,,$9.42 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.60 ,55,,,$9.42 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.80 ,90,,,$9.42 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$283.24 ,97,,,$9.42 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$9.42 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$9.42 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.20 ,85,,,$9.42 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.80 ,90,,,$9.42 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$9.42 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,90,,,$9.42 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$9.42 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.56 ,93,,,$9.42 ,$283.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88275 In Situ Hybridz,8196787,CDM,310,RC,88275,HCPCS,outpatient,,,$188.00 ,$141.00 ,,$172.96 ,92,,,$22.52 ,$182.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.40 ,55,,,$22.52 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.52 ,$182.36 ,other,,Not applicable. No negotiated rates per contract,$22.52 ,44,,,$22.52 ,$182.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$150.40 ,80,,,$22.52 ,$182.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.40 ,55,,,$22.52 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,95,,,$22.52 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.60 ,95,,,$22.52 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.00 ,75,,,$22.52 ,$182.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$159.80 ,85,,,$22.52 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.36 ,97,,,$22.52 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.40 ,55,,,$22.52 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.20 ,90,,,$22.52 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.36 ,97,,,$22.52 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$22.52 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$22.52 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.80 ,85,,,$22.52 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.20 ,90,,,$22.52 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$22.52 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,90,,,$22.52 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$22.52 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.84 ,93,,,$22.52 ,$182.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88305 Surg Level IV,8196781,CDM,310,RC,88305,HCPCS,outpatient,,,$212.00 ,$159.00 ,,$195.04 ,92,,,$116.60 ,$205.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.60 ,55,,,$116.60 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$116.60 ,$205.64 ,other,,Not applicable. No negotiated rates per contract,$182.32 ,86,,,$116.60 ,$205.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$169.60 ,80,,,$116.60 ,$205.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.60 ,55,,,$116.60 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,95,,,$116.60 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.40 ,95,,,$116.60 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.00 ,75,,,$116.60 ,$205.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$180.20 ,85,,,$116.60 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$205.64 ,97,,,$116.60 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.60 ,55,,,$116.60 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.80 ,90,,,$116.60 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.64 ,97,,,$116.60 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$116.60 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$116.60 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.20 ,85,,,$116.60 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.80 ,90,,,$116.60 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$116.60 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,90,,,$116.60 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$116.60 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.16 ,93,,,$116.60 ,$205.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88307 Surg Level V,8196783,CDM,310,RC,88307,HCPCS,outpatient,,,$881.00 ,$660.75 ,,$810.52 ,92,,,$484.55 ,$854.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$484.55 ,$854.57 ,other,,Not applicable. No negotiated rates per contract,$757.66 ,86,,,$484.55 ,$854.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$704.80 ,80,,,$484.55 ,$854.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$836.95 ,95,,,$484.55 ,$854.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$660.75 ,75,,,$484.55 ,$854.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.57 ,97,,,$484.55 ,$854.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.85 ,85,,,$484.55 ,$854.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$792.90 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$836.95 ,90,,,$484.55 ,$854.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$484.55 ,55,,,$484.55 ,$854.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.33 ,93,,,$484.55 ,$854.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88341 IMMUNOCYTOCHEM STAIN ADDL ANTI,8501843,CDM,310,RC,88341,HCPCS,outpatient,,,$230.00 ,$172.50 ,,$211.60 ,92,,,$126.50 ,$223.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$126.50 ,$223.10 ,other,,Not applicable. No negotiated rates per contract,$197.80 ,86,,,$126.50 ,$223.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$184.00 ,80,,,$126.50 ,$223.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.50 ,95,,,$126.50 ,$223.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$218.50 ,95,,,$126.50 ,$223.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.50 ,75,,,$126.50 ,$223.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$195.50 ,85,,,$126.50 ,$223.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.00 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.10 ,97,,,$126.50 ,$223.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.50 ,85,,,$126.50 ,$223.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$207.00 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.50 ,90,,,$126.50 ,$223.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.50 ,55,,,$126.50 ,$223.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.90 ,93,,,$126.50 ,$223.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88342 IHC EA Ab,8196804,CDM,310,RC,88342,HCPCS,outpatient,,,$626.00 ,$469.50 ,,$575.92 ,92,,,$344.30 ,$607.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$344.30 ,55,,,$344.30 ,$607.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$344.30 ,$607.22 ,other,,Not applicable. No negotiated rates per contract,$538.36 ,86,,,$344.30 ,$607.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$500.80 ,80,,,$344.30 ,$607.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$344.30 ,55,,,$344.30 ,$607.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$594.70 ,95,,,$344.30 ,$607.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$594.70 ,95,,,$344.30 ,$607.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$469.50 ,75,,,$344.30 ,$607.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$532.10 ,85,,,$344.30 ,$607.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$607.22 ,97,,,$344.30 ,$607.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.30 ,55,,,$344.30 ,$607.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$563.40 ,90,,,$344.30 ,$607.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$607.22 ,97,,,$344.30 ,$607.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$607.22 ,97,,,$344.30 ,$607.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$607.22 ,97,,,$344.30 ,$607.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$532.10 ,85,,,$344.30 ,$607.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$563.40 ,90,,,$344.30 ,$607.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$344.30 ,55,,,$344.30 ,$607.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$594.70 ,90,,,$344.30 ,$607.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$344.30 ,55,,,$344.30 ,$607.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$582.18 ,93,,,$344.30 ,$607.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only AP 88360 Bill Manual Tumor Analysis,8080887,CDM,310,RC,88360,HCPCS,outpatient,,,$734.00 ,$550.50 ,,$675.28 ,92,,,$403.70 ,$711.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$403.70 ,55,,,$403.70 ,$711.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$403.70 ,$711.98 ,other,,Not applicable. No negotiated rates per contract,$631.24 ,86,,,$403.70 ,$711.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$587.20 ,80,,,$403.70 ,$711.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$403.70 ,55,,,$403.70 ,$711.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$697.30 ,95,,,$403.70 ,$711.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$697.30 ,95,,,$403.70 ,$711.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$550.50 ,75,,,$403.70 ,$711.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$623.90 ,85,,,$403.70 ,$711.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$711.98 ,97,,,$403.70 ,$711.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.70 ,55,,,$403.70 ,$711.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$660.60 ,90,,,$403.70 ,$711.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$711.98 ,97,,,$403.70 ,$711.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$711.98 ,97,,,$403.70 ,$711.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$711.98 ,97,,,$403.70 ,$711.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$623.90 ,85,,,$403.70 ,$711.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$660.60 ,90,,,$403.70 ,$711.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.70 ,55,,,$403.70 ,$711.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$697.30 ,90,,,$403.70 ,$711.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.70 ,55,,,$403.70 ,$711.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$682.62 ,93,,,$403.70 ,$711.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only Capillary Draw Charge,8301484,CDM,300,RC,36416,HCPCS,outpatient,,,$21.00 ,$15.75 ,,$19.32 ,92,,,$11.55 ,$20.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.55 ,$20.37 ,other,,Not applicable. No negotiated rates per contract,$18.06 ,86,,,$11.55 ,$20.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$16.80 ,80,,,$11.55 ,$20.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,95,,,$11.55 ,$20.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.95 ,95,,,$11.55 ,$20.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.75 ,75,,,$11.55 ,$20.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$17.85 ,85,,,$11.55 ,$20.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$18.90 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.85 ,85,,,$11.55 ,$20.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$18.90 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.53 ,93,,,$11.55 ,$20.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only Decalcification,9156392,CDM,310,RC,88311,HCPCS,outpatient,,,$70.00 ,$52.50 ,,$64.40 ,92,,,$38.50 ,$67.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.50 ,55,,,$38.50 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.50 ,$67.90 ,other,,Not applicable. No negotiated rates per contract,$60.20 ,86,,,$38.50 ,$67.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.00 ,80,,,$38.50 ,$67.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.50 ,55,,,$38.50 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,95,,,$38.50 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.50 ,95,,,$38.50 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.50 ,75,,,$38.50 ,$67.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.50 ,85,,,$38.50 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.90 ,97,,,$38.50 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.50 ,55,,,$38.50 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.00 ,90,,,$38.50 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.90 ,97,,,$38.50 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$38.50 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$38.50 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.50 ,85,,,$38.50 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.00 ,90,,,$38.50 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$38.50 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,90,,,$38.50 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$38.50 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.10 ,93,,,$38.50 ,$67.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bill Only Shipping & Handling,9091447,CDM,300,RC,99001,HCPCS,outpatient,,,$56.00 ,$42.00 ,,$51.52 ,92,,,$30.80 ,$54.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.80 ,55,,,$30.80 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.80 ,$54.32 ,other,,Not applicable. No negotiated rates per contract,$48.16 ,86,,,$30.80 ,$54.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$44.80 ,80,,,$30.80 ,$54.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.80 ,55,,,$30.80 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,95,,,$30.80 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.20 ,95,,,$30.80 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.00 ,75,,,$30.80 ,$54.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.60 ,85,,,$30.80 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.32 ,97,,,$30.80 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.80 ,55,,,$30.80 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.40 ,90,,,$30.80 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.32 ,97,,,$30.80 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$30.80 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$30.80 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.60 ,85,,,$30.80 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.40 ,90,,,$30.80 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$30.80 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,90,,,$30.80 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$30.80 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.08 ,93,,,$30.80 ,$54.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BioTe Female Post Pellet Tests,8970549,CDM,300,RC,,HCPCS,outpatient,,,$39.00 ,$29.25 ,,$35.88 ,92,,,$21.45 ,$37.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.45 ,$37.83 ,other,,Not applicable. No negotiated rates per contract,$33.54 ,86,,,$21.45 ,$37.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.20 ,80,,,$21.45 ,$37.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.25 ,75,,,$21.45 ,$37.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.27 ,93,,,$21.45 ,$37.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BioTe Female Pre Pellet Tests,8970529,CDM,300,RC,,HCPCS,outpatient,,,$115.00 ,$86.25 ,,$105.80 ,92,,,$63.25 ,$111.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.25 ,$111.55 ,other,,Not applicable. No negotiated rates per contract,$98.90 ,86,,,$63.25 ,$111.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.00 ,80,,,$63.25 ,$111.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.25 ,75,,,$63.25 ,$111.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.95 ,93,,,$63.25 ,$111.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BioTe Male Post Pellet Tests,8970530,CDM,300,RC,,HCPCS,outpatient,,,$39.00 ,$29.25 ,,$35.88 ,92,,,$21.45 ,$37.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.45 ,$37.83 ,other,,Not applicable. No negotiated rates per contract,$33.54 ,86,,,$21.45 ,$37.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.20 ,80,,,$21.45 ,$37.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.25 ,75,,,$21.45 ,$37.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.27 ,93,,,$21.45 ,$37.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BioTe Male Pre Pellet Tests,8970531,CDM,300,RC,,HCPCS,outpatient,,,$115.00 ,$86.25 ,,$105.80 ,92,,,$63.25 ,$111.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.25 ,$111.55 ,other,,Not applicable. No negotiated rates per contract,$98.90 ,86,,,$63.25 ,$111.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.00 ,80,,,$63.25 ,$111.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.25 ,75,,,$63.25 ,$111.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.95 ,93,,,$63.25 ,$111.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture HBL,8819667,CDM,306,RC,87040,HCPCS,outpatient,,,$168.00 ,$126.00 ,,$154.56 ,92,,,$4.54 ,$162.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$92.40 ,55,,,$4.54 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.54 ,$162.96 ,other,,Not applicable. No negotiated rates per contract,$4.54 ,44,,,$4.54 ,$162.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$134.40 ,80,,,$4.54 ,$162.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$92.40 ,55,,,$4.54 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,95,,,$4.54 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.60 ,95,,,$4.54 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.00 ,75,,,$4.54 ,$162.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$142.80 ,85,,,$4.54 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.96 ,97,,,$4.54 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.40 ,55,,,$4.54 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.20 ,90,,,$4.54 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.96 ,97,,,$4.54 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$4.54 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$4.54 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.80 ,85,,,$4.54 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.20 ,90,,,$4.54 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$4.54 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,90,,,$4.54 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$4.54 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.24 ,93,,,$4.54 ,$162.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture ID (BioFire),8036838,CDM,306,RC,87150,HCPCS,outpatient,,,$464.00 ,$348.00 ,,$426.88 ,92,,,$15.44 ,$450.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$450.08 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$450.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$371.20 ,80,,,$15.44 ,$450.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,95,,,$15.44 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.80 ,95,,,$15.44 ,$450.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.00 ,75,,,$15.44 ,$450.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$394.40 ,85,,,$15.44 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.60 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.08 ,97,,,$15.44 ,$450.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.40 ,85,,,$15.44 ,$450.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.60 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.80 ,90,,,$15.44 ,$450.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.20 ,55,,,$15.44 ,$450.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.52 ,93,,,$15.44 ,$450.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture ID (Biofire) 2,9494624,CDM,306,RC,87150,HCPCS,outpatient,,,$735.00 ,$551.25 ,,$676.20 ,92,,,$15.44 ,$712.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$404.25 ,55,,,$15.44 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$712.95 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$712.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$588.00 ,80,,,$15.44 ,$712.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$404.25 ,55,,,$15.44 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$698.25 ,95,,,$15.44 ,$712.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$698.25 ,95,,,$15.44 ,$712.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$551.25 ,75,,,$15.44 ,$712.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$624.75 ,85,,,$15.44 ,$712.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$712.95 ,97,,,$15.44 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.25 ,55,,,$15.44 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$661.50 ,90,,,$15.44 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$712.95 ,97,,,$15.44 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$712.95 ,97,,,$15.44 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$712.95 ,97,,,$15.44 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$624.75 ,85,,,$15.44 ,$712.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$661.50 ,90,,,$15.44 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$404.25 ,55,,,$15.44 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$698.25 ,90,,,$15.44 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$404.25 ,55,,,$15.44 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.55 ,93,,,$15.44 ,$712.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Gas Arterial,4185532,CDM,301,RC,82803,HCPCS,outpatient,,,$177.00 ,$132.75 ,,$162.84 ,92,,,$11.47 ,$171.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.47 ,$171.69 ,other,,Not applicable. No negotiated rates per contract,$11.47 ,44,,,$11.47 ,$171.69 ,fee schedule,,44% of CMS Medicare lab fee schedule,$141.60 ,80,,,$11.47 ,$171.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,95,,,$11.47 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.15 ,95,,,$11.47 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.75 ,75,,,$11.47 ,$171.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$150.45 ,85,,,$11.47 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.30 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.45 ,85,,,$11.47 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.30 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.61 ,93,,,$11.47 ,$171.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Urea Nitrogen,633605,CDM,301,RC,84520,HCPCS,outpatient,,,$81.00 ,$60.75 ,,$74.52 ,92,,,$1.74 ,$78.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.74 ,$78.57 ,other,,Not applicable. No negotiated rates per contract,$1.74 ,44,,,$1.74 ,$78.57 ,fee schedule,,44% of CMS Medicare lab fee schedule,$64.80 ,80,,,$1.74 ,$78.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.95 ,95,,,$1.74 ,$78.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.95 ,95,,,$1.74 ,$78.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.75 ,75,,,$1.74 ,$78.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.85 ,85,,,$1.74 ,$78.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.90 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.57 ,97,,,$1.74 ,$78.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.85 ,85,,,$1.74 ,$78.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.90 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.95 ,90,,,$1.74 ,$78.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.55 ,55,,,$1.74 ,$78.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.33 ,93,,,$1.74 ,$78.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Body Fluid Culture HBL,10031528,CDM,300,RC,87070,HCPCS,outpatient,,,$210.00 ,$157.50 ,,$193.20 ,92,,,$3.79 ,$203.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.50 ,55,,,$3.79 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$203.70 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$203.70 ,fee schedule,,44% of CMS Medicare lab fee schedule,$168.00 ,80,,,$3.79 ,$203.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.50 ,55,,,$3.79 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,95,,,$3.79 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.50 ,95,,,$3.79 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.50 ,75,,,$3.79 ,$203.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.50 ,85,,,$3.79 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.70 ,97,,,$3.79 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.50 ,55,,,$3.79 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.00 ,90,,,$3.79 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.70 ,97,,,$3.79 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.79 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.79 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.50 ,85,,,$3.79 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.00 ,90,,,$3.79 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.79 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,90,,,$3.79 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.79 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.30 ,93,,,$3.79 ,$203.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C Diff Tox,7934630,CDM,306,RC,87324,HCPCS,outpatient,,,$211.00 ,$158.25 ,,$194.12 ,92,,,$5.27 ,$204.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.05 ,55,,,$5.27 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.27 ,$204.67 ,other,,Not applicable. No negotiated rates per contract,$5.27 ,44,,,$5.27 ,$204.67 ,fee schedule,,44% of CMS Medicare lab fee schedule,$168.80 ,80,,,$5.27 ,$204.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.05 ,55,,,$5.27 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,95,,,$5.27 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.45 ,95,,,$5.27 ,$204.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.25 ,75,,,$5.27 ,$204.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.35 ,85,,,$5.27 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.67 ,97,,,$5.27 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.05 ,55,,,$5.27 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.90 ,90,,,$5.27 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.67 ,97,,,$5.27 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$5.27 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.67 ,97,,,$5.27 ,$204.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.35 ,85,,,$5.27 ,$204.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.90 ,90,,,$5.27 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$5.27 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.45 ,90,,,$5.27 ,$204.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.05 ,55,,,$5.27 ,$204.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.23 ,93,,,$5.27 ,$204.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-Reactive Protein,1628890,CDM,302,RC,86140,HCPCS,outpatient,,,$90.00 ,$67.50 ,,$82.80 ,92,,,$2.28 ,$87.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.50 ,55,,,$2.28 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$87.30 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$87.30 ,fee schedule,,44% of CMS Medicare lab fee schedule,$72.00 ,80,,,$2.28 ,$87.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.50 ,55,,,$2.28 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,95,,,$2.28 ,$87.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.50 ,95,,,$2.28 ,$87.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.50 ,75,,,$2.28 ,$87.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$76.50 ,85,,,$2.28 ,$87.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.30 ,97,,,$2.28 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.50 ,55,,,$2.28 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.00 ,90,,,$2.28 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.30 ,97,,,$2.28 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.30 ,97,,,$2.28 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.30 ,97,,,$2.28 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.50 ,85,,,$2.28 ,$87.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.00 ,90,,,$2.28 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.50 ,55,,,$2.28 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,90,,,$2.28 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.50 ,55,,,$2.28 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.70 ,93,,,$2.28 ,$87.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C. Albicans,8611509,CDM,300,RC,87481,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
C. Glabrata,8611510,CDM,300,RC,87481,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
C. Parapsilosis,8611512,CDM,300,RC,87481,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
C. Tropicalis,8611511,CDM,300,RC,87481,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CA 125 QST,8042489,CDM,302,RC,86304,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$9.16 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$9.16 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.16 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$9.16 ,44,,,$9.16 ,$103.79 ,fee schedule,,44% of CMS Medicare lab fee schedule,$85.60 ,80,,,$9.16 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$9.16 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$9.16 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$9.16 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$9.16 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$9.16 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$9.16 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$9.16 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$9.16 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$9.16 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$9.16 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$9.16 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$9.16 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$9.16 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$9.16 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$9.16 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$9.16 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$9.16 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CA 15-3 QST,8042671,CDM,302,RC,86300,HCPCS,outpatient,,,$487.00 ,$365.25 ,,$448.04 ,92,,,$9.16 ,$472.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.16 ,$472.39 ,other,,Not applicable. No negotiated rates per contract,$9.16 ,44,,,$9.16 ,$472.39 ,fee schedule,,44% of CMS Medicare lab fee schedule,$389.60 ,80,,,$9.16 ,$472.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,95,,,$9.16 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$462.65 ,95,,,$9.16 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$365.25 ,75,,,$9.16 ,$472.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$413.95 ,85,,,$9.16 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.30 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.95 ,85,,,$9.16 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.30 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.91 ,93,,,$9.16 ,$472.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CA 19-9 QST,8042624,CDM,302,RC,86301,HCPCS,outpatient,,,$291.00 ,$218.25 ,,$267.72 ,92,,,$9.16 ,$282.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.05 ,55,,,$9.16 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.16 ,$282.27 ,other,,Not applicable. No negotiated rates per contract,$9.16 ,44,,,$9.16 ,$282.27 ,fee schedule,,44% of CMS Medicare lab fee schedule,$232.80 ,80,,,$9.16 ,$282.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.05 ,55,,,$9.16 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,95,,,$9.16 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$276.45 ,95,,,$9.16 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$218.25 ,75,,,$9.16 ,$282.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$247.35 ,85,,,$9.16 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$282.27 ,97,,,$9.16 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,55,,,$9.16 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.90 ,90,,,$9.16 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.27 ,97,,,$9.16 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$9.16 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$9.16 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,85,,,$9.16 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.90 ,90,,,$9.16 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$9.16 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,90,,,$9.16 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$9.16 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.63 ,93,,,$9.16 ,$282.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CA 27.29 QST,8042490,CDM,302,RC,86300,HCPCS,outpatient,,,$487.00 ,$365.25 ,,$448.04 ,92,,,$9.16 ,$472.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.16 ,$472.39 ,other,,Not applicable. No negotiated rates per contract,$9.16 ,44,,,$9.16 ,$472.39 ,fee schedule,,44% of CMS Medicare lab fee schedule,$389.60 ,80,,,$9.16 ,$472.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,95,,,$9.16 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$462.65 ,95,,,$9.16 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$365.25 ,75,,,$9.16 ,$472.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$413.95 ,85,,,$9.16 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.30 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$9.16 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.95 ,85,,,$9.16 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.30 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,90,,,$9.16 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.85 ,55,,,$9.16 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.91 ,93,,,$9.16 ,$472.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CBC w/ Auto Diff,633683,CDM,305,RC,85025,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$3.42 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$3.42 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.42 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$3.42 ,44,,,$3.42 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$3.42 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$3.42 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$3.42 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$3.42 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$3.42 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$3.42 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$3.42 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$3.42 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$3.42 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$3.42 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$3.42 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$3.42 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$3.42 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$3.42 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$3.42 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$3.42 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$3.42 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$3.42 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CBC w/ Man Diff,633682,CDM,305,RC,85027,HCPCS,outpatient,,,$72.00 ,$54.00 ,,$66.24 ,92,,,$2.85 ,$69.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.60 ,55,,,$2.85 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$69.84 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$69.84 ,fee schedule,,44% of CMS Medicare lab fee schedule,$57.60 ,80,,,$2.85 ,$69.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.60 ,55,,,$2.85 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,95,,,$2.85 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.40 ,95,,,$2.85 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.00 ,75,,,$2.85 ,$69.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.20 ,85,,,$2.85 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.84 ,97,,,$2.85 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.60 ,55,,,$2.85 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.80 ,90,,,$2.85 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.84 ,97,,,$2.85 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$2.85 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$2.85 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.20 ,85,,,$2.85 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.80 ,90,,,$2.85 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$2.85 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$2.85 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$2.85 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.96 ,93,,,$2.85 ,$69.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CBC w/o Diff,3798345,CDM,305,RC,85027,HCPCS,outpatient,,,$74.00 ,$55.50 ,,$68.08 ,92,,,$2.85 ,$71.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.70 ,55,,,$2.85 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$71.78 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$71.78 ,fee schedule,,44% of CMS Medicare lab fee schedule,$59.20 ,80,,,$2.85 ,$71.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.70 ,55,,,$2.85 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.30 ,95,,,$2.85 ,$71.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.30 ,95,,,$2.85 ,$71.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.50 ,75,,,$2.85 ,$71.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$62.90 ,85,,,$2.85 ,$71.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.78 ,97,,,$2.85 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.70 ,55,,,$2.85 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.60 ,90,,,$2.85 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.78 ,97,,,$2.85 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.78 ,97,,,$2.85 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.78 ,97,,,$2.85 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.90 ,85,,,$2.85 ,$71.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.60 ,90,,,$2.85 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.70 ,55,,,$2.85 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.30 ,90,,,$2.85 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.70 ,55,,,$2.85 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.82 ,93,,,$2.85 ,$71.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CBC without Differential,9216165,CDM,305,RC,85027,HCPCS,outpatient,,,,,,,,,,$2.85 ,$2.85 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.85 ,$2.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.85 ,$2.85 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$2.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.85 ,$2.85 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.85 ,$2.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.85 ,$2.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.85 ,$2.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.85 ,$2.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.85 ,$2.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.85 ,$2.85 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CCP Ab (IgG) QST,8042329,CDM,302,RC,86200,HCPCS,outpatient,,,$236.00 ,$177.00 ,,$217.12 ,92,,,$5.70 ,$228.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.70 ,$228.92 ,other,,Not applicable. No negotiated rates per contract,$5.70 ,44,,,$5.70 ,$228.92 ,fee schedule,,44% of CMS Medicare lab fee schedule,$188.80 ,80,,,$5.70 ,$228.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,95,,,$5.70 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.20 ,95,,,$5.70 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.00 ,75,,,$5.70 ,$228.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$200.60 ,85,,,$5.70 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.40 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.60 ,85,,,$5.70 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.40 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.48 ,93,,,$5.70 ,$228.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CCP Antibody (IgG) QST,8743201,CDM,302,RC,86200,HCPCS,outpatient,,,$236.00 ,$177.00 ,,$217.12 ,92,,,$5.70 ,$228.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.70 ,$228.92 ,other,,Not applicable. No negotiated rates per contract,$5.70 ,44,,,$5.70 ,$228.92 ,fee schedule,,44% of CMS Medicare lab fee schedule,$188.80 ,80,,,$5.70 ,$228.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,95,,,$5.70 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.20 ,95,,,$5.70 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.00 ,75,,,$5.70 ,$228.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$200.60 ,85,,,$5.70 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.40 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$5.70 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.60 ,85,,,$5.70 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.40 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,90,,,$5.70 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$5.70 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.48 ,93,,,$5.70 ,$228.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CEA QST,8042793,CDM,301,RC,82378,HCPCS,outpatient,,,$184.00 ,$138.00 ,,$169.28 ,92,,,$8.34 ,$178.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.20 ,55,,,$8.34 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.34 ,$178.48 ,other,,Not applicable. No negotiated rates per contract,$8.34 ,44,,,$8.34 ,$178.48 ,fee schedule,,44% of CMS Medicare lab fee schedule,$147.20 ,80,,,$8.34 ,$178.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.20 ,55,,,$8.34 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,95,,,$8.34 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.80 ,95,,,$8.34 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.00 ,75,,,$8.34 ,$178.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.40 ,85,,,$8.34 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.48 ,97,,,$8.34 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.20 ,55,,,$8.34 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.60 ,90,,,$8.34 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.48 ,97,,,$8.34 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$8.34 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$8.34 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.40 ,85,,,$8.34 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.60 ,90,,,$8.34 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$8.34 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,90,,,$8.34 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$8.34 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.12 ,93,,,$8.34 ,$178.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CMP,633709,CDM,301,RC,80053,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$4.65 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.65 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$4.65 ,44,,,$4.65 ,$226.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$186.40 ,80,,,$4.65 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$4.65 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$4.65 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$4.65 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$4.65 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$4.65 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$4.65 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COLLECTION: Capillary,1779386,CDM,300,RC,36416,HCPCS,outpatient,,,$21.00 ,$15.75 ,,$19.32 ,92,,,$11.55 ,$20.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.55 ,$20.37 ,other,,Not applicable. No negotiated rates per contract,$18.06 ,86,,,$11.55 ,$20.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$16.80 ,80,,,$11.55 ,$20.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,95,,,$11.55 ,$20.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.95 ,95,,,$11.55 ,$20.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.75 ,75,,,$11.55 ,$20.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$17.85 ,85,,,$11.55 ,$20.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$18.90 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$11.55 ,$20.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.85 ,85,,,$11.55 ,$20.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$18.90 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,90,,,$11.55 ,$20.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.55 ,55,,,$11.55 ,$20.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.53 ,93,,,$11.55 ,$20.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COLLECTION: Venous Draw,1779389,CDM,300,RC,36415,HCPCS,outpatient,,,$33.00 ,$24.75 ,,$30.36 ,92,,,$1.32 ,$32.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.32 ,$32.01 ,other,,Not applicable. No negotiated rates per contract,$1.32 ,44,,,$1.32 ,$32.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$26.40 ,80,,,$1.32 ,$32.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,95,,,$1.32 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.35 ,95,,,$1.32 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.75 ,75,,,$1.32 ,$32.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.05 ,85,,,$1.32 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$1.32 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,85,,,$1.32 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.70 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$1.32 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$1.32 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.69 ,93,,,$1.32 ,$32.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Calcium Level Ionized,3454378,CDM,301,RC,82330,HCPCS,outpatient,,,$212.00 ,$159.00 ,,$195.04 ,92,,,$6.02 ,$205.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.60 ,55,,,$6.02 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.02 ,$205.64 ,other,,Not applicable. No negotiated rates per contract,$6.02 ,44,,,$6.02 ,$205.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$169.60 ,80,,,$6.02 ,$205.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.60 ,55,,,$6.02 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,95,,,$6.02 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.40 ,95,,,$6.02 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.00 ,75,,,$6.02 ,$205.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$180.20 ,85,,,$6.02 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$205.64 ,97,,,$6.02 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.60 ,55,,,$6.02 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.80 ,90,,,$6.02 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.64 ,97,,,$6.02 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$6.02 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$6.02 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.20 ,85,,,$6.02 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.80 ,90,,,$6.02 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$6.02 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,90,,,$6.02 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$6.02 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.16 ,93,,,$6.02 ,$205.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Calcium Level Total,1628887,CDM,301,RC,82310,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$2.27 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.27 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$2.27 ,44,,,$2.27 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$2.27 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$2.27 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$2.27 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$2.27 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$2.27 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$2.27 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$2.27 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Calcium QST,8542152,CDM,300,RC,82310,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$2.27 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.27 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$2.27 ,44,,,$2.27 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$2.27 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$2.27 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$2.27 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$2.27 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$2.27 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$2.27 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$2.27 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$2.27 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$2.27 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$2.27 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Carbamazepine,8042518,CDM,300,RC,80156,HCPCS,outpatient,,,,,,,,,,$6.41 ,$6.41 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.41 ,$6.41 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.41 ,$6.41 ,other,,Not applicable. No negotiated rates per contract,$6.41 ,44,,,$6.41 ,$6.41 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.41 ,$6.41 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.41 ,$6.41 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.41 ,$6.41 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.41 ,$6.41 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.41 ,$6.41 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.41 ,$6.41 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.41 ,$6.41 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Carbidopa QST,8311215,CDM,300,RC,80299,HCPCS,outpatient,,,$235.00 ,$176.25 ,,$216.20 ,92,,,$8.20 ,$227.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.25 ,55,,,$8.20 ,$227.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.20 ,$227.95 ,other,,Not applicable. No negotiated rates per contract,$8.20 ,44,,,$8.20 ,$227.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$188.00 ,80,,,$8.20 ,$227.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.25 ,55,,,$8.20 ,$227.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.25 ,95,,,$8.20 ,$227.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$223.25 ,95,,,$8.20 ,$227.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.25 ,75,,,$8.20 ,$227.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$199.75 ,85,,,$8.20 ,$227.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$227.95 ,97,,,$8.20 ,$227.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.25 ,55,,,$8.20 ,$227.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$211.50 ,90,,,$8.20 ,$227.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.95 ,97,,,$8.20 ,$227.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.95 ,97,,,$8.20 ,$227.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.95 ,97,,,$8.20 ,$227.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.75 ,85,,,$8.20 ,$227.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$211.50 ,90,,,$8.20 ,$227.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.25 ,55,,,$8.20 ,$227.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.25 ,90,,,$8.20 ,$227.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.25 ,55,,,$8.20 ,$227.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.55 ,93,,,$8.20 ,$227.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Carbon Dioxide Level,8036769,CDM,301,RC,82374,HCPCS,outpatient,,,$98.00 ,$73.50 ,,$90.16 ,92,,,$2.15 ,$95.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.90 ,55,,,$2.15 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.15 ,$95.06 ,other,,Not applicable. No negotiated rates per contract,$2.15 ,44,,,$2.15 ,$95.06 ,fee schedule,,44% of CMS Medicare lab fee schedule,$78.40 ,80,,,$2.15 ,$95.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.90 ,55,,,$2.15 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.10 ,95,,,$2.15 ,$95.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.10 ,95,,,$2.15 ,$95.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.50 ,75,,,$2.15 ,$95.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$83.30 ,85,,,$2.15 ,$95.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.06 ,97,,,$2.15 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.90 ,55,,,$2.15 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.20 ,90,,,$2.15 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.06 ,97,,,$2.15 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.06 ,97,,,$2.15 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.06 ,97,,,$2.15 ,$95.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.30 ,85,,,$2.15 ,$95.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.20 ,90,,,$2.15 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.90 ,55,,,$2.15 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.10 ,90,,,$2.15 ,$95.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.90 ,55,,,$2.15 ,$95.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.14 ,93,,,$2.15 ,$95.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cardiac Enzymes,8479441,CDM,301,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Catheter Tip Culture HBL,8836656,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cell Count And Diff,8147273,CDM,300,RC,89051,HCPCS,outpatient,,,$409.00 ,$306.75 ,,$376.28 ,92,,,$2.46 ,$396.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$224.95 ,55,,,$2.46 ,$396.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.46 ,$396.73 ,other,,Not applicable. No negotiated rates per contract,$2.46 ,44,,,$2.46 ,$396.73 ,fee schedule,,44% of CMS Medicare lab fee schedule,$327.20 ,80,,,$2.46 ,$396.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$224.95 ,55,,,$2.46 ,$396.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.55 ,95,,,$2.46 ,$396.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$388.55 ,95,,,$2.46 ,$396.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$306.75 ,75,,,$2.46 ,$396.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$347.65 ,85,,,$2.46 ,$396.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$396.73 ,97,,,$2.46 ,$396.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.95 ,55,,,$2.46 ,$396.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.10 ,90,,,$2.46 ,$396.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$396.73 ,97,,,$2.46 ,$396.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$396.73 ,97,,,$2.46 ,$396.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$396.73 ,97,,,$2.46 ,$396.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$347.65 ,85,,,$2.46 ,$396.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$368.10 ,90,,,$2.46 ,$396.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.95 ,55,,,$2.46 ,$396.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$388.55 ,90,,,$2.46 ,$396.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.95 ,55,,,$2.46 ,$396.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.37 ,93,,,$2.46 ,$396.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cell Count/Diff Synovial Fluid HBL,10031527,CDM,300,RC,89050,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$2.08 ,$101.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.75 ,55,,,$2.08 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.08 ,$101.85 ,other,,Not applicable. No negotiated rates per contract,$2.08 ,44,,,$2.08 ,$101.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.00 ,80,,,$2.08 ,$101.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.75 ,55,,,$2.08 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$2.08 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$2.08 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$2.08 ,$101.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$2.08 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$2.08 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.75 ,55,,,$2.08 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.50 ,90,,,$2.08 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$2.08 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$2.08 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$2.08 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$2.08 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$2.08 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$2.08 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$2.08 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$2.08 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.65 ,93,,,$2.08 ,$101.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ceruloplasmin QST,8042517,CDM,301,RC,82390,HCPCS,outpatient,,,$157.00 ,$117.75 ,,$144.44 ,92,,,$4.73 ,$152.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$86.35 ,55,,,$4.73 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$152.29 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$152.29 ,fee schedule,,44% of CMS Medicare lab fee schedule,$125.60 ,80,,,$4.73 ,$152.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$86.35 ,55,,,$4.73 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,95,,,$4.73 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.15 ,95,,,$4.73 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.75 ,75,,,$4.73 ,$152.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$133.45 ,85,,,$4.73 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.29 ,97,,,$4.73 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.35 ,55,,,$4.73 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.30 ,90,,,$4.73 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.29 ,97,,,$4.73 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$4.73 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$4.73 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.45 ,85,,,$4.73 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.30 ,90,,,$4.73 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$4.73 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,90,,,$4.73 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$4.73 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.01 ,93,,,$4.73 ,$152.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Chem 8 Panel POCT,8273390,CDM,301,RC,80047,HCPCS,outpatient,,,$153.00 ,$114.75 ,,$140.76 ,92,,,$6.04 ,$148.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.15 ,55,,,$6.04 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.04 ,$148.41 ,other,,Not applicable. No negotiated rates per contract,$6.04 ,44,,,$6.04 ,$148.41 ,fee schedule,,44% of CMS Medicare lab fee schedule,$122.40 ,80,,,$6.04 ,$148.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.15 ,55,,,$6.04 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.35 ,95,,,$6.04 ,$148.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.35 ,95,,,$6.04 ,$148.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.75 ,75,,,$6.04 ,$148.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.05 ,85,,,$6.04 ,$148.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.41 ,97,,,$6.04 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.15 ,55,,,$6.04 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.70 ,90,,,$6.04 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.41 ,97,,,$6.04 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.41 ,97,,,$6.04 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.41 ,97,,,$6.04 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.05 ,85,,,$6.04 ,$148.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.70 ,90,,,$6.04 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.15 ,55,,,$6.04 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.35 ,90,,,$6.04 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.15 ,55,,,$6.04 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.29 ,93,,,$6.04 ,$148.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Chlamydia Trachomatis RNA,8611500,CDM,306,RC,87491,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Chlamydia Trachomatis RNA,8743178,CDM,306,RC,87491,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Chlamydia/N. Gonorrhoeae RNA,8042344,CDM,301,RC,87591,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Cholesterol Total,633705,CDM,301,RC,82465,HCPCS,outpatient,,,$104.00 ,$78.00 ,,$95.68 ,92,,,$1.91 ,$100.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.20 ,55,,,$1.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.91 ,$100.88 ,other,,Not applicable. No negotiated rates per contract,$1.91 ,44,,,$1.91 ,$100.88 ,fee schedule,,44% of CMS Medicare lab fee schedule,$83.20 ,80,,,$1.91 ,$100.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.20 ,55,,,$1.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,95,,,$1.91 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.80 ,95,,,$1.91 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.00 ,75,,,$1.91 ,$100.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.40 ,85,,,$1.91 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.88 ,97,,,$1.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.20 ,55,,,$1.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.60 ,90,,,$1.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.88 ,97,,,$1.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$1.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$1.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.40 ,85,,,$1.91 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.60 ,90,,,$1.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$1.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,90,,,$1.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$1.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.72 ,93,,,$1.91 ,$100.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Collection Processing Fee,8134317,CDM,300,RC,99001,HCPCS,outpatient,,,$57.00 ,$42.75 ,,$52.44 ,92,,,$31.35 ,$55.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.35 ,$55.29 ,other,,Not applicable. No negotiated rates per contract,$49.02 ,86,,,$31.35 ,$55.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.60 ,80,,,$31.35 ,$55.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,75,,,$31.35 ,$55.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.01 ,93,,,$31.35 ,$55.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Complement Component C3C QST,8177955,CDM,302,RC,86160,HCPCS,outpatient,,,$66.00 ,$49.50 ,,$60.72 ,92,,,$5.28 ,$64.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.28 ,$64.02 ,other,,Not applicable. No negotiated rates per contract,$5.28 ,44,,,$5.28 ,$64.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$52.80 ,80,,,$5.28 ,$64.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,95,,,$5.28 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.70 ,95,,,$5.28 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.50 ,75,,,$5.28 ,$64.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.10 ,85,,,$5.28 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.40 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,85,,,$5.28 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.40 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.38 ,93,,,$5.28 ,$64.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Complement Component C4C QST,8177956,CDM,302,RC,86160,HCPCS,outpatient,,,$66.00 ,$49.50 ,,$60.72 ,92,,,$5.28 ,$64.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.28 ,$64.02 ,other,,Not applicable. No negotiated rates per contract,$5.28 ,44,,,$5.28 ,$64.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$52.80 ,80,,,$5.28 ,$64.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,95,,,$5.28 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.70 ,95,,,$5.28 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.50 ,75,,,$5.28 ,$64.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.10 ,85,,,$5.28 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.40 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$5.28 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,85,,,$5.28 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.40 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,90,,,$5.28 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$5.28 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.38 ,93,,,$5.28 ,$64.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Complement,8042679,CDM,302,RC,86162,HCPCS,outpatient,,,,,,,,,,$8.94 ,$8.94 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.94 ,$8.94 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.94 ,$8.94 ,other,,Not applicable. No negotiated rates per contract,$8.94 ,44,,,$8.94 ,$8.94 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.94 ,$8.94 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.94 ,$8.94 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.94 ,$8.94 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.94 ,$8.94 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.94 ,$8.94 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.94 ,$8.94 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.94 ,$8.94 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Comprehensive Metabolic Panel QST,8147224,CDM,301,RC,80053,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$4.65 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.65 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$4.65 ,44,,,$4.65 ,$226.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$186.40 ,80,,,$4.65 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$4.65 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$4.65 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$4.65 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$4.65 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$4.65 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$4.65 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$4.65 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$4.65 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$4.65 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Comprehensive Metabolic Panel,9216161,CDM,301,RC,80053,HCPCS,outpatient,,,,,,,,,,$4.65 ,$4.65 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$4.65 ,$4.65 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.65 ,$4.65 ,other,,Not applicable. No negotiated rates per contract,$4.65 ,44,,,$4.65 ,$4.65 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$4.65 ,$4.65 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$4.65 ,$4.65 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.65 ,$4.65 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.65 ,$4.65 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.65 ,$4.65 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.65 ,$4.65 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.65 ,$4.65 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Copper QST,8042561,CDM,301,RC,82525,HCPCS,outpatient,,,$272.00 ,$204.00 ,,$250.24 ,92,,,$5.46 ,$263.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.60 ,55,,,$5.46 ,$263.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.46 ,$263.84 ,other,,Not applicable. No negotiated rates per contract,$5.46 ,44,,,$5.46 ,$263.84 ,fee schedule,,44% of CMS Medicare lab fee schedule,$217.60 ,80,,,$5.46 ,$263.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.60 ,55,,,$5.46 ,$263.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.40 ,95,,,$5.46 ,$263.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.40 ,95,,,$5.46 ,$263.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.00 ,75,,,$5.46 ,$263.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$231.20 ,85,,,$5.46 ,$263.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.84 ,97,,,$5.46 ,$263.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.60 ,55,,,$5.46 ,$263.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.80 ,90,,,$5.46 ,$263.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.84 ,97,,,$5.46 ,$263.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.84 ,97,,,$5.46 ,$263.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.84 ,97,,,$5.46 ,$263.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.20 ,85,,,$5.46 ,$263.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.80 ,90,,,$5.46 ,$263.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.60 ,55,,,$5.46 ,$263.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.40 ,90,,,$5.46 ,$263.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.60 ,55,,,$5.46 ,$263.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.96 ,93,,,$5.46 ,$263.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cortisol,8042609,CDM,301,RC,82533,HCPCS,outpatient,,,,,,,,,,$7.17 ,$7.17 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,,Not applicable. No negotiated rates per contract,$7.17 ,44,,,$7.17 ,$7.17 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.17 ,$7.17 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Cortisol,8042574,CDM,301,RC,82533,HCPCS,outpatient,,,,,,,,,,$7.17 ,$7.17 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,,Not applicable. No negotiated rates per contract,$7.17 ,44,,,$7.17 ,$7.17 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.17 ,$7.17 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.17 ,$7.17 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.17 ,$7.17 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Creat Clear,633609,CDM,301,RC,82575,HCPCS,outpatient,,,$282.00 ,$211.50 ,,$259.44 ,92,,,$4.16 ,$273.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.10 ,55,,,$4.16 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.16 ,$273.54 ,other,,Not applicable. No negotiated rates per contract,$4.16 ,44,,,$4.16 ,$273.54 ,fee schedule,,44% of CMS Medicare lab fee schedule,$225.60 ,80,,,$4.16 ,$273.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.10 ,55,,,$4.16 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.90 ,95,,,$4.16 ,$273.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.90 ,95,,,$4.16 ,$273.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$211.50 ,75,,,$4.16 ,$273.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$239.70 ,85,,,$4.16 ,$273.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$273.54 ,97,,,$4.16 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.10 ,55,,,$4.16 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$253.80 ,90,,,$4.16 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.54 ,97,,,$4.16 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.54 ,97,,,$4.16 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.54 ,97,,,$4.16 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.70 ,85,,,$4.16 ,$273.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$253.80 ,90,,,$4.16 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.10 ,55,,,$4.16 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.90 ,90,,,$4.16 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.10 ,55,,,$4.16 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.26 ,93,,,$4.16 ,$273.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatine Kinase,633712,CDM,301,RC,82550,HCPCS,outpatient,,,$143.00 ,$107.25 ,,$131.56 ,92,,,$2.86 ,$138.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.65 ,55,,,$2.86 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.86 ,$138.71 ,other,,Not applicable. No negotiated rates per contract,$2.86 ,44,,,$2.86 ,$138.71 ,fee schedule,,44% of CMS Medicare lab fee schedule,$114.40 ,80,,,$2.86 ,$138.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.65 ,55,,,$2.86 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.85 ,95,,,$2.86 ,$138.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.85 ,95,,,$2.86 ,$138.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$107.25 ,75,,,$2.86 ,$138.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$121.55 ,85,,,$2.86 ,$138.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.71 ,97,,,$2.86 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.65 ,55,,,$2.86 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.70 ,90,,,$2.86 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.71 ,97,,,$2.86 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.71 ,97,,,$2.86 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.71 ,97,,,$2.86 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,85,,,$2.86 ,$138.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.70 ,90,,,$2.86 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.65 ,55,,,$2.86 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.85 ,90,,,$2.86 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.65 ,55,,,$2.86 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.99 ,93,,,$2.86 ,$138.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine,3454470,CDM,301,RC,82565,HCPCS,outpatient,,,$136.00 ,$102.00 ,,$125.12 ,92,,,$2.25 ,$131.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.25 ,$131.92 ,other,,Not applicable. No negotiated rates per contract,$2.25 ,44,,,$2.25 ,$131.92 ,fee schedule,,44% of CMS Medicare lab fee schedule,$108.80 ,80,,,$2.25 ,$131.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,95,,,$2.25 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$129.20 ,95,,,$2.25 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.00 ,75,,,$2.25 ,$131.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$115.60 ,85,,,$2.25 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.40 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.25 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.60 ,85,,,$2.25 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.40 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,90,,,$2.25 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.25 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.48 ,93,,,$2.25 ,$131.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine Level 24 Hour Urine,1634894,CDM,301,RC,82570,HCPCS,outpatient,,,$33.00 ,$24.75 ,,$30.36 ,92,,,$2.28 ,$32.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.15 ,55,,,$2.28 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$32.01 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$32.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$26.40 ,80,,,$2.28 ,$32.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.15 ,55,,,$2.28 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,95,,,$2.28 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.35 ,95,,,$2.28 ,$32.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.75 ,75,,,$2.28 ,$32.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.05 ,85,,,$2.28 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.01 ,97,,,$2.28 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.15 ,55,,,$2.28 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,90,,,$2.28 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.01 ,97,,,$2.28 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$2.28 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$2.28 ,$32.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,85,,,$2.28 ,$32.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.70 ,90,,,$2.28 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$2.28 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$2.28 ,$32.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.15 ,55,,,$2.28 ,$32.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.69 ,93,,,$2.28 ,$32.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine Urine,1930782,CDM,301,RC,82570,HCPCS,outpatient,,,$106.00 ,$79.50 ,,$97.52 ,92,,,$2.28 ,$102.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$102.82 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$102.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.80 ,80,,,$2.28 ,$102.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,95,,,$2.28 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.70 ,95,,,$2.28 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.50 ,75,,,$2.28 ,$102.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.10 ,85,,,$2.28 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.40 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.28 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.10 ,85,,,$2.28 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.40 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,90,,,$2.28 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.28 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.58 ,93,,,$2.28 ,$102.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Creatinine,8042717,CDM,300,RC,82570,HCPCS,outpatient,,,,,,,,,,$2.28 ,$2.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$2.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.28 ,$2.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Creatinine,8049080,CDM,300,RC,82570,HCPCS,outpatient,,,,,,,,,,$2.28 ,$2.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$2.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.28 ,$2.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Creatinine,8422361,CDM,300,RC,82570,HCPCS,outpatient,,,,,,,,,,$2.28 ,$2.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$2.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.28 ,$2.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Creatinine,8743211,CDM,300,RC,82570,HCPCS,outpatient,,,,,,,,,,$2.28 ,$2.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$2.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$2.28 ,$2.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$2.28 ,$2.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$2.28 ,$2.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Crystal Identification HBL,10031526,CDM,300,RC,89060,HCPCS,outpatient,,,$210.00 ,$157.50 ,,$193.20 ,92,,,$3.23 ,$203.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.23 ,$203.70 ,other,,Not applicable. No negotiated rates per contract,$3.23 ,44,,,$3.23 ,$203.70 ,fee schedule,,44% of CMS Medicare lab fee schedule,$168.00 ,80,,,$3.23 ,$203.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,95,,,$3.23 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.50 ,95,,,$3.23 ,$203.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.50 ,75,,,$3.23 ,$203.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.50 ,85,,,$3.23 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.00 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.70 ,97,,,$3.23 ,$203.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.50 ,85,,,$3.23 ,$203.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.00 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.50 ,90,,,$3.23 ,$203.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.50 ,55,,,$3.23 ,$203.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.30 ,93,,,$3.23 ,$203.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cystatin C w/ GFR,8414453,CDM,301,RC,82610,HCPCS,outpatient,,,$514.00 ,$385.50 ,,$472.88 ,92,,,$8.15 ,$498.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.70 ,55,,,$8.15 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.15 ,$498.58 ,other,,Not applicable. No negotiated rates per contract,$8.15 ,44,,,$8.15 ,$498.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,$411.20 ,80,,,$8.15 ,$498.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.70 ,55,,,$8.15 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,95,,,$8.15 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.30 ,95,,,$8.15 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.50 ,75,,,$8.15 ,$498.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.90 ,85,,,$8.15 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$498.58 ,97,,,$8.15 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.70 ,55,,,$8.15 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.60 ,90,,,$8.15 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$498.58 ,97,,,$8.15 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$8.15 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$8.15 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.90 ,85,,,$8.15 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.60 ,90,,,$8.15 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$8.15 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,90,,,$8.15 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$8.15 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.02 ,93,,,$8.15 ,$498.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cytomegalovirus Ab (IgG) QST,8042607,CDM,300,RC,86644,HCPCS,outpatient,,,$300.00 ,$225.00 ,,$276.00 ,92,,,$6.33 ,$291.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$165.00 ,55,,,$6.33 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$291.00 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$291.00 ,fee schedule,,44% of CMS Medicare lab fee schedule,$240.00 ,80,,,$6.33 ,$291.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$165.00 ,55,,,$6.33 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.00 ,95,,,$6.33 ,$291.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$285.00 ,95,,,$6.33 ,$291.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.00 ,75,,,$6.33 ,$291.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$255.00 ,85,,,$6.33 ,$291.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.00 ,97,,,$6.33 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.00 ,55,,,$6.33 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.00 ,90,,,$6.33 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.00 ,97,,,$6.33 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.00 ,97,,,$6.33 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.00 ,97,,,$6.33 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.00 ,85,,,$6.33 ,$291.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.00 ,90,,,$6.33 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.00 ,55,,,$6.33 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.00 ,90,,,$6.33 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.00 ,55,,,$6.33 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$279.00 ,93,,,$6.33 ,$291.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cytomegalovirus Ab (IgG) QST,8422811,CDM,300,RC,86644,HCPCS,outpatient,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$6.33 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$6.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$117.37 ,fee schedule,,44% of CMS Medicare lab fee schedule,$96.80 ,80,,,$6.33 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$6.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$6.33 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$6.33 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$6.33 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$6.33 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$6.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$6.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$6.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$6.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$6.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$6.33 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$6.33 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$6.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$6.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$6.33 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$6.33 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$6.33 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cytomegalovirus Ab (IgM) QST,8042721,CDM,300,RC,86645,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$7.41 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.41 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$7.41 ,44,,,$7.41 ,$262.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$216.80 ,80,,,$7.41 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$7.41 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$7.41 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$7.41 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$7.41 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$7.41 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$7.41 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Cytomegalovirus Ab (IgM) QST,8422458,CDM,300,RC,86645,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$7.41 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.41 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$7.41 ,44,,,$7.41 ,$262.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$216.80 ,80,,,$7.41 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$7.41 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$7.41 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$7.41 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$7.41 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$7.41 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$7.41 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$7.41 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$7.41 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$7.41 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
D-Dimer,3454398,CDM,305,RC,85379,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$4.48 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$4.48 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.48 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$4.48 ,44,,,$4.48 ,$146.47 ,fee schedule,,44% of CMS Medicare lab fee schedule,$120.80 ,80,,,$4.48 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$4.48 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$4.48 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$4.48 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$4.48 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$4.48 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$4.48 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$4.48 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$4.48 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$4.48 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$4.48 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$4.48 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$4.48 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$4.48 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$4.48 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$4.48 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$4.48 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$4.48 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DHEA Sulfate QST,8042605,CDM,301,RC,82627,HCPCS,outpatient,,,$420.00 ,$315.00 ,,$386.40 ,92,,,$9.78 ,$407.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$231.00 ,55,,,$9.78 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.78 ,$407.40 ,other,,Not applicable. No negotiated rates per contract,$9.78 ,44,,,$9.78 ,$407.40 ,fee schedule,,44% of CMS Medicare lab fee schedule,$336.00 ,80,,,$9.78 ,$407.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$231.00 ,55,,,$9.78 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.00 ,95,,,$9.78 ,$407.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$399.00 ,95,,,$9.78 ,$407.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.00 ,75,,,$9.78 ,$407.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$357.00 ,85,,,$9.78 ,$407.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$407.40 ,97,,,$9.78 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.00 ,55,,,$9.78 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.00 ,90,,,$9.78 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.40 ,97,,,$9.78 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.40 ,97,,,$9.78 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.40 ,97,,,$9.78 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$357.00 ,85,,,$9.78 ,$407.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$378.00 ,90,,,$9.78 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.00 ,55,,,$9.78 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.00 ,90,,,$9.78 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.00 ,55,,,$9.78 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$390.60 ,93,,,$9.78 ,$407.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DNA (ds) Antibody QST,8042450,CDM,302,RC,86225,HCPCS,outpatient,,,$284.00 ,$213.00 ,,$261.28 ,92,,,$6.05 ,$275.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.20 ,55,,,$6.05 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.05 ,$275.48 ,other,,Not applicable. No negotiated rates per contract,$6.05 ,44,,,$6.05 ,$275.48 ,fee schedule,,44% of CMS Medicare lab fee schedule,$227.20 ,80,,,$6.05 ,$275.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.20 ,55,,,$6.05 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,95,,,$6.05 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.80 ,95,,,$6.05 ,$275.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.00 ,75,,,$6.05 ,$275.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.40 ,85,,,$6.05 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.48 ,97,,,$6.05 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.20 ,55,,,$6.05 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.60 ,90,,,$6.05 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.48 ,97,,,$6.05 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$6.05 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.48 ,97,,,$6.05 ,$275.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.40 ,85,,,$6.05 ,$275.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.60 ,90,,,$6.05 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$6.05 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.80 ,90,,,$6.05 ,$275.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.20 ,55,,,$6.05 ,$275.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.12 ,93,,,$6.05 ,$275.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Digoxin Level,1628891,CDM,301,RC,80162,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$5.84 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$5.84 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.84 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$5.84 ,44,,,$5.84 ,$173.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$143.20 ,80,,,$5.84 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$5.84 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$5.84 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$5.84 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$5.84 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$5.84 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$5.84 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$5.84 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$5.84 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$5.84 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$5.84 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$5.84 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$5.84 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$5.84 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$5.84 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$5.84 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$5.84 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$5.84 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Diphtheria Antitoxoid QST,8042632,CDM,300,RC,86648,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$103.04 ,92,,,$6.69 ,$108.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.69 ,$108.64 ,other,,Not applicable. No negotiated rates per contract,$6.69 ,44,,,$6.69 ,$108.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$89.60 ,80,,,$6.69 ,$108.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,95,,,$6.69 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.40 ,95,,,$6.69 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.00 ,75,,,$6.69 ,$108.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$95.20 ,85,,,$6.69 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.80 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.20 ,85,,,$6.69 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.80 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.16 ,93,,,$6.69 ,$108.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Diphtheria Antitoxoid QST,8178026,CDM,300,RC,86648,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$103.04 ,92,,,$6.69 ,$108.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.69 ,$108.64 ,other,,Not applicable. No negotiated rates per contract,$6.69 ,44,,,$6.69 ,$108.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$89.60 ,80,,,$6.69 ,$108.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,95,,,$6.69 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.40 ,95,,,$6.69 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.00 ,75,,,$6.69 ,$108.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$95.20 ,85,,,$6.69 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.80 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.69 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.20 ,85,,,$6.69 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.80 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,90,,,$6.69 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.69 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.16 ,93,,,$6.69 ,$108.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Drug Screen Urine,3454403,CDM,301,RC,80306,HCPCS,outpatient,,,$70.00 ,$52.50 ,,$64.40 ,92,,,$7.54 ,$67.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.50 ,55,,,$7.54 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.54 ,$67.90 ,other,,Not applicable. No negotiated rates per contract,$7.54 ,44,,,$7.54 ,$67.90 ,fee schedule,,44% of CMS Medicare lab fee schedule,$56.00 ,80,,,$7.54 ,$67.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.50 ,55,,,$7.54 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,95,,,$7.54 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.50 ,95,,,$7.54 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.50 ,75,,,$7.54 ,$67.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.50 ,85,,,$7.54 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.90 ,97,,,$7.54 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.50 ,55,,,$7.54 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.00 ,90,,,$7.54 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.90 ,97,,,$7.54 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$7.54 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$7.54 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.50 ,85,,,$7.54 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.00 ,90,,,$7.54 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$7.54 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,90,,,$7.54 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$7.54 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.10 ,93,,,$7.54 ,$67.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Drug Screen Urine - Employee,8277381,CDM,301,RC,80305,HCPCS,outpatient,,,$41.00 ,$30.75 ,,$37.72 ,92,,,$5.54 ,$39.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.55 ,55,,,$5.54 ,$39.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.54 ,$39.77 ,other,,Not applicable. No negotiated rates per contract,$5.54 ,44,,,$5.54 ,$39.77 ,fee schedule,,44% of CMS Medicare lab fee schedule,$32.80 ,80,,,$5.54 ,$39.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.55 ,55,,,$5.54 ,$39.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.95 ,95,,,$5.54 ,$39.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.95 ,95,,,$5.54 ,$39.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.75 ,75,,,$5.54 ,$39.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.85 ,85,,,$5.54 ,$39.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.77 ,97,,,$5.54 ,$39.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.55 ,55,,,$5.54 ,$39.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.90 ,90,,,$5.54 ,$39.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.77 ,97,,,$5.54 ,$39.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.77 ,97,,,$5.54 ,$39.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.77 ,97,,,$5.54 ,$39.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.85 ,85,,,$5.54 ,$39.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.90 ,90,,,$5.54 ,$39.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.55 ,55,,,$5.54 ,$39.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.95 ,90,,,$5.54 ,$39.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.55 ,55,,,$5.54 ,$39.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.13 ,93,,,$5.54 ,$39.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Drug Screen- Collection Only DOT,8134319,CDM,300,RC,99001,HCPCS,outpatient,,,$57.00 ,$42.75 ,,$52.44 ,92,,,$31.35 ,$55.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.35 ,$55.29 ,other,,Not applicable. No negotiated rates per contract,$49.02 ,86,,,$31.35 ,$55.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.60 ,80,,,$31.35 ,$55.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.15 ,95,,,$31.35 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,75,,,$31.35 ,$55.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$31.35 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.45 ,85,,,$31.35 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.30 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,90,,,$31.35 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$31.35 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.01 ,93,,,$31.35 ,$55.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Drug Scrn Panel (10),8046168,CDM,301,RC,80306,HCPCS,outpatient,,,$69.00 ,$51.75 ,,$63.48 ,92,,,$7.54 ,$66.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.95 ,55,,,$7.54 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.54 ,$66.93 ,other,,Not applicable. No negotiated rates per contract,$7.54 ,44,,,$7.54 ,$66.93 ,fee schedule,,44% of CMS Medicare lab fee schedule,$55.20 ,80,,,$7.54 ,$66.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.95 ,55,,,$7.54 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,95,,,$7.54 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.55 ,95,,,$7.54 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.75 ,75,,,$7.54 ,$66.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.65 ,85,,,$7.54 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.93 ,97,,,$7.54 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.95 ,55,,,$7.54 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.10 ,90,,,$7.54 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.93 ,97,,,$7.54 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$7.54 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$7.54 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.65 ,85,,,$7.54 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.10 ,90,,,$7.54 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$7.54 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,90,,,$7.54 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$7.54 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.17 ,93,,,$7.54 ,$66.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EBV Nuclear Ag (EBNA) Ab (IgG) QST,8042725,CDM,302,RC,86664,HCPCS,outpatient,,,$292.00 ,$219.00 ,,$268.64 ,92,,,$6.73 ,$283.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.60 ,55,,,$6.73 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.73 ,$283.24 ,other,,Not applicable. No negotiated rates per contract,$6.73 ,44,,,$6.73 ,$283.24 ,fee schedule,,44% of CMS Medicare lab fee schedule,$233.60 ,80,,,$6.73 ,$283.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.60 ,55,,,$6.73 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,95,,,$6.73 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.40 ,95,,,$6.73 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.00 ,75,,,$6.73 ,$283.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$248.20 ,85,,,$6.73 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.24 ,97,,,$6.73 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.60 ,55,,,$6.73 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.80 ,90,,,$6.73 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$283.24 ,97,,,$6.73 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$6.73 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$6.73 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.20 ,85,,,$6.73 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.80 ,90,,,$6.73 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$6.73 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,90,,,$6.73 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$6.73 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.56 ,93,,,$6.73 ,$283.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EBV Viral Capsid Ag (VCA) Ab (IgM) QST,8042716,CDM,302,RC,86665,HCPCS,outpatient,,,$292.00 ,$219.00 ,,$268.64 ,92,,,$7.98 ,$283.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.60 ,55,,,$7.98 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.98 ,$283.24 ,other,,Not applicable. No negotiated rates per contract,$7.98 ,44,,,$7.98 ,$283.24 ,fee schedule,,44% of CMS Medicare lab fee schedule,$233.60 ,80,,,$7.98 ,$283.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.60 ,55,,,$7.98 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,95,,,$7.98 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.40 ,95,,,$7.98 ,$283.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.00 ,75,,,$7.98 ,$283.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$248.20 ,85,,,$7.98 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.24 ,97,,,$7.98 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.60 ,55,,,$7.98 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.80 ,90,,,$7.98 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$283.24 ,97,,,$7.98 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$7.98 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.24 ,97,,,$7.98 ,$283.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.20 ,85,,,$7.98 ,$283.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.80 ,90,,,$7.98 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$7.98 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.40 ,90,,,$7.98 ,$283.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.60 ,55,,,$7.98 ,$283.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.56 ,93,,,$7.98 ,$283.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ESR,1902793,CDM,305,RC,85652,HCPCS,outpatient,,,$30.00 ,$22.50 ,,$27.60 ,92,,,$1.19 ,$29.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.50 ,55,,,$1.19 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.19 ,$29.10 ,other,,Not applicable. No negotiated rates per contract,$1.19 ,44,,,$1.19 ,$29.10 ,fee schedule,,44% of CMS Medicare lab fee schedule,$24.00 ,80,,,$1.19 ,$29.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.50 ,55,,,$1.19 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,95,,,$1.19 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.50 ,95,,,$1.19 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.50 ,75,,,$1.19 ,$29.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.50 ,85,,,$1.19 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.10 ,97,,,$1.19 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.50 ,55,,,$1.19 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.00 ,90,,,$1.19 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.10 ,97,,,$1.19 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.19 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.19 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.50 ,85,,,$1.19 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.00 ,90,,,$1.19 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.19 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,90,,,$1.19 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.19 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.90 ,93,,,$1.19 ,$29.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ear Culture HBL,8836658,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Endomysial Ab Scr (IgA) w/Rfx To Titer QST SMOOTH MUSCLE (ACTIN),8602824,CDM,302,RC,86255,HCPCS,outpatient,,,$97.00 ,$72.75 ,,$89.24 ,92,,,$5.30 ,$94.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.30 ,$94.09 ,other,,Not applicable. No negotiated rates per contract,$5.30 ,44,,,$5.30 ,$94.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,$77.60 ,80,,,$5.30 ,$94.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,95,,,$5.30 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.15 ,95,,,$5.30 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.75 ,75,,,$5.30 ,$94.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$82.45 ,85,,,$5.30 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.30 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$5.30 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,85,,,$5.30 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.30 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,90,,,$5.30 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$5.30 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.21 ,93,,,$5.30 ,$94.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Erythropoietin QST,8042610,CDM,300,RC,82668,HCPCS,outpatient,,,$374.00 ,$280.50 ,,$344.08 ,92,,,$8.27 ,$362.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.70 ,55,,,$8.27 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.27 ,$362.78 ,other,,Not applicable. No negotiated rates per contract,$8.27 ,44,,,$8.27 ,$362.78 ,fee schedule,,44% of CMS Medicare lab fee schedule,$299.20 ,80,,,$8.27 ,$362.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.70 ,55,,,$8.27 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,95,,,$8.27 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$355.30 ,95,,,$8.27 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$280.50 ,75,,,$8.27 ,$362.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.90 ,85,,,$8.27 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$362.78 ,97,,,$8.27 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.70 ,55,,,$8.27 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$336.60 ,90,,,$8.27 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$362.78 ,97,,,$8.27 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$8.27 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$8.27 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.90 ,85,,,$8.27 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$336.60 ,90,,,$8.27 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$8.27 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,90,,,$8.27 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$8.27 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.82 ,93,,,$8.27 ,$362.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Estradiol QST,8042606,CDM,301,RC,82670,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$12.29 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$12.29 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$12.29 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$12.29 ,44,,,$12.29 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$12.29 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$12.29 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$12.29 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$12.29 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$12.29 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$12.29 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$12.29 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$12.29 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$12.29 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$12.29 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$12.29 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$12.29 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$12.29 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$12.29 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$12.29 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$12.29 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$12.29 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$12.29 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FSH QST,8042625,CDM,301,RC,83001,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$8.18 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$8.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.18 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$8.18 ,44,,,$8.18 ,$174.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,$144.00 ,80,,,$8.18 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$8.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$8.18 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$8.18 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$8.18 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$8.18 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$8.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$8.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$8.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$8.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$8.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$8.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$8.18 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$8.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$8.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$8.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$8.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$8.18 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FTA-Abs QST,8042608,CDM,302,RC,86780,HCPCS,outpatient,,,$162.00 ,$121.50 ,,$149.04 ,92,,,$5.83 ,$157.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.10 ,55,,,$5.83 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.83 ,$157.14 ,other,,Not applicable. No negotiated rates per contract,$5.83 ,44,,,$5.83 ,$157.14 ,fee schedule,,44% of CMS Medicare lab fee schedule,$129.60 ,80,,,$5.83 ,$157.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.10 ,55,,,$5.83 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,95,,,$5.83 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.90 ,95,,,$5.83 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.50 ,75,,,$5.83 ,$157.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$137.70 ,85,,,$5.83 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.14 ,97,,,$5.83 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.10 ,55,,,$5.83 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.80 ,90,,,$5.83 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.14 ,97,,,$5.83 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$5.83 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$5.83 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.70 ,85,,,$5.83 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.80 ,90,,,$5.83 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$5.83 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$5.83 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$5.83 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.66 ,93,,,$5.83 ,$157.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Factor V (Leiden) Mutation Analysis QST,8042399,CDM,306,RC,81241,HCPCS,outpatient,,,$919.00 ,$689.25 ,,$845.48 ,92,,,$32.28 ,$891.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$505.45 ,55,,,$32.28 ,$891.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.28 ,$891.43 ,other,,Not applicable. No negotiated rates per contract,$32.28 ,44,,,$32.28 ,$891.43 ,fee schedule,,44% of CMS Medicare lab fee schedule,$735.20 ,80,,,$32.28 ,$891.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$505.45 ,55,,,$32.28 ,$891.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$873.05 ,95,,,$32.28 ,$891.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$873.05 ,95,,,$32.28 ,$891.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$689.25 ,75,,,$32.28 ,$891.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$781.15 ,85,,,$32.28 ,$891.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$891.43 ,97,,,$32.28 ,$891.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.45 ,55,,,$32.28 ,$891.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.10 ,90,,,$32.28 ,$891.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$891.43 ,97,,,$32.28 ,$891.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$891.43 ,97,,,$32.28 ,$891.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$891.43 ,97,,,$32.28 ,$891.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$781.15 ,85,,,$32.28 ,$891.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$827.10 ,90,,,$32.28 ,$891.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$505.45 ,55,,,$32.28 ,$891.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$873.05 ,90,,,$32.28 ,$891.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$505.45 ,55,,,$32.28 ,$891.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$854.67 ,93,,,$32.28 ,$891.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Fecal Occult Blood,4123037,CDM,301,RC,82274,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$7.00 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$7.00 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.00 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$7.00 ,44,,,$7.00 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$7.00 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$7.00 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$7.00 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$7.00 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$7.00 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$7.00 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$7.00 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$7.00 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$7.00 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$7.00 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$7.00 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$7.00 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$7.00 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$7.00 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$7.00 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$7.00 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$7.00 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$7.00 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Fecal WBC,4123047,CDM,300,RC,83630,HCPCS,outpatient,,,$190.00 ,$142.50 ,,$174.80 ,92,,,$8.67 ,$184.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.50 ,55,,,$8.67 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.67 ,$184.30 ,other,,Not applicable. No negotiated rates per contract,$8.67 ,44,,,$8.67 ,$184.30 ,fee schedule,,44% of CMS Medicare lab fee schedule,$152.00 ,80,,,$8.67 ,$184.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.50 ,55,,,$8.67 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,95,,,$8.67 ,$184.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.50 ,95,,,$8.67 ,$184.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,75,,,$8.67 ,$184.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$161.50 ,85,,,$8.67 ,$184.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$184.30 ,97,,,$8.67 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.50 ,55,,,$8.67 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$8.67 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.30 ,97,,,$8.67 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$8.67 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$8.67 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.50 ,85,,,$8.67 ,$184.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.00 ,90,,,$8.67 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.50 ,55,,,$8.67 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,90,,,$8.67 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.50 ,55,,,$8.67 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,93,,,$8.67 ,$184.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ferritin,1628893,CDM,301,RC,82728,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$6.00 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.00 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$6.00 ,44,,,$6.00 ,$174.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,$144.00 ,80,,,$6.00 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$6.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$6.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$6.00 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$6.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$6.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$6.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$6.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$6.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$6.00 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
First Trimester Screen,9052718,CDM,300,RC,81508,HCPCS,outpatient,,,,,,,,,,$23.89 ,$23.89 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$23.89 ,$23.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$23.89 ,$23.89 ,other,,Not applicable. No negotiated rates per contract,$23.89 ,44,,,$23.89 ,$23.89 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$23.89 ,$23.89 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$23.89 ,$23.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$23.89 ,$23.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$23.89 ,$23.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$23.89 ,$23.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$23.89 ,$23.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$23.89 ,$23.89 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Folate QST,8147204,CDM,301,RC,82746,HCPCS,outpatient,,,$162.00 ,$121.50 ,,$149.04 ,92,,,$6.47 ,$157.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.10 ,55,,,$6.47 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.47 ,$157.14 ,other,,Not applicable. No negotiated rates per contract,$6.47 ,44,,,$6.47 ,$157.14 ,fee schedule,,44% of CMS Medicare lab fee schedule,$129.60 ,80,,,$6.47 ,$157.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.10 ,55,,,$6.47 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,95,,,$6.47 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.90 ,95,,,$6.47 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.50 ,75,,,$6.47 ,$157.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$137.70 ,85,,,$6.47 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.14 ,97,,,$6.47 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.10 ,55,,,$6.47 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.80 ,90,,,$6.47 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.14 ,97,,,$6.47 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$6.47 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$6.47 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.70 ,85,,,$6.47 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.80 ,90,,,$6.47 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$6.47 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$6.47 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$6.47 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.66 ,93,,,$6.47 ,$157.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Free T4 Level,3170324,CDM,301,RC,84439,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$3.97 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$3.97 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.97 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$3.97 ,44,,,$3.97 ,$93.12 ,fee schedule,,44% of CMS Medicare lab fee schedule,$76.80 ,80,,,$3.97 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$3.97 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$3.97 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$3.97 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$3.97 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$3.97 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$3.97 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$3.97 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$3.97 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$3.97 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$3.97 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$3.97 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$3.97 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$3.97 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$3.97 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$3.97 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$3.97 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$3.97 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Fungus Culture HBL,8836659,CDM,306,RC,87102,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$3.70 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$3.70 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.70 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$3.70 ,44,,,$3.70 ,$122.22 ,fee schedule,,44% of CMS Medicare lab fee schedule,$100.80 ,80,,,$3.70 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$3.70 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$3.70 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$3.70 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$3.70 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$3.70 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$3.70 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$3.70 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$3.70 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$3.70 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$3.70 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$3.70 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$3.70 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$3.70 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$3.70 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$3.70 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$3.70 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$3.70 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GC/Chlamydia Combo Target Amp HBL,8836678,CDM,306,RC,87491,HCPCS,outpatient,,,$164.00 ,$123.00 ,,$150.88 ,92,,,$15.44 ,$159.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$159.08 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$159.08 ,fee schedule,,44% of CMS Medicare lab fee schedule,$131.20 ,80,,,$15.44 ,$159.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,95,,,$15.44 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$155.80 ,95,,,$15.44 ,$159.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.00 ,75,,,$15.44 ,$159.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.40 ,85,,,$15.44 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.60 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.08 ,97,,,$15.44 ,$159.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.40 ,85,,,$15.44 ,$159.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.60 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.80 ,90,,,$15.44 ,$159.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.20 ,55,,,$15.44 ,$159.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.52 ,93,,,$15.44 ,$159.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GI Panel (BioFire),8044905,CDM,306,RC,87507,HCPCS,outpatient,,,"$1,298.00 ",$973.50 ,,"$1,194.16 ",92,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$713.90 ,55,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.38 ,"$1,259.06 ",other,,Not applicable. No negotiated rates per contract,$183.38 ,44,,,$183.38 ,"$1,259.06 ",fee schedule,,44% of CMS Medicare lab fee schedule,"$1,038.40 ",80,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$713.90 ,55,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",95,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,233.10 ",95,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$973.50 ,75,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$713.90 ,55,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,168.20 ",90,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,168.20 ",90,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",90,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,207.14 ",93,,,$183.38 ,"$1,259.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Gamma Glutamyl Transferase,1628895,CDM,301,RC,82977,HCPCS,outpatient,,,$182.00 ,$136.50 ,,$167.44 ,92,,,$3.17 ,$176.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.10 ,55,,,$3.17 ,$176.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.17 ,$176.54 ,other,,Not applicable. No negotiated rates per contract,$3.17 ,44,,,$3.17 ,$176.54 ,fee schedule,,44% of CMS Medicare lab fee schedule,$145.60 ,80,,,$3.17 ,$176.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.10 ,55,,,$3.17 ,$176.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,95,,,$3.17 ,$176.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.90 ,95,,,$3.17 ,$176.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.50 ,75,,,$3.17 ,$176.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$154.70 ,85,,,$3.17 ,$176.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.54 ,97,,,$3.17 ,$176.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.10 ,55,,,$3.17 ,$176.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.80 ,90,,,$3.17 ,$176.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.54 ,97,,,$3.17 ,$176.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$3.17 ,$176.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.54 ,97,,,$3.17 ,$176.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.70 ,85,,,$3.17 ,$176.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$163.80 ,90,,,$3.17 ,$176.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.10 ,55,,,$3.17 ,$176.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.90 ,90,,,$3.17 ,$176.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.10 ,55,,,$3.17 ,$176.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.26 ,93,,,$3.17 ,$176.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gardnerella Vaginalis QST,8611507,CDM,306,RC,87512,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$18.37 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$18.37 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.37 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$18.37 ,44,,,$18.37 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$18.37 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$18.37 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$18.37 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$18.37 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$18.37 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$18.37 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$18.37 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$18.37 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$18.37 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$18.37 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.37 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.37 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$18.37 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$18.37 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.37 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$18.37 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.37 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$18.37 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Genital Cult & GC Screen HBL,8836660,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gluc F,3454411,CDM,301,RC,82947,HCPCS,outpatient,,,$35.00 ,$26.25 ,,$32.20 ,92,,,$1.73 ,$33.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.73 ,$33.95 ,other,,Not applicable. No negotiated rates per contract,$1.73 ,44,,,$1.73 ,$33.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$28.00 ,80,,,$1.73 ,$33.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,95,,,$1.73 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.25 ,95,,,$1.73 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.25 ,75,,,$1.73 ,$33.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.75 ,85,,,$1.73 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$1.73 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.75 ,85,,,$1.73 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.50 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,90,,,$1.73 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$1.73 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.55 ,93,,,$1.73 ,$33.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Glucose CSF,1628897,CDM,301,RC,82945,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.73 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.73 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.73 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.73 ,44,,,$1.73 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.73 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.73 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.73 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.73 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.73 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.73 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.73 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.73 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.73 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.73 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.73 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.73 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.73 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.73 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.73 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.73 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.73 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.73 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Glucose POCT,1635509,CDM,305,RC,82962,HCPCS,outpatient,,,$30.00 ,$22.50 ,,$27.60 ,92,,,$1.44 ,$29.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.44 ,$29.10 ,other,,Not applicable. No negotiated rates per contract,$1.44 ,44,,,$1.44 ,$29.10 ,fee schedule,,44% of CMS Medicare lab fee schedule,$24.00 ,80,,,$1.44 ,$29.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,95,,,$1.44 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.50 ,95,,,$1.44 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.50 ,75,,,$1.44 ,$29.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.50 ,85,,,$1.44 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.00 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.50 ,85,,,$1.44 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.00 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.90 ,93,,,$1.44 ,$29.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Glucose Tolerance Test 1 Hour,8190576,CDM,301,RC,82950,HCPCS,outpatient,,,$97.00 ,$72.75 ,,$89.24 ,92,,,$2.09 ,$94.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.35 ,55,,,$2.09 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.09 ,$94.09 ,other,,Not applicable. No negotiated rates per contract,$2.09 ,44,,,$2.09 ,$94.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,$77.60 ,80,,,$2.09 ,$94.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.35 ,55,,,$2.09 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,95,,,$2.09 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.15 ,95,,,$2.09 ,$94.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.75 ,75,,,$2.09 ,$94.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$82.45 ,85,,,$2.09 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.09 ,97,,,$2.09 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.35 ,55,,,$2.09 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.30 ,90,,,$2.09 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.09 ,97,,,$2.09 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$2.09 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.09 ,97,,,$2.09 ,$94.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,85,,,$2.09 ,$94.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.30 ,90,,,$2.09 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$2.09 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.15 ,90,,,$2.09 ,$94.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.35 ,55,,,$2.09 ,$94.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.21 ,93,,,$2.09 ,$94.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Glucose Tolerance Test 3 Hour,8686279,CDM,301,RC,82951,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$5.66 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$5.66 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.66 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$5.66 ,44,,,$5.66 ,$226.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$186.40 ,80,,,$5.66 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$5.66 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$5.66 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$5.66 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$5.66 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$5.66 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$5.66 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$5.66 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$5.66 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$5.66 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$5.66 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$5.66 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$5.66 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$5.66 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$5.66 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$5.66 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$5.66 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$5.66 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gram Stain HBL,8836661,CDM,306,RC,87205,HCPCS,outpatient,,,$90.00 ,$67.50 ,,$82.80 ,92,,,$1.88 ,$87.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.50 ,55,,,$1.88 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.88 ,$87.30 ,other,,Not applicable. No negotiated rates per contract,$1.88 ,44,,,$1.88 ,$87.30 ,fee schedule,,44% of CMS Medicare lab fee schedule,$72.00 ,80,,,$1.88 ,$87.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.50 ,55,,,$1.88 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,95,,,$1.88 ,$87.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.50 ,95,,,$1.88 ,$87.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.50 ,75,,,$1.88 ,$87.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$76.50 ,85,,,$1.88 ,$87.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.30 ,97,,,$1.88 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.50 ,55,,,$1.88 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.00 ,90,,,$1.88 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.30 ,97,,,$1.88 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.30 ,97,,,$1.88 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.30 ,97,,,$1.88 ,$87.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.50 ,85,,,$1.88 ,$87.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.00 ,90,,,$1.88 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.50 ,55,,,$1.88 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.50 ,90,,,$1.88 ,$87.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.50 ,55,,,$1.88 ,$87.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.70 ,93,,,$1.88 ,$87.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Grp B Molecular Assay HBL,8836662,CDM,306,RC,87081,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$2.92 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.92 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$2.92 ,44,,,$2.92 ,$119.31 ,fee schedule,,44% of CMS Medicare lab fee schedule,$98.40 ,80,,,$2.92 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$2.92 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$2.92 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$2.92 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$2.92 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.70 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$2.92 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$2.92 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
H. Pylori Ag,8042543,CDM,306,RC,87338,HCPCS,outpatient,,,,,,,,,,$6.33 ,$6.33 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.33 ,$6.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.33 ,$6.33 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$6.33 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.33 ,$6.33 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.33 ,$6.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.33 ,$6.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.33 ,$6.33 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.33 ,$6.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.33 ,$6.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.33 ,$6.33 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
H. Pylori,8042350,CDM,300,RC,83013,HCPCS,outpatient,,,,,,,,,,$29.64 ,$29.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$29.64 ,$29.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$29.64 ,$29.64 ,other,,Not applicable. No negotiated rates per contract,$29.64 ,44,,,$29.64 ,$29.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$29.64 ,$29.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$29.64 ,$29.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$29.64 ,$29.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$29.64 ,$29.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$29.64 ,$29.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$29.64 ,$29.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$29.64 ,$29.64 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HCV Ab/HIV 1/2 Scr/Diag Pnl W/Ref QST,8213268,CDM,300,RC,86803,HCPCS,outpatient,,,,,,,,,,$6.28 ,$6.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,,Not applicable. No negotiated rates per contract,$6.28 ,44,,,$6.28 ,$6.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.28 ,$6.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HCV RNA,8042340,CDM,306,RC,87522,HCPCS,outpatient,,,,,,,,,,$18.85 ,$18.85 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$18.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$18.85 ,$18.85 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HCV RNA,8042557,CDM,306,RC,87522,HCPCS,outpatient,,,$892.00 ,$669.00 ,,$820.64 ,92,,,$18.85 ,$865.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.85 ,$865.24 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$865.24 ,fee schedule,,44% of CMS Medicare lab fee schedule,$713.60 ,80,,,$18.85 ,$865.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,95,,,$18.85 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$847.40 ,95,,,$18.85 ,$865.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$669.00 ,75,,,$18.85 ,$865.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$758.20 ,85,,,$18.85 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$802.80 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$865.24 ,97,,,$18.85 ,$865.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$758.20 ,85,,,$18.85 ,$865.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$802.80 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.40 ,90,,,$18.85 ,$865.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$490.60 ,55,,,$18.85 ,$865.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$829.56 ,93,,,$18.85 ,$865.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HDL,3170344,CDM,301,RC,83718,HCPCS,outpatient,,,$120.00 ,$90.00 ,,$110.40 ,92,,,$3.60 ,$116.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.00 ,55,,,$3.60 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.60 ,$116.40 ,other,,Not applicable. No negotiated rates per contract,$3.60 ,44,,,$3.60 ,$116.40 ,fee schedule,,44% of CMS Medicare lab fee schedule,$96.00 ,80,,,$3.60 ,$116.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.00 ,55,,,$3.60 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.00 ,95,,,$3.60 ,$116.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.00 ,95,,,$3.60 ,$116.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.00 ,75,,,$3.60 ,$116.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.00 ,85,,,$3.60 ,$116.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.40 ,97,,,$3.60 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.00 ,55,,,$3.60 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.00 ,90,,,$3.60 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.40 ,97,,,$3.60 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.40 ,97,,,$3.60 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.40 ,97,,,$3.60 ,$116.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.00 ,85,,,$3.60 ,$116.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.00 ,90,,,$3.60 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.00 ,55,,,$3.60 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.00 ,90,,,$3.60 ,$116.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.00 ,55,,,$3.60 ,$116.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.60 ,93,,,$3.60 ,$116.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HIV 1 RNA,8042372,CDM,300,RC,87535,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HIV 1/2 Ag/Ab,8042760,CDM,306,RC,87389,HCPCS,outpatient,,,$66.00 ,$49.50 ,,$60.72 ,92,,,$10.60 ,$64.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.30 ,55,,,$10.60 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$10.60 ,$64.02 ,other,,Not applicable. No negotiated rates per contract,$10.60 ,44,,,$10.60 ,$64.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$52.80 ,80,,,$10.60 ,$64.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.30 ,55,,,$10.60 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,95,,,$10.60 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.70 ,95,,,$10.60 ,$64.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.50 ,75,,,$10.60 ,$64.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.10 ,85,,,$10.60 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.02 ,97,,,$10.60 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.30 ,55,,,$10.60 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.40 ,90,,,$10.60 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.02 ,97,,,$10.60 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$10.60 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,97,,,$10.60 ,$64.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,85,,,$10.60 ,$64.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.40 ,90,,,$10.60 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$10.60 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.70 ,90,,,$10.60 ,$64.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.30 ,55,,,$10.60 ,$64.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.38 ,93,,,$10.60 ,$64.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HIV Ag/Ab Scrn,633757,CDM,302,RC,86703,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$6.03 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$6.03 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.03 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$6.03 ,44,,,$6.03 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$6.03 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$6.03 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$6.03 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$6.03 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$6.03 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$6.03 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$6.03 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$6.03 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$6.03 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$6.03 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.03 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.03 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$6.03 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$6.03 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.03 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$6.03 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.03 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$6.03 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HS CRP QST,8042314,CDM,302,RC,86141,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$5.70 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$5.70 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.70 ,$97.00 ,other,,Not applicable. No negotiated rates per contract,$5.70 ,44,,,$5.70 ,$97.00 ,fee schedule,,44% of CMS Medicare lab fee schedule,$80.00 ,80,,,$5.70 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$5.70 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$5.70 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$5.70 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$5.70 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$5.70 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$5.70 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$5.70 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.00 ,90,,,$5.70 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.00 ,97,,,$5.70 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$5.70 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$5.70 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$5.70 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$5.70 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$5.70 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$5.70 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$5.70 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$5.70 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HSV 1 IgG,8048862,CDM,302,RC,86695,HCPCS,outpatient,,,,,,,,,,$5.80 ,$5.80 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.80 ,$5.80 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.80 ,$5.80 ,other,,Not applicable. No negotiated rates per contract,$5.80 ,44,,,$5.80 ,$5.80 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.80 ,$5.80 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.80 ,$5.80 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.80 ,$5.80 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.80 ,$5.80 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.80 ,$5.80 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.80 ,$5.80 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.80 ,$5.80 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HSV 1 IgM Screen QST,8049242,CDM,302,RC,86695,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$5.80 ,$59.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$5.80 ,$59.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.80 ,$59.17 ,other,,Not applicable. No negotiated rates per contract,$5.80 ,44,,,$5.80 ,$59.17 ,fee schedule,,44% of CMS Medicare lab fee schedule,$48.80 ,80,,,$5.80 ,$59.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$5.80 ,$59.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$5.80 ,$59.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$5.80 ,$59.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$5.80 ,$59.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$5.80 ,$59.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$5.80 ,$59.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$5.80 ,$59.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.90 ,90,,,$5.80 ,$59.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.17 ,97,,,$5.80 ,$59.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$5.80 ,$59.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$5.80 ,$59.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$5.80 ,$59.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$5.80 ,$59.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$5.80 ,$59.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$5.80 ,$59.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$5.80 ,$59.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$5.80 ,$59.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HSV 2 IgG,8048863,CDM,302,RC,86696,HCPCS,outpatient,,,,,,,,,,$8.51 ,$8.51 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.51 ,$8.51 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.51 ,$8.51 ,other,,Not applicable. No negotiated rates per contract,$8.51 ,44,,,$8.51 ,$8.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.51 ,$8.51 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.51 ,$8.51 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.51 ,$8.51 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.51 ,$8.51 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.51 ,$8.51 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.51 ,$8.51 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.51 ,$8.51 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HSV 2 IgM Screen QST,8049245,CDM,302,RC,86696,HCPCS,outpatient,,,$89.00 ,$66.75 ,,$81.88 ,92,,,$8.51 ,$86.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.95 ,55,,,$8.51 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.51 ,$86.33 ,other,,Not applicable. No negotiated rates per contract,$8.51 ,44,,,$8.51 ,$86.33 ,fee schedule,,44% of CMS Medicare lab fee schedule,$71.20 ,80,,,$8.51 ,$86.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.95 ,55,,,$8.51 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,95,,,$8.51 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.55 ,95,,,$8.51 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.75 ,75,,,$8.51 ,$86.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.65 ,85,,,$8.51 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.33 ,97,,,$8.51 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.95 ,55,,,$8.51 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.10 ,90,,,$8.51 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.33 ,97,,,$8.51 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$8.51 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$8.51 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.65 ,85,,,$8.51 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.10 ,90,,,$8.51 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$8.51 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,90,,,$8.51 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$8.51 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.77 ,93,,,$8.51 ,$86.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HSV Culture Prelim QST,8620523,CDM,306,RC,87254,HCPCS,outpatient,,,$91.00 ,$68.25 ,,$83.72 ,92,,,$8.61 ,$88.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.61 ,$88.27 ,other,,Not applicable. No negotiated rates per contract,$8.61 ,44,,,$8.61 ,$88.27 ,fee schedule,,44% of CMS Medicare lab fee schedule,$72.80 ,80,,,$8.61 ,$88.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,95,,,$8.61 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.45 ,95,,,$8.61 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.25 ,75,,,$8.61 ,$88.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.35 ,85,,,$8.61 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.90 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.35 ,85,,,$8.61 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.90 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.63 ,93,,,$8.61 ,$88.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HSV,8836681,CDM,306,RC,87255,HCPCS,outpatient,,,,,,,,,,$14.90 ,$14.90 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$14.90 ,$14.90 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$14.90 ,$14.90 ,other,,Not applicable. No negotiated rates per contract,$14.90 ,44,,,$14.90 ,$14.90 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$14.90 ,$14.90 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$14.90 ,$14.90 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$14.90 ,$14.90 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$14.90 ,$14.90 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$14.90 ,$14.90 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$14.90 ,$14.90 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$14.90 ,$14.90 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HSV,8042524,CDM,306,RC,87529,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Haptoglobin QST,8042641,CDM,301,RC,83010,HCPCS,outpatient,,,$147.00 ,$110.25 ,,$135.24 ,92,,,$5.54 ,$142.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.85 ,55,,,$5.54 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.54 ,$142.59 ,other,,Not applicable. No negotiated rates per contract,$5.54 ,44,,,$5.54 ,$142.59 ,fee schedule,,44% of CMS Medicare lab fee schedule,$117.60 ,80,,,$5.54 ,$142.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.85 ,55,,,$5.54 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,95,,,$5.54 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.65 ,95,,,$5.54 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.25 ,75,,,$5.54 ,$142.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.95 ,85,,,$5.54 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.59 ,97,,,$5.54 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.85 ,55,,,$5.54 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.30 ,90,,,$5.54 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.59 ,97,,,$5.54 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$5.54 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$5.54 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.95 ,85,,,$5.54 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.30 ,90,,,$5.54 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$5.54 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,90,,,$5.54 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$5.54 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.71 ,93,,,$5.54 ,$142.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hematocrit,633742,CDM,305,RC,85014,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.04 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.04 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.04 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.04 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hemoglobin,633741,CDM,305,RC,85018,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.04 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.04 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.04 ,44,,,$1.04 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.04 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.04 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.04 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.04 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.04 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.04 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.04 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.04 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hemoglobin A1c w/eAG,9216164,CDM,301,RC,83036,HCPCS,outpatient,,,,,,,,,,$4.27 ,$4.27 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$4.27 ,$4.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.27 ,$4.27 ,other,,Not applicable. No negotiated rates per contract,$4.27 ,44,,,$4.27 ,$4.27 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$4.27 ,$4.27 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$4.27 ,$4.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.27 ,$4.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.27 ,$4.27 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.27 ,$4.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$4.27 ,$4.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$4.27 ,$4.27 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hemoglobin and Hematocrit,1628899,CDM,305,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hep A Ab,8042643,CDM,302,RC,86708,HCPCS,outpatient,,,,,,,,,,$5.45 ,$5.45 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,,Not applicable. No negotiated rates per contract,$5.45 ,44,,,$5.45 ,$5.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.45 ,$5.45 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hep A IgM QST,8042645,CDM,301,RC,86709,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$4.95 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$4.95 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.95 ,$122.22 ,other,,Not applicable. No negotiated rates per contract,$4.95 ,44,,,$4.95 ,$122.22 ,fee schedule,,44% of CMS Medicare lab fee schedule,$100.80 ,80,,,$4.95 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$4.95 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$4.95 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$4.95 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$4.95 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$4.95 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$4.95 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$4.95 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.40 ,90,,,$4.95 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.22 ,97,,,$4.95 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$4.95 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$4.95 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$4.95 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$4.95 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$4.95 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$4.95 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$4.95 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$4.95 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Core Ab (IgM) QST,8042630,CDM,302,RC,86705,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$5.18 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$5.18 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.18 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$5.18 ,44,,,$5.18 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$5.18 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$5.18 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$5.18 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$5.18 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$5.18 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$5.18 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$5.18 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$5.18 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$5.18 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$5.18 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$5.18 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$5.18 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$5.18 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$5.18 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$5.18 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$5.18 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$5.18 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$5.18 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Core Ab Total QST,8042640,CDM,302,RC,86704,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$5.30 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.30 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$5.30 ,44,,,$5.30 ,$165.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$136.80 ,80,,,$5.30 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$5.30 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$5.30 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$5.30 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$5.30 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$5.30 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$5.30 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Core Ab Total QST,8518789,CDM,302,RC,86704,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$5.30 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.30 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$5.30 ,44,,,$5.30 ,$165.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$136.80 ,80,,,$5.30 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$5.30 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$5.30 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$5.30 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$5.30 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$5.30 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$5.30 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$5.30 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$5.30 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$5.30 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Surface Ab Ql QST,8042638,CDM,302,RC,86706,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$4.73 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$4.73 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$4.73 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$4.73 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$4.73 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$4.73 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$4.73 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$4.73 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Surface Ag QST,8518790,CDM,306,RC,87340,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$4.55 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.55 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$4.55 ,44,,,$4.55 ,$173.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$143.20 ,80,,,$4.55 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$4.55 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$4.55 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$4.55 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$4.55 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$4.55 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$4.55 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Surface Ag w/Refl Confirm QST,8042637,CDM,306,RC,87340,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$4.55 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.55 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$4.55 ,44,,,$4.55 ,$173.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$143.20 ,80,,,$4.55 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$4.55 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$4.55 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$4.55 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$4.55 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$4.55 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$4.55 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$4.55 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$4.55 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$4.55 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Surface Antibody Ql QST,8518788,CDM,302,RC,86706,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$4.73 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$4.73 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$4.73 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$4.73 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$4.73 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$4.73 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$4.73 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$4.73 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$4.73 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$4.73 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$4.73 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep B Virus DNA,8042714,CDM,306,RC,87517,HCPCS,outpatient,,,,,,,,,,$18.85 ,$18.85 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$18.85 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$18.85 ,$18.85 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.85 ,$18.85 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.85 ,$18.85 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hep C Ab QST,8518792,CDM,302,RC,86803,HCPCS,outpatient,,,$204.00 ,$153.00 ,,$187.68 ,92,,,$6.28 ,$197.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$112.20 ,55,,,$6.28 ,$197.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.28 ,$197.88 ,other,,Not applicable. No negotiated rates per contract,$6.28 ,44,,,$6.28 ,$197.88 ,fee schedule,,44% of CMS Medicare lab fee schedule,$163.20 ,80,,,$6.28 ,$197.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$112.20 ,55,,,$6.28 ,$197.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.80 ,95,,,$6.28 ,$197.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.80 ,95,,,$6.28 ,$197.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.00 ,75,,,$6.28 ,$197.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$173.40 ,85,,,$6.28 ,$197.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.88 ,97,,,$6.28 ,$197.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,55,,,$6.28 ,$197.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.60 ,90,,,$6.28 ,$197.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.88 ,97,,,$6.28 ,$197.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.88 ,97,,,$6.28 ,$197.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.88 ,97,,,$6.28 ,$197.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.40 ,85,,,$6.28 ,$197.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.60 ,90,,,$6.28 ,$197.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.20 ,55,,,$6.28 ,$197.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.80 ,90,,,$6.28 ,$197.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.20 ,55,,,$6.28 ,$197.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.72 ,93,,,$6.28 ,$197.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hep C Ab w/Refl To HCV RNA,8042718,CDM,302,RC,86803,HCPCS,outpatient,,,,,,,,,,$6.28 ,$6.28 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,,Not applicable. No negotiated rates per contract,$6.28 ,44,,,$6.28 ,$6.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.28 ,$6.28 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.28 ,$6.28 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.28 ,$6.28 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Hep C Viral RNA Genotype,8042593,CDM,306,RC,87902,HCPCS,outpatient,,,"$1,876.00 ","$1,407.00 ",,"$1,725.92 ",92,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,031.80 ",55,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$113.28 ,"$1,819.72 ",other,,Not applicable. No negotiated rates per contract,$113.28 ,44,,,$113.28 ,"$1,819.72 ",fee schedule,,44% of CMS Medicare lab fee schedule,"$1,500.80 ",80,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,031.80 ",55,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,782.20 ",95,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,782.20 ",95,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,407.00 ",75,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,594.60 ",85,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,819.72 ",97,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,031.80 ",55,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,688.40 ",90,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,819.72 ",97,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,819.72 ",97,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,819.72 ",97,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,594.60 ",85,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,688.40 ",90,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,031.80 ",55,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,782.20 ",90,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,031.80 ",55,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,744.68 ",93,,,$113.28 ,"$1,819.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Hep Fnct Pnl,633744,CDM,301,RC,80076,HCPCS,outpatient,,,$185.00 ,$138.75 ,,$170.20 ,92,,,$3.59 ,$179.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.75 ,55,,,$3.59 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.59 ,$179.45 ,other,,Not applicable. No negotiated rates per contract,$3.59 ,44,,,$3.59 ,$179.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,$148.00 ,80,,,$3.59 ,$179.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.75 ,55,,,$3.59 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,95,,,$3.59 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.75 ,95,,,$3.59 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.75 ,75,,,$3.59 ,$179.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$157.25 ,85,,,$3.59 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.45 ,97,,,$3.59 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.75 ,55,,,$3.59 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.50 ,90,,,$3.59 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$179.45 ,97,,,$3.59 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$3.59 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$3.59 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.25 ,85,,,$3.59 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.50 ,90,,,$3.59 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$3.59 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,90,,,$3.59 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$3.59 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.05 ,93,,,$3.59 ,$179.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hepatitis A Ab,8311338,CDM,302,RC,86708,HCPCS,outpatient,,,,,,,,,,$5.45 ,$5.45 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,,Not applicable. No negotiated rates per contract,$5.45 ,44,,,$5.45 ,$5.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.45 ,$5.45 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.45 ,$5.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.45 ,$5.45 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Herpes Simplex Virus Culture QST,8042463,CDM,306,RC,87255,HCPCS,outpatient,,,$341.00 ,$255.75 ,,$313.72 ,92,,,$14.90 ,$330.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$187.55 ,55,,,$14.90 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.90 ,$330.77 ,other,,Not applicable. No negotiated rates per contract,$14.90 ,44,,,$14.90 ,$330.77 ,fee schedule,,44% of CMS Medicare lab fee schedule,$272.80 ,80,,,$14.90 ,$330.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$187.55 ,55,,,$14.90 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,95,,,$14.90 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$323.95 ,95,,,$14.90 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.75 ,75,,,$14.90 ,$330.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$289.85 ,85,,,$14.90 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$330.77 ,97,,,$14.90 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.55 ,55,,,$14.90 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.90 ,90,,,$14.90 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$330.77 ,97,,,$14.90 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$14.90 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$14.90 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.85 ,85,,,$14.90 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.90 ,90,,,$14.90 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$14.90 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,90,,,$14.90 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$14.90 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.13 ,93,,,$14.90 ,$330.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hgb A1c w/eAG,1383763,CDM,301,RC,83036,HCPCS,outpatient,,,$188.00 ,$141.00 ,,$172.96 ,92,,,$4.27 ,$182.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.40 ,55,,,$4.27 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.27 ,$182.36 ,other,,Not applicable. No negotiated rates per contract,$4.27 ,44,,,$4.27 ,$182.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$150.40 ,80,,,$4.27 ,$182.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.40 ,55,,,$4.27 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,95,,,$4.27 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.60 ,95,,,$4.27 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.00 ,75,,,$4.27 ,$182.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$159.80 ,85,,,$4.27 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.36 ,97,,,$4.27 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.40 ,55,,,$4.27 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.20 ,90,,,$4.27 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.36 ,97,,,$4.27 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$4.27 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$4.27 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.80 ,85,,,$4.27 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.20 ,90,,,$4.27 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$4.27 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,90,,,$4.27 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$4.27 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.84 ,93,,,$4.27 ,$182.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Histamine Release QST,8713368,CDM,302,RC,86343,HCPCS,outpatient,,,$335.00 ,$251.25 ,,$308.20 ,92,,,$5.48 ,$324.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.48 ,$324.95 ,other,,Not applicable. No negotiated rates per contract,$5.48 ,44,,,$5.48 ,$324.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$268.00 ,80,,,$5.48 ,$324.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,95,,,$5.48 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$318.25 ,95,,,$5.48 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.25 ,75,,,$5.48 ,$324.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.75 ,85,,,$5.48 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.50 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.75 ,85,,,$5.48 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$301.50 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.55 ,93,,,$5.48 ,$324.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Histamine Release QST,8743311,CDM,302,RC,86343,HCPCS,outpatient,,,$335.00 ,$251.25 ,,$308.20 ,92,,,$5.48 ,$324.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.48 ,$324.95 ,other,,Not applicable. No negotiated rates per contract,$5.48 ,44,,,$5.48 ,$324.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$268.00 ,80,,,$5.48 ,$324.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,95,,,$5.48 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$318.25 ,95,,,$5.48 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.25 ,75,,,$5.48 ,$324.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.75 ,85,,,$5.48 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.50 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.48 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.75 ,85,,,$5.48 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$301.50 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,90,,,$5.48 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.48 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.55 ,93,,,$5.48 ,$324.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IgE Antibody (Anti IgE IgG) QST,8743310,CDM,301,RC,83520,HCPCS,outpatient,,,$265.00 ,$198.75 ,,$243.80 ,92,,,$7.60 ,$257.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.60 ,$257.05 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$257.05 ,fee schedule,,44% of CMS Medicare lab fee schedule,$212.00 ,80,,,$7.60 ,$257.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.75 ,75,,,$7.60 ,$257.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.45 ,93,,,$7.60 ,$257.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunofixation QST,8042663,CDM,302,RC,86334,HCPCS,outpatient,,,$188.00 ,$141.00 ,,$172.96 ,92,,,$9.83 ,$182.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.40 ,55,,,$9.83 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.83 ,$182.36 ,other,,Not applicable. No negotiated rates per contract,$9.83 ,44,,,$9.83 ,$182.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$150.40 ,80,,,$9.83 ,$182.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.40 ,55,,,$9.83 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,95,,,$9.83 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.60 ,95,,,$9.83 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.00 ,75,,,$9.83 ,$182.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$159.80 ,85,,,$9.83 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.36 ,97,,,$9.83 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.40 ,55,,,$9.83 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.20 ,90,,,$9.83 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.36 ,97,,,$9.83 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$9.83 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$9.83 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.80 ,85,,,$9.83 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.20 ,90,,,$9.83 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$9.83 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,90,,,$9.83 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$9.83 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.84 ,93,,,$9.83 ,$182.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin A QST,8042653,CDM,301,RC,82784,HCPCS,outpatient,,,$88.00 ,$66.00 ,,$80.96 ,92,,,$4.09 ,$85.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$85.36 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$85.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$70.40 ,80,,,$4.09 ,$85.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.00 ,75,,,$4.09 ,$85.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.84 ,93,,,$4.09 ,$85.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin A QST,8186933,CDM,301,RC,82784,HCPCS,outpatient,,,$88.00 ,$66.00 ,,$80.96 ,92,,,$4.09 ,$85.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$85.36 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$85.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$70.40 ,80,,,$4.09 ,$85.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.00 ,75,,,$4.09 ,$85.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.84 ,93,,,$4.09 ,$85.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin A QST,8225257,CDM,301,RC,82784,HCPCS,outpatient,,,$88.00 ,$66.00 ,,$80.96 ,92,,,$4.09 ,$85.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$85.36 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$85.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$70.40 ,80,,,$4.09 ,$85.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.00 ,75,,,$4.09 ,$85.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.84 ,93,,,$4.09 ,$85.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin A QST,8743196,CDM,301,RC,82784,HCPCS,outpatient,,,$88.00 ,$66.00 ,,$80.96 ,92,,,$4.09 ,$85.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$85.36 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$85.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$70.40 ,80,,,$4.09 ,$85.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.60 ,95,,,$4.09 ,$85.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.00 ,75,,,$4.09 ,$85.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.36 ,97,,,$4.09 ,$85.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,85,,,$4.09 ,$85.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.20 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.60 ,90,,,$4.09 ,$85.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.40 ,55,,,$4.09 ,$85.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.84 ,93,,,$4.09 ,$85.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin E QST,8042656,CDM,301,RC,82785,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$7.24 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.24 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$7.24 ,44,,,$7.24 ,$173.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$143.20 ,80,,,$7.24 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$7.24 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$7.24 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$7.24 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$7.24 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$7.24 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$7.24 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin E QST,8743197,CDM,301,RC,82785,HCPCS,outpatient,,,$179.00 ,$134.25 ,,$164.68 ,92,,,$7.24 ,$173.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.24 ,$173.63 ,other,,Not applicable. No negotiated rates per contract,$7.24 ,44,,,$7.24 ,$173.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$143.20 ,80,,,$7.24 ,$173.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,95,,,$7.24 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.05 ,95,,,$7.24 ,$173.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.25 ,75,,,$7.24 ,$173.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.15 ,85,,,$7.24 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.10 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.63 ,97,,,$7.24 ,$173.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.15 ,85,,,$7.24 ,$173.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.10 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.05 ,90,,,$7.24 ,$173.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.45 ,55,,,$7.24 ,$173.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,93,,,$7.24 ,$173.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin G QST,8042661,CDM,301,RC,82784,HCPCS,outpatient,,,$114.00 ,$85.50 ,,$104.88 ,92,,,$4.09 ,$110.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$110.58 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$110.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,$91.20 ,80,,,$4.09 ,$110.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.50 ,75,,,$4.09 ,$110.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.02 ,93,,,$4.09 ,$110.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin G QST,8186934,CDM,301,RC,82784,HCPCS,outpatient,,,$114.00 ,$85.50 ,,$104.88 ,92,,,$4.09 ,$110.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$110.58 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$110.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,$91.20 ,80,,,$4.09 ,$110.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.50 ,75,,,$4.09 ,$110.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.02 ,93,,,$4.09 ,$110.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin G QST,8743198,CDM,301,RC,82784,HCPCS,outpatient,,,$114.00 ,$85.50 ,,$104.88 ,92,,,$4.09 ,$110.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$110.58 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$110.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,$91.20 ,80,,,$4.09 ,$110.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.30 ,95,,,$4.09 ,$110.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.50 ,75,,,$4.09 ,$110.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.58 ,97,,,$4.09 ,$110.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.90 ,85,,,$4.09 ,$110.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.60 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.30 ,90,,,$4.09 ,$110.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.70 ,55,,,$4.09 ,$110.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.02 ,93,,,$4.09 ,$110.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin M QST,8042662,CDM,301,RC,82784,HCPCS,outpatient,,,$212.00 ,$159.00 ,,$195.04 ,92,,,$4.09 ,$205.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$205.64 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$205.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$169.60 ,80,,,$4.09 ,$205.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.00 ,75,,,$4.09 ,$205.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.16 ,93,,,$4.09 ,$205.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin M QST,8186935,CDM,301,RC,82784,HCPCS,outpatient,,,$212.00 ,$159.00 ,,$195.04 ,92,,,$4.09 ,$205.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$205.64 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$205.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$169.60 ,80,,,$4.09 ,$205.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.00 ,75,,,$4.09 ,$205.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.16 ,93,,,$4.09 ,$205.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Immunoglobulin M QST,8743199,CDM,301,RC,82784,HCPCS,outpatient,,,$212.00 ,$159.00 ,,$195.04 ,92,,,$4.09 ,$205.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.09 ,$205.64 ,other,,Not applicable. No negotiated rates per contract,$4.09 ,44,,,$4.09 ,$205.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$169.60 ,80,,,$4.09 ,$205.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.40 ,95,,,$4.09 ,$205.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.00 ,75,,,$4.09 ,$205.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.64 ,97,,,$4.09 ,$205.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.20 ,85,,,$4.09 ,$205.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.80 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.40 ,90,,,$4.09 ,$205.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.60 ,55,,,$4.09 ,$205.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.16 ,93,,,$4.09 ,$205.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Infectious agent detection by nucleic acid (DNA or RNA),10027741,CDM,306,RC,87801,HCPCS,outpatient,,,,,,,,,,$30.89 ,$30.89 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$30.89 ,$30.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$30.89 ,$30.89 ,other,,Not applicable. No negotiated rates per contract,$30.89 ,44,,,$30.89 ,$30.89 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$30.89 ,$30.89 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$30.89 ,$30.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$30.89 ,$30.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$30.89 ,$30.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$30.89 ,$30.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$30.89 ,$30.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$30.89 ,$30.89 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Iron,633765,CDM,301,RC,83540,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$2.85 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$2.85 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$2.85 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$2.85 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Iron Panel,8036784,CDM,301,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Iron Pnl w/ Ferritin,8648465,CDM,301,RC,83540,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$2.85 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.85 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$2.85 ,44,,,$2.85 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$2.85 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$2.85 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$2.85 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$2.85 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$2.85 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$2.85 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$2.85 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$2.85 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Kappa S QST,8186987,CDM,300,RC,83883,HCPCS,outpatient,,,$266.00 ,$199.50 ,,$244.72 ,92,,,$5.98 ,$258.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$146.30 ,55,,,$5.98 ,$258.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.98 ,$258.02 ,other,,Not applicable. No negotiated rates per contract,$5.98 ,44,,,$5.98 ,$258.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$212.80 ,80,,,$5.98 ,$258.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$146.30 ,55,,,$5.98 ,$258.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.70 ,95,,,$5.98 ,$258.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$252.70 ,95,,,$5.98 ,$258.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.50 ,75,,,$5.98 ,$258.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$226.10 ,85,,,$5.98 ,$258.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$258.02 ,97,,,$5.98 ,$258.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.30 ,55,,,$5.98 ,$258.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.40 ,90,,,$5.98 ,$258.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$258.02 ,97,,,$5.98 ,$258.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.02 ,97,,,$5.98 ,$258.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.02 ,97,,,$5.98 ,$258.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.10 ,85,,,$5.98 ,$258.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$239.40 ,90,,,$5.98 ,$258.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.30 ,55,,,$5.98 ,$258.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.70 ,90,,,$5.98 ,$258.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.30 ,55,,,$5.98 ,$258.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.38 ,93,,,$5.98 ,$258.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Kappa/Lambda Light Chains Fr w/Ratio QST,8046683,CDM,301,RC,83520,HCPCS,outpatient,,,$265.00 ,$198.75 ,,$243.80 ,92,,,$7.60 ,$257.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.60 ,$257.05 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$257.05 ,fee schedule,,44% of CMS Medicare lab fee schedule,$212.00 ,80,,,$7.60 ,$257.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.75 ,75,,,$7.60 ,$257.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.45 ,93,,,$7.60 ,$257.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LH QST,8042678,CDM,301,RC,83002,HCPCS,outpatient,,,$194.00 ,$145.50 ,,$178.48 ,92,,,$8.15 ,$188.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.70 ,55,,,$8.15 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.15 ,$188.18 ,other,,Not applicable. No negotiated rates per contract,$8.15 ,44,,,$8.15 ,$188.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$155.20 ,80,,,$8.15 ,$188.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.70 ,55,,,$8.15 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,95,,,$8.15 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.30 ,95,,,$8.15 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.50 ,75,,,$8.15 ,$188.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.90 ,85,,,$8.15 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$188.18 ,97,,,$8.15 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,55,,,$8.15 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.60 ,90,,,$8.15 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.18 ,97,,,$8.15 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$8.15 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$8.15 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.90 ,85,,,$8.15 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,90,,,$8.15 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$8.15 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,90,,,$8.15 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$8.15 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.42 ,93,,,$8.15 ,$188.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lactate Dehydrogenase,633770,CDM,301,RC,83615,HCPCS,outpatient,,,$136.00 ,$102.00 ,,$125.12 ,92,,,$2.66 ,$131.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.80 ,55,,,$2.66 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.66 ,$131.92 ,other,,Not applicable. No negotiated rates per contract,$2.66 ,44,,,$2.66 ,$131.92 ,fee schedule,,44% of CMS Medicare lab fee schedule,$108.80 ,80,,,$2.66 ,$131.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.80 ,55,,,$2.66 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,95,,,$2.66 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$129.20 ,95,,,$2.66 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.00 ,75,,,$2.66 ,$131.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$115.60 ,85,,,$2.66 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.92 ,97,,,$2.66 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,55,,,$2.66 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.40 ,90,,,$2.66 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.92 ,97,,,$2.66 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.66 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$2.66 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.60 ,85,,,$2.66 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.40 ,90,,,$2.66 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.66 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,90,,,$2.66 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$2.66 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.48 ,93,,,$2.66 ,$131.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lactic Acid,3454442,CDM,301,RC,83605,HCPCS,outpatient,,,$167.00 ,$125.25 ,,$153.64 ,92,,,$5.09 ,$161.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.85 ,55,,,$5.09 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.09 ,$161.99 ,other,,Not applicable. No negotiated rates per contract,$5.09 ,44,,,$5.09 ,$161.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,$133.60 ,80,,,$5.09 ,$161.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.85 ,55,,,$5.09 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,95,,,$5.09 ,$161.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.65 ,95,,,$5.09 ,$161.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.25 ,75,,,$5.09 ,$161.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.95 ,85,,,$5.09 ,$161.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.99 ,97,,,$5.09 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.85 ,55,,,$5.09 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.30 ,90,,,$5.09 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.99 ,97,,,$5.09 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$5.09 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$5.09 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.95 ,85,,,$5.09 ,$161.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.30 ,90,,,$5.09 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.85 ,55,,,$5.09 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,90,,,$5.09 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.85 ,55,,,$5.09 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.31 ,93,,,$5.09 ,$161.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lactic Acid POCT,8486991,CDM,301,RC,83605,HCPCS,outpatient,,,$163.00 ,$122.25 ,,$149.96 ,92,,,$5.09 ,$158.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.65 ,55,,,$5.09 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.09 ,$158.11 ,other,,Not applicable. No negotiated rates per contract,$5.09 ,44,,,$5.09 ,$158.11 ,fee schedule,,44% of CMS Medicare lab fee schedule,$130.40 ,80,,,$5.09 ,$158.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.65 ,55,,,$5.09 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,95,,,$5.09 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$154.85 ,95,,,$5.09 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.25 ,75,,,$5.09 ,$158.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$138.55 ,85,,,$5.09 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$158.11 ,97,,,$5.09 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.65 ,55,,,$5.09 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.70 ,90,,,$5.09 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.11 ,97,,,$5.09 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$5.09 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$5.09 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.55 ,85,,,$5.09 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.70 ,90,,,$5.09 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$5.09 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,90,,,$5.09 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$5.09 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.59 ,93,,,$5.09 ,$158.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lactobacillus Species QST,8611504,CDM,306,RC,87799,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$18.85 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.85 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$18.85 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$18.85 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$18.85 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lambda S QST,8186988,CDM,300,RC,83883,HCPCS,outpatient,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$5.98 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$5.98 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.98 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$5.98 ,44,,,$5.98 ,$98.94 ,fee schedule,,44% of CMS Medicare lab fee schedule,$81.60 ,80,,,$5.98 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$5.98 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$5.98 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$5.98 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$5.98 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$5.98 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$5.98 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$5.98 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.80 ,90,,,$5.98 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.94 ,97,,,$5.98 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$5.98 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$5.98 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$5.98 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$5.98 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$5.98 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$5.98 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$5.98 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$5.98 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lamotrigine QST,8042425,CDM,301,RC,80175,HCPCS,outpatient,,,$294.00 ,$220.50 ,,$270.48 ,92,,,$5.83 ,$285.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$161.70 ,55,,,$5.83 ,$285.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.83 ,$285.18 ,other,,Not applicable. No negotiated rates per contract,$5.83 ,44,,,$5.83 ,$285.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$235.20 ,80,,,$5.83 ,$285.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$161.70 ,55,,,$5.83 ,$285.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$279.30 ,95,,,$5.83 ,$285.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.30 ,95,,,$5.83 ,$285.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.50 ,75,,,$5.83 ,$285.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$249.90 ,85,,,$5.83 ,$285.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$285.18 ,97,,,$5.83 ,$285.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.70 ,55,,,$5.83 ,$285.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.60 ,90,,,$5.83 ,$285.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$285.18 ,97,,,$5.83 ,$285.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$285.18 ,97,,,$5.83 ,$285.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$285.18 ,97,,,$5.83 ,$285.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.90 ,85,,,$5.83 ,$285.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$264.60 ,90,,,$5.83 ,$285.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.70 ,55,,,$5.83 ,$285.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$279.30 ,90,,,$5.83 ,$285.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.70 ,55,,,$5.83 ,$285.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$273.42 ,93,,,$5.83 ,$285.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lead QST,8290767,CDM,301,RC,83655,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$5.33 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$5.33 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.33 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$5.33 ,44,,,$5.33 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$5.33 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$5.33 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$5.33 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$5.33 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$5.33 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$5.33 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$5.33 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$5.33 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$5.33 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$5.33 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$5.33 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$5.33 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$5.33 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$5.33 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$5.33 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$5.33 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$5.33 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$5.33 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lead,8422357,CDM,301,RC,83655,HCPCS,outpatient,,,,,,,,,,$5.33 ,$5.33 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.33 ,$5.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.33 ,$5.33 ,other,,Not applicable. No negotiated rates per contract,$5.33 ,44,,,$5.33 ,$5.33 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.33 ,$5.33 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.33 ,$5.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.33 ,$5.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.33 ,$5.33 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.33 ,$5.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.33 ,$5.33 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.33 ,$5.33 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Leukemia/Lymphoma Evaluation QST,8713379,CDM,311,RC,88184,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Levetiracetam QST,8042361,CDM,301,RC,80177,HCPCS,outpatient,,,$82.00 ,$61.50 ,,$75.44 ,92,,,$5.83 ,$79.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.10 ,55,,,$5.83 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.83 ,$79.54 ,other,,Not applicable. No negotiated rates per contract,$5.83 ,44,,,$5.83 ,$79.54 ,fee schedule,,44% of CMS Medicare lab fee schedule,$65.60 ,80,,,$5.83 ,$79.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.10 ,55,,,$5.83 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,95,,,$5.83 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.90 ,95,,,$5.83 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.50 ,75,,,$5.83 ,$79.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.70 ,85,,,$5.83 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.54 ,97,,,$5.83 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.10 ,55,,,$5.83 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.80 ,90,,,$5.83 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.54 ,97,,,$5.83 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$5.83 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$5.83 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,85,,,$5.83 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.80 ,90,,,$5.83 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$5.83 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,90,,,$5.83 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$5.83 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.26 ,93,,,$5.83 ,$79.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Levodopa QST,8311212,CDM,300,RC,80299,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$8.20 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$8.20 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.20 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$8.20 ,44,,,$8.20 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$8.20 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$8.20 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$8.20 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$8.20 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$8.20 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$8.20 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$8.20 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$8.20 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$8.20 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$8.20 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$8.20 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$8.20 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$8.20 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$8.20 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$8.20 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$8.20 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$8.20 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$8.20 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lipase Level,633776,CDM,301,RC,83690,HCPCS,outpatient,,,$157.00 ,$117.75 ,,$144.44 ,92,,,$3.03 ,$152.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$86.35 ,55,,,$3.03 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.03 ,$152.29 ,other,,Not applicable. No negotiated rates per contract,$3.03 ,44,,,$3.03 ,$152.29 ,fee schedule,,44% of CMS Medicare lab fee schedule,$125.60 ,80,,,$3.03 ,$152.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$86.35 ,55,,,$3.03 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,95,,,$3.03 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.15 ,95,,,$3.03 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.75 ,75,,,$3.03 ,$152.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$133.45 ,85,,,$3.03 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.29 ,97,,,$3.03 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.35 ,55,,,$3.03 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.30 ,90,,,$3.03 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.29 ,97,,,$3.03 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$3.03 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$3.03 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.45 ,85,,,$3.03 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.30 ,90,,,$3.03 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$3.03 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,90,,,$3.03 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$3.03 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.01 ,93,,,$3.03 ,$152.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lipid Panel,9216162,CDM,301,RC,80061,HCPCS,outpatient,,,,,,,,,,$5.89 ,$5.89 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.89 ,$5.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.89 ,$5.89 ,other,,Not applicable. No negotiated rates per contract,$5.89 ,44,,,$5.89 ,$5.89 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.89 ,$5.89 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.89 ,$5.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.89 ,$5.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.89 ,$5.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.89 ,$5.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.89 ,$5.89 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.89 ,$5.89 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Lipid Pnl,633777,CDM,301,RC,80061,HCPCS,outpatient,,,$184.00 ,$138.00 ,,$169.28 ,92,,,$5.89 ,$178.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.20 ,55,,,$5.89 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.89 ,$178.48 ,other,,Not applicable. No negotiated rates per contract,$5.89 ,44,,,$5.89 ,$178.48 ,fee schedule,,44% of CMS Medicare lab fee schedule,$147.20 ,80,,,$5.89 ,$178.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.20 ,55,,,$5.89 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,95,,,$5.89 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.80 ,95,,,$5.89 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.00 ,75,,,$5.89 ,$178.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.40 ,85,,,$5.89 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.48 ,97,,,$5.89 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.20 ,55,,,$5.89 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.60 ,90,,,$5.89 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.48 ,97,,,$5.89 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$5.89 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$5.89 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.40 ,85,,,$5.89 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.60 ,90,,,$5.89 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$5.89 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,90,,,$5.89 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$5.89 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.12 ,93,,,$5.89 ,$178.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lithium QST,8042677,CDM,301,RC,80178,HCPCS,outpatient,,,$104.00 ,$78.00 ,,$95.68 ,92,,,$2.91 ,$100.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.20 ,55,,,$2.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.91 ,$100.88 ,other,,Not applicable. No negotiated rates per contract,$2.91 ,44,,,$2.91 ,$100.88 ,fee schedule,,44% of CMS Medicare lab fee schedule,$83.20 ,80,,,$2.91 ,$100.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.20 ,55,,,$2.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,95,,,$2.91 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.80 ,95,,,$2.91 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.00 ,75,,,$2.91 ,$100.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.40 ,85,,,$2.91 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.88 ,97,,,$2.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.20 ,55,,,$2.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.60 ,90,,,$2.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.88 ,97,,,$2.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$2.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$2.91 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.40 ,85,,,$2.91 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.60 ,90,,,$2.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$2.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,90,,,$2.91 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$2.91 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.72 ,93,,,$2.91 ,$100.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Liver Fibrosis,8042781,CDM,300,RC,81596,HCPCS,outpatient,,,,,,,,,,$31.76 ,$31.76 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$31.76 ,$31.76 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$31.76 ,$31.76 ,other,,Not applicable. No negotiated rates per contract,$31.76 ,44,,,$31.76 ,$31.76 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$31.76 ,$31.76 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$31.76 ,$31.76 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$31.76 ,$31.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$31.76 ,$31.76 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$31.76 ,$31.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$31.76 ,$31.76 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$31.76 ,$31.76 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Liver Kidney Microsomal Ab (IgG) QST,8743315,CDM,302,RC,86376,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$6.40 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.40 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$6.40 ,44,,,$6.40 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$6.40 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$6.40 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$6.40 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Liver Kidney Microsome Ab (IgG) QST,8713372,CDM,302,RC,86376,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$6.40 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.40 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$6.40 ,44,,,$6.40 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$6.40 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$6.40 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$6.40 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Lytes,633610,CDM,301,RC,80051,HCPCS,outpatient,,,$125.00 ,$93.75 ,,$115.00 ,92,,,$3.08 ,$121.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.75 ,55,,,$3.08 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.08 ,$121.25 ,other,,Not applicable. No negotiated rates per contract,$3.08 ,44,,,$3.08 ,$121.25 ,fee schedule,,44% of CMS Medicare lab fee schedule,$100.00 ,80,,,$3.08 ,$121.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.75 ,55,,,$3.08 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,95,,,$3.08 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.75 ,95,,,$3.08 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.75 ,75,,,$3.08 ,$121.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$106.25 ,85,,,$3.08 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.25 ,97,,,$3.08 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.75 ,55,,,$3.08 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.50 ,90,,,$3.08 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.25 ,97,,,$3.08 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$3.08 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$3.08 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.25 ,85,,,$3.08 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.50 ,90,,,$3.08 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$3.08 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,90,,,$3.08 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$3.08 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.25 ,93,,,$3.08 ,$121.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MRSA Screen HBL,8836664,CDM,306,RC,87641,HCPCS,outpatient,,,$93.00 ,$69.75 ,,$85.56 ,92,,,$15.44 ,$90.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.15 ,55,,,$15.44 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$90.21 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$90.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$74.40 ,80,,,$15.44 ,$90.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.15 ,55,,,$15.44 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,95,,,$15.44 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.35 ,95,,,$15.44 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.75 ,75,,,$15.44 ,$90.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.05 ,85,,,$15.44 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.21 ,97,,,$15.44 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.15 ,55,,,$15.44 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.70 ,90,,,$15.44 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.21 ,97,,,$15.44 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$15.44 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$15.44 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.05 ,85,,,$15.44 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.70 ,90,,,$15.44 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$15.44 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,90,,,$15.44 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$15.44 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.49 ,93,,,$15.44 ,$90.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Magnesium Level,633781,CDM,301,RC,83735,HCPCS,outpatient,,,$138.00 ,$103.50 ,,$126.96 ,92,,,$2.95 ,$133.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$75.90 ,55,,,$2.95 ,$133.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.95 ,$133.86 ,other,,Not applicable. No negotiated rates per contract,$2.95 ,44,,,$2.95 ,$133.86 ,fee schedule,,44% of CMS Medicare lab fee schedule,$110.40 ,80,,,$2.95 ,$133.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$75.90 ,55,,,$2.95 ,$133.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.10 ,95,,,$2.95 ,$133.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.10 ,95,,,$2.95 ,$133.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.50 ,75,,,$2.95 ,$133.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$117.30 ,85,,,$2.95 ,$133.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.86 ,97,,,$2.95 ,$133.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.90 ,55,,,$2.95 ,$133.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.20 ,90,,,$2.95 ,$133.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.86 ,97,,,$2.95 ,$133.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.86 ,97,,,$2.95 ,$133.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.86 ,97,,,$2.95 ,$133.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.30 ,85,,,$2.95 ,$133.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.20 ,90,,,$2.95 ,$133.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.90 ,55,,,$2.95 ,$133.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.10 ,90,,,$2.95 ,$133.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.90 ,55,,,$2.95 ,$133.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.34 ,93,,,$2.95 ,$133.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Megasphaera Species QST,8611506,CDM,306,RC,87799,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$18.85 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.85 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$18.85 ,44,,,$18.85 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$18.85 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$18.85 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$18.85 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$18.85 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$18.85 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$18.85 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$18.85 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$18.85 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Mercury,8042681,CDM,301,RC,83825,HCPCS,outpatient,,,,,,,,,,$7.15 ,$7.15 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,,Not applicable. No negotiated rates per contract,$7.15 ,44,,,$7.15 ,$7.15 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.15 ,$7.15 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Mercury,8422360,CDM,301,RC,83825,HCPCS,outpatient,,,,,,,,,,$7.15 ,$7.15 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,,Not applicable. No negotiated rates per contract,$7.15 ,44,,,$7.15 ,$7.15 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.15 ,$7.15 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.15 ,$7.15 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.15 ,$7.15 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Microalbumin Level Urine,8036770,CDM,301,RC,82043,HCPCS,outpatient,,,$131.00 ,$98.25 ,,$120.52 ,92,,,$2.54 ,$127.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.05 ,55,,,$2.54 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.54 ,$127.07 ,other,,Not applicable. No negotiated rates per contract,$2.54 ,44,,,$2.54 ,$127.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$104.80 ,80,,,$2.54 ,$127.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.05 ,55,,,$2.54 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,95,,,$2.54 ,$127.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.45 ,95,,,$2.54 ,$127.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.25 ,75,,,$2.54 ,$127.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$111.35 ,85,,,$2.54 ,$127.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.07 ,97,,,$2.54 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.05 ,55,,,$2.54 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.90 ,90,,,$2.54 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.07 ,97,,,$2.54 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$2.54 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.07 ,97,,,$2.54 ,$127.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.35 ,85,,,$2.54 ,$127.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.90 ,90,,,$2.54 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.05 ,55,,,$2.54 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.45 ,90,,,$2.54 ,$127.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.05 ,55,,,$2.54 ,$127.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.83 ,93,,,$2.54 ,$127.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Microalbumin/Creatinine Ratio Urine,8036783,CDM,301,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Misc Test to Quest (Rmt) QST,8713044,CDM,300,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Misc Test to Quest QST,8235497,CDM,300,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Miscellaneous Test HBL,8836684,CDM,300,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Mitochondrial Ab Scrn QST,8743213,CDM,301,RC,83516,HCPCS,outpatient,,,$328.00 ,$246.00 ,,$301.76 ,92,,,$5.07 ,$318.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$180.40 ,55,,,$5.07 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.07 ,$318.16 ,other,,Not applicable. No negotiated rates per contract,$5.07 ,44,,,$5.07 ,$318.16 ,fee schedule,,44% of CMS Medicare lab fee schedule,$262.40 ,80,,,$5.07 ,$318.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$180.40 ,55,,,$5.07 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,95,,,$5.07 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$311.60 ,95,,,$5.07 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.00 ,75,,,$5.07 ,$318.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$278.80 ,85,,,$5.07 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$318.16 ,97,,,$5.07 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.40 ,55,,,$5.07 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.20 ,90,,,$5.07 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$318.16 ,97,,,$5.07 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$5.07 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$5.07 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.80 ,85,,,$5.07 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.20 ,90,,,$5.07 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.40 ,55,,,$5.07 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,90,,,$5.07 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.40 ,55,,,$5.07 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$305.04 ,93,,,$5.07 ,$318.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Mitochondrial Ab w/Rfx Titer QST,8235501,CDM,300,RC,86255,HCPCS,outpatient,,,$162.00 ,$121.50 ,,$149.04 ,92,,,$5.30 ,$157.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.10 ,55,,,$5.30 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.30 ,$157.14 ,other,,Not applicable. No negotiated rates per contract,$5.30 ,44,,,$5.30 ,$157.14 ,fee schedule,,44% of CMS Medicare lab fee schedule,$129.60 ,80,,,$5.30 ,$157.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.10 ,55,,,$5.30 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,95,,,$5.30 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.90 ,95,,,$5.30 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.50 ,75,,,$5.30 ,$157.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$137.70 ,85,,,$5.30 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.14 ,97,,,$5.30 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.10 ,55,,,$5.30 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.80 ,90,,,$5.30 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.14 ,97,,,$5.30 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$5.30 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$5.30 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.70 ,85,,,$5.30 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.80 ,90,,,$5.30 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$5.30 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$5.30 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$5.30 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.66 ,93,,,$5.30 ,$157.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Mono Scrn,633785,CDM,302,RC,86308,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$2.28 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.28 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$2.28 ,44,,,$2.28 ,$114.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$94.40 ,80,,,$2.28 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$2.28 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$2.28 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$2.28 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$2.28 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$2.28 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$2.28 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$2.28 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$2.28 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$2.28 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Myeloperoxidase Antibody QST,8177894,CDM,300,RC,86021,HCPCS,outpatient,,,$563.00 ,$422.25 ,,$517.96 ,92,,,$6.62 ,$546.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.62 ,$546.11 ,other,,Not applicable. No negotiated rates per contract,$6.62 ,44,,,$6.62 ,$546.11 ,fee schedule,,44% of CMS Medicare lab fee schedule,$450.40 ,80,,,$6.62 ,$546.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.85 ,95,,,$6.62 ,$546.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$534.85 ,95,,,$6.62 ,$546.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$422.25 ,75,,,$6.62 ,$546.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$478.55 ,85,,,$6.62 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$506.70 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$478.55 ,85,,,$6.62 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$506.70 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.85 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.59 ,93,,,$6.62 ,$546.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
N Telopeptide (NTx) QST,8743304,CDM,300,RC,82523,HCPCS,outpatient,,,$85.00 ,$63.75 ,,$78.20 ,92,,,$8.22 ,$82.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.75 ,55,,,$8.22 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.22 ,$82.45 ,other,,Not applicable. No negotiated rates per contract,$8.22 ,44,,,$8.22 ,$82.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,$68.00 ,80,,,$8.22 ,$82.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.75 ,55,,,$8.22 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,95,,,$8.22 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.75 ,95,,,$8.22 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.75 ,75,,,$8.22 ,$82.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.25 ,85,,,$8.22 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.45 ,97,,,$8.22 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.75 ,55,,,$8.22 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.50 ,90,,,$8.22 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.45 ,97,,,$8.22 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$8.22 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$8.22 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.25 ,85,,,$8.22 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.50 ,90,,,$8.22 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$8.22 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,90,,,$8.22 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$8.22 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.05 ,93,,,$8.22 ,$82.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NT-Pro BNP,1503769,CDM,301,RC,83880,HCPCS,outpatient,,,$247.00 ,$185.25 ,,$227.24 ,92,,,$17.27 ,$239.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$135.85 ,55,,,$17.27 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.27 ,$239.59 ,other,,Not applicable. No negotiated rates per contract,$17.27 ,44,,,$17.27 ,$239.59 ,fee schedule,,44% of CMS Medicare lab fee schedule,$197.60 ,80,,,$17.27 ,$239.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$135.85 ,55,,,$17.27 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.65 ,95,,,$17.27 ,$239.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.65 ,95,,,$17.27 ,$239.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$185.25 ,75,,,$17.27 ,$239.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$209.95 ,85,,,$17.27 ,$239.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$239.59 ,97,,,$17.27 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.85 ,55,,,$17.27 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,90,,,$17.27 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.59 ,97,,,$17.27 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.59 ,97,,,$17.27 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.59 ,97,,,$17.27 ,$239.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.95 ,85,,,$17.27 ,$239.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$222.30 ,90,,,$17.27 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.85 ,55,,,$17.27 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.65 ,90,,,$17.27 ,$239.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.85 ,55,,,$17.27 ,$239.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$229.71 ,93,,,$17.27 ,$239.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Neisseria Gonorrhoeae RNA,8611501,CDM,306,RC,87591,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Osmolality (S) QST,8042690,CDM,301,RC,83930,HCPCS,outpatient,,,$77.00 ,$57.75 ,,$70.84 ,92,,,$2.91 ,$74.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.35 ,55,,,$2.91 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.91 ,$74.69 ,other,,Not applicable. No negotiated rates per contract,$2.91 ,44,,,$2.91 ,$74.69 ,fee schedule,,44% of CMS Medicare lab fee schedule,$61.60 ,80,,,$2.91 ,$74.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.35 ,55,,,$2.91 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,95,,,$2.91 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.15 ,95,,,$2.91 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.75 ,75,,,$2.91 ,$74.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.45 ,85,,,$2.91 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.69 ,97,,,$2.91 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.35 ,55,,,$2.91 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.30 ,90,,,$2.91 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.69 ,97,,,$2.91 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$2.91 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$2.91 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,85,,,$2.91 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.30 ,90,,,$2.91 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$2.91 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,90,,,$2.91 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$2.91 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.61 ,93,,,$2.91 ,$74.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Osmolality (U) QST,8042691,CDM,301,RC,83935,HCPCS,outpatient,,,$77.00 ,$57.75 ,,$70.84 ,92,,,$3.00 ,$74.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.35 ,55,,,$3.00 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.00 ,$74.69 ,other,,Not applicable. No negotiated rates per contract,$3.00 ,44,,,$3.00 ,$74.69 ,fee schedule,,44% of CMS Medicare lab fee schedule,$61.60 ,80,,,$3.00 ,$74.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.35 ,55,,,$3.00 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,95,,,$3.00 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.15 ,95,,,$3.00 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.75 ,75,,,$3.00 ,$74.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.45 ,85,,,$3.00 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.69 ,97,,,$3.00 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.35 ,55,,,$3.00 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.30 ,90,,,$3.00 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.69 ,97,,,$3.00 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$3.00 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$3.00 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,85,,,$3.00 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.30 ,90,,,$3.00 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$3.00 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,90,,,$3.00 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$3.00 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.61 ,93,,,$3.00 ,$74.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ova & Parasites HBL,8836665,CDM,306,RC,87177,HCPCS,outpatient,,,$168.00 ,$126.00 ,,$154.56 ,92,,,$3.92 ,$162.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$92.40 ,55,,,$3.92 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.92 ,$162.96 ,other,,Not applicable. No negotiated rates per contract,$3.92 ,44,,,$3.92 ,$162.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$134.40 ,80,,,$3.92 ,$162.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$92.40 ,55,,,$3.92 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,95,,,$3.92 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.60 ,95,,,$3.92 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.00 ,75,,,$3.92 ,$162.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$142.80 ,85,,,$3.92 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.96 ,97,,,$3.92 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.40 ,55,,,$3.92 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.20 ,90,,,$3.92 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.96 ,97,,,$3.92 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$3.92 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$3.92 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.80 ,85,,,$3.92 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.20 ,90,,,$3.92 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$3.92 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,90,,,$3.92 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$3.92 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.24 ,93,,,$3.92 ,$162.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Oxcarbazepine Metabolite QST,8042573,CDM,301,RC,80183,HCPCS,outpatient,,,$222.00 ,$166.50 ,,$204.24 ,92,,,$5.83 ,$215.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$122.10 ,55,,,$5.83 ,$215.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.83 ,$215.34 ,other,,Not applicable. No negotiated rates per contract,$5.83 ,44,,,$5.83 ,$215.34 ,fee schedule,,44% of CMS Medicare lab fee schedule,$177.60 ,80,,,$5.83 ,$215.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$122.10 ,55,,,$5.83 ,$215.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.90 ,95,,,$5.83 ,$215.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$210.90 ,95,,,$5.83 ,$215.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.50 ,75,,,$5.83 ,$215.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$188.70 ,85,,,$5.83 ,$215.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$215.34 ,97,,,$5.83 ,$215.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.10 ,55,,,$5.83 ,$215.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.80 ,90,,,$5.83 ,$215.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$215.34 ,97,,,$5.83 ,$215.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.34 ,97,,,$5.83 ,$215.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.34 ,97,,,$5.83 ,$215.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.70 ,85,,,$5.83 ,$215.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$199.80 ,90,,,$5.83 ,$215.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.10 ,55,,,$5.83 ,$215.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.90 ,90,,,$5.83 ,$215.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.10 ,55,,,$5.83 ,$215.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.46 ,93,,,$5.83 ,$215.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POCT Flu A&B,8863999,CDM,306,RC,87502,HCPCS,outpatient,,,$184.00 ,$138.00 ,,$169.28 ,92,,,$42.15 ,$178.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.20 ,55,,,$42.15 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.15 ,$178.48 ,other,,Not applicable. No negotiated rates per contract,$42.15 ,44,,,$42.15 ,$178.48 ,fee schedule,,44% of CMS Medicare lab fee schedule,$147.20 ,80,,,$42.15 ,$178.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.20 ,55,,,$42.15 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,95,,,$42.15 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.80 ,95,,,$42.15 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.00 ,75,,,$42.15 ,$178.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.40 ,85,,,$42.15 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.48 ,97,,,$42.15 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.20 ,55,,,$42.15 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.60 ,90,,,$42.15 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.48 ,97,,,$42.15 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$42.15 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$42.15 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.40 ,85,,,$42.15 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.60 ,90,,,$42.15 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$42.15 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,90,,,$42.15 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$42.15 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.12 ,93,,,$42.15 ,$178.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POCT RSV,8864030,CDM,306,RC,87801,HCPCS,outpatient,,,$318.00 ,$238.50 ,,$292.56 ,92,,,$30.89 ,$308.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$174.90 ,55,,,$30.89 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.89 ,$308.46 ,other,,Not applicable. No negotiated rates per contract,$30.89 ,44,,,$30.89 ,$308.46 ,fee schedule,,44% of CMS Medicare lab fee schedule,$254.40 ,80,,,$30.89 ,$308.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$174.90 ,55,,,$30.89 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,95,,,$30.89 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.10 ,95,,,$30.89 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.50 ,75,,,$30.89 ,$308.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.30 ,85,,,$30.89 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.46 ,97,,,$30.89 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.90 ,55,,,$30.89 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.20 ,90,,,$30.89 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.46 ,97,,,$30.89 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$30.89 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$30.89 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.30 ,85,,,$30.89 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.20 ,90,,,$30.89 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$30.89 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,90,,,$30.89 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$30.89 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.74 ,93,,,$30.89 ,$308.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POCT SARS-CoV-2 (COVID-19) RNA (ID Now),9024318,CDM,306,RC,87635,HCPCS,outpatient,,,$132.00 ,$99.00 ,,$121.44 ,92,,,$22.58 ,$128.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.58 ,$128.04 ,other,,Not applicable. No negotiated rates per contract,$22.58 ,44,,,$22.58 ,$128.04 ,fee schedule,,44% of CMS Medicare lab fee schedule,$105.60 ,80,,,$22.58 ,$128.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,95,,,$22.58 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.40 ,95,,,$22.58 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.00 ,75,,,$22.58 ,$128.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.20 ,85,,,$22.58 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.80 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,85,,,$22.58 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.80 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.76 ,93,,,$22.58 ,$128.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POCT Strep A,8864031,CDM,306,RC,87651,HCPCS,outpatient,,,$143.00 ,$107.25 ,,$131.56 ,92,,,$15.44 ,$138.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.65 ,55,,,$15.44 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$138.71 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$138.71 ,fee schedule,,44% of CMS Medicare lab fee schedule,$114.40 ,80,,,$15.44 ,$138.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.65 ,55,,,$15.44 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.85 ,95,,,$15.44 ,$138.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.85 ,95,,,$15.44 ,$138.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$107.25 ,75,,,$15.44 ,$138.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$121.55 ,85,,,$15.44 ,$138.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.71 ,97,,,$15.44 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.65 ,55,,,$15.44 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.70 ,90,,,$15.44 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.71 ,97,,,$15.44 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.71 ,97,,,$15.44 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.71 ,97,,,$15.44 ,$138.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,85,,,$15.44 ,$138.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.70 ,90,,,$15.44 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.65 ,55,,,$15.44 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.85 ,90,,,$15.44 ,$138.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.65 ,55,,,$15.44 ,$138.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.99 ,93,,,$15.44 ,$138.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSA Diagnostic,1634882,CDM,301,RC,84153,HCPCS,outpatient,,,$185.00 ,$138.75 ,,$170.20 ,92,,,$8.09 ,$179.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.09 ,$179.45 ,other,,Not applicable. No negotiated rates per contract,$8.09 ,44,,,$8.09 ,$179.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,$148.00 ,80,,,$8.09 ,$179.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,95,,,$8.09 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.75 ,95,,,$8.09 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.75 ,75,,,$8.09 ,$179.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$157.25 ,85,,,$8.09 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.50 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.25 ,85,,,$8.09 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.50 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.05 ,93,,,$8.09 ,$179.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSA Screen,9216166,CDM,301,RC,84153,HCPCS,outpatient,,,,,,,,,,$8.09 ,$8.09 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,,Not applicable. No negotiated rates per contract,$8.09 ,44,,,$8.09 ,$8.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.09 ,$8.09 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
PSA Scrn,4123035,CDM,301,RC,84153,HCPCS,outpatient,,,$162.00 ,$121.50 ,,$149.04 ,92,,,$8.09 ,$157.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.10 ,55,,,$8.09 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.09 ,$157.14 ,other,,Not applicable. No negotiated rates per contract,$8.09 ,44,,,$8.09 ,$157.14 ,fee schedule,,44% of CMS Medicare lab fee schedule,$129.60 ,80,,,$8.09 ,$157.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.10 ,55,,,$8.09 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,95,,,$8.09 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.90 ,95,,,$8.09 ,$157.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.50 ,75,,,$8.09 ,$157.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$137.70 ,85,,,$8.09 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.14 ,97,,,$8.09 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.10 ,55,,,$8.09 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.80 ,90,,,$8.09 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.14 ,97,,,$8.09 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$8.09 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.14 ,97,,,$8.09 ,$157.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.70 ,85,,,$8.09 ,$157.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.80 ,90,,,$8.09 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$8.09 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$8.09 ,$157.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.10 ,55,,,$8.09 ,$157.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.66 ,93,,,$8.09 ,$157.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSA Total QST,8047852,CDM,300,RC,84153,HCPCS,outpatient,,,$185.00 ,$138.75 ,,$170.20 ,92,,,$8.09 ,$179.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.09 ,$179.45 ,other,,Not applicable. No negotiated rates per contract,$8.09 ,44,,,$8.09 ,$179.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,$148.00 ,80,,,$8.09 ,$179.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,95,,,$8.09 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.75 ,95,,,$8.09 ,$179.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.75 ,75,,,$8.09 ,$179.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$157.25 ,85,,,$8.09 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.50 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.45 ,97,,,$8.09 ,$179.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.25 ,85,,,$8.09 ,$179.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.50 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.75 ,90,,,$8.09 ,$179.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.75 ,55,,,$8.09 ,$179.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.05 ,93,,,$8.09 ,$179.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSA,8047855,CDM,301,RC,84154,HCPCS,outpatient,,,,,,,,,,$8.09 ,$8.09 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,,Not applicable. No negotiated rates per contract,$8.09 ,44,,,$8.09 ,$8.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$8.09 ,$8.09 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$8.09 ,$8.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$8.09 ,$8.09 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
PT (INR),8046171,CDM,305,RC,85610,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$1.89 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.89 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$1.89 ,44,,,$1.89 ,$56.26 ,fee schedule,,44% of CMS Medicare lab fee schedule,$46.40 ,80,,,$1.89 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$1.89 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$1.89 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT/INR POCT,8278742,CDM,305,RC,85610,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$1.89 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.89 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$1.89 ,44,,,$1.89 ,$56.26 ,fee schedule,,44% of CMS Medicare lab fee schedule,$46.40 ,80,,,$1.89 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$1.89 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$1.89 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$1.89 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$1.89 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$1.89 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$1.89 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$1.89 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PTH,8414408,CDM,301,RC,83970,HCPCS,outpatient,,,,,,,,,,$18.16 ,$18.16 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,,Not applicable. No negotiated rates per contract,$18.16 ,44,,,$18.16 ,$18.16 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$18.16 ,$18.16 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Parathyroid Hormone,8426365,CDM,301,RC,83970,HCPCS,outpatient,,,,,,,,,,$18.16 ,$18.16 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,,Not applicable. No negotiated rates per contract,$18.16 ,44,,,$18.16 ,$18.16 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$18.16 ,$18.16 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.16 ,$18.16 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.16 ,$18.16 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Partial Thromboplastin Time,633794,CDM,305,RC,85730,HCPCS,outpatient,,,$86.00 ,$64.50 ,,$79.12 ,92,,,$2.64 ,$83.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.30 ,55,,,$2.64 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.64 ,$83.42 ,other,,Not applicable. No negotiated rates per contract,$2.64 ,44,,,$2.64 ,$83.42 ,fee schedule,,44% of CMS Medicare lab fee schedule,$68.80 ,80,,,$2.64 ,$83.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.30 ,55,,,$2.64 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,95,,,$2.64 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.70 ,95,,,$2.64 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.50 ,75,,,$2.64 ,$83.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.10 ,85,,,$2.64 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.42 ,97,,,$2.64 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.30 ,55,,,$2.64 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.40 ,90,,,$2.64 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.42 ,97,,,$2.64 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$2.64 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$2.64 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.10 ,85,,,$2.64 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.40 ,90,,,$2.64 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$2.64 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,90,,,$2.64 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$2.64 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.98 ,93,,,$2.64 ,$83.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Path Review of Peripheral Smear QST,8147212,CDM,300,RC,85060,HCPCS,outpatient,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$66.55 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.55 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$104.06 ,86,,,$66.55 ,$117.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.80 ,80,,,$66.55 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$66.55 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$66.55 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Peanut (F13) IgE QST,8042476,CDM,300,RC,,HCPCS,outpatient,,,$35.00 ,$26.25 ,,$32.20 ,92,,,$19.25 ,$33.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.25 ,$33.95 ,other,,Not applicable. No negotiated rates per contract,$30.10 ,86,,,$19.25 ,$33.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.00 ,80,,,$19.25 ,$33.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,95,,,$19.25 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.25 ,95,,,$19.25 ,$33.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.25 ,75,,,$19.25 ,$33.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,90,,,$19.25 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$33.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$33.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.50 ,90,,,$19.25 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,90,,,$19.25 ,$33.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$33.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.55 ,93,,,$19.25 ,$33.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Phenytoin Lvl,8166364,CDM,301,RC,80185,HCPCS,outpatient,,,$153.00 ,$114.75 ,,$140.76 ,92,,,$5.83 ,$148.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.15 ,55,,,$5.83 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.83 ,$148.41 ,other,,Not applicable. No negotiated rates per contract,$5.83 ,44,,,$5.83 ,$148.41 ,fee schedule,,44% of CMS Medicare lab fee schedule,$122.40 ,80,,,$5.83 ,$148.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.15 ,55,,,$5.83 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.35 ,95,,,$5.83 ,$148.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.35 ,95,,,$5.83 ,$148.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.75 ,75,,,$5.83 ,$148.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.05 ,85,,,$5.83 ,$148.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.41 ,97,,,$5.83 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.15 ,55,,,$5.83 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.70 ,90,,,$5.83 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.41 ,97,,,$5.83 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.41 ,97,,,$5.83 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.41 ,97,,,$5.83 ,$148.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.05 ,85,,,$5.83 ,$148.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.70 ,90,,,$5.83 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.15 ,55,,,$5.83 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.35 ,90,,,$5.83 ,$148.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.15 ,55,,,$5.83 ,$148.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.29 ,93,,,$5.83 ,$148.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Phosphorus Level,633803,CDM,301,RC,84100,HCPCS,outpatient,,,$106.00 ,$79.50 ,,$97.52 ,92,,,$2.09 ,$102.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.30 ,55,,,$2.09 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.09 ,$102.82 ,other,,Not applicable. No negotiated rates per contract,$2.09 ,44,,,$2.09 ,$102.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.80 ,80,,,$2.09 ,$102.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.30 ,55,,,$2.09 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,95,,,$2.09 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.70 ,95,,,$2.09 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.50 ,75,,,$2.09 ,$102.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.10 ,85,,,$2.09 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.82 ,97,,,$2.09 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.30 ,55,,,$2.09 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.40 ,90,,,$2.09 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.82 ,97,,,$2.09 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.09 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.09 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.10 ,85,,,$2.09 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.40 ,90,,,$2.09 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.09 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,90,,,$2.09 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.09 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.58 ,93,,,$2.09 ,$102.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Plasma Renin Activity,8042383,CDM,301,RC,84244,HCPCS,outpatient,,,,,,,,,,$9.68 ,$9.68 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,,Not applicable. No negotiated rates per contract,$9.68 ,44,,,$9.68 ,$9.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$9.68 ,$9.68 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Plasma Renin Activity,8227456,CDM,301,RC,84244,HCPCS,outpatient,,,,,,,,,,$9.68 ,$9.68 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,,Not applicable. No negotiated rates per contract,$9.68 ,44,,,$9.68 ,$9.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$9.68 ,$9.68 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$9.68 ,$9.68 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$9.68 ,$9.68 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Platelet Count,2182297,CDM,305,RC,85049,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$1.97 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$1.97 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.97 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$1.97 ,44,,,$1.97 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$1.97 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$1.97 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$1.97 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$1.97 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$1.97 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$1.97 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$1.97 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$1.97 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$1.97 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$1.97 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.97 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$1.97 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$1.97 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$1.97 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.97 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$1.97 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$1.97 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$1.97 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Potassium Level,633616,CDM,301,RC,84132,HCPCS,outpatient,,,$93.00 ,$69.75 ,,$85.56 ,92,,,$2.09 ,$90.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.15 ,55,,,$2.09 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.09 ,$90.21 ,other,,Not applicable. No negotiated rates per contract,$2.09 ,44,,,$2.09 ,$90.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$74.40 ,80,,,$2.09 ,$90.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.15 ,55,,,$2.09 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,95,,,$2.09 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.35 ,95,,,$2.09 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.75 ,75,,,$2.09 ,$90.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.05 ,85,,,$2.09 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.21 ,97,,,$2.09 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.15 ,55,,,$2.09 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.70 ,90,,,$2.09 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.21 ,97,,,$2.09 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$2.09 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$2.09 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.05 ,85,,,$2.09 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.70 ,90,,,$2.09 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$2.09 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,90,,,$2.09 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$2.09 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.49 ,93,,,$2.09 ,$90.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Potassium Level Urine,4185373,CDM,301,RC,84133,HCPCS,outpatient,,,$78.00 ,$58.50 ,,$71.76 ,92,,,$2.08 ,$75.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.90 ,55,,,$2.08 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.08 ,$75.66 ,other,,Not applicable. No negotiated rates per contract,$2.08 ,44,,,$2.08 ,$75.66 ,fee schedule,,44% of CMS Medicare lab fee schedule,$62.40 ,80,,,$2.08 ,$75.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.90 ,55,,,$2.08 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.10 ,95,,,$2.08 ,$75.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.10 ,95,,,$2.08 ,$75.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.50 ,75,,,$2.08 ,$75.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.30 ,85,,,$2.08 ,$75.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.66 ,97,,,$2.08 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.90 ,55,,,$2.08 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.20 ,90,,,$2.08 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.66 ,97,,,$2.08 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.66 ,97,,,$2.08 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.66 ,97,,,$2.08 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.30 ,85,,,$2.08 ,$75.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.20 ,90,,,$2.08 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.90 ,55,,,$2.08 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.10 ,90,,,$2.08 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.90 ,55,,,$2.08 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.54 ,93,,,$2.08 ,$75.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Prealbumin QST,8042629,CDM,301,RC,84134,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$6.42 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$6.42 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.42 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$6.42 ,44,,,$6.42 ,$177.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,$146.40 ,80,,,$6.42 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$6.42 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$6.42 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$6.42 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$6.42 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$6.42 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$6.42 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$6.42 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.70 ,90,,,$6.42 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.51 ,97,,,$6.42 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$6.42 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$6.42 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$6.42 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$6.42 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$6.42 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$6.42 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$6.42 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$6.42 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Pregnancy Test Serum Qual,8036827,CDM,301,RC,84703,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$3.31 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$3.31 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.31 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$3.31 ,44,,,$3.31 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$3.31 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$3.31 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$3.31 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$3.31 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$3.31 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$3.31 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$3.31 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$3.31 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$3.31 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$3.31 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$3.31 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$3.31 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$3.31 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$3.31 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$3.31 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$3.31 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$3.31 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$3.31 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Pregnancy Test Urine,8036828,CDM,307,RC,81025,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$3.79 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$3.79 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$46.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$38.40 ,80,,,$3.79 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$3.79 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$3.79 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$3.79 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$3.79 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$3.79 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$3.79 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$3.79 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$3.79 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$3.79 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$3.79 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$3.79 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$3.79 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$3.79 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$3.79 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$3.79 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$3.79 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$3.79 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Progesterone QST,8042703,CDM,301,RC,84144,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$9.18 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$9.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.18 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$9.18 ,44,,,$9.18 ,$174.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,$144.00 ,80,,,$9.18 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$9.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$9.18 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$9.18 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$9.18 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$9.18 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$9.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$9.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$9.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$9.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$9.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$9.18 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$9.18 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$9.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$9.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$9.18 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$9.18 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$9.18 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Prolactin QST,8147217,CDM,301,RC,84146,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$8.53 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$8.53 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.53 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$8.53 ,44,,,$8.53 ,$174.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,$144.00 ,80,,,$8.53 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$8.53 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$8.53 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$8.53 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$8.53 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$8.53 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$8.53 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$8.53 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$8.53 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$8.53 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$8.53 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$8.53 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$8.53 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$8.53 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$8.53 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$8.53 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$8.53 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$8.53 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein C,8042396,CDM,305,RC,85303,HCPCS,outpatient,,,,,,,,,,$6.09 ,$6.09 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.09 ,$6.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.09 ,$6.09 ,other,,Not applicable. No negotiated rates per contract,$6.09 ,44,,,$6.09 ,$6.09 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.09 ,$6.09 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.09 ,$6.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.09 ,$6.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.09 ,$6.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.09 ,$6.09 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.09 ,$6.09 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.09 ,$6.09 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Protein Cerebrospinal Fluid,1634881,CDM,301,RC,84157,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$1.76 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$1.76 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.76 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$1.76 ,44,,,$1.76 ,$64.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,$53.60 ,80,,,$1.76 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$1.76 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$1.76 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$1.76 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$1.76 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$1.76 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$1.76 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$1.76 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$1.76 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$1.76 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$1.76 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$1.76 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$1.76 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$1.76 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$1.76 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$1.76 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$1.76 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$1.76 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Level 24 Hour Urine,633811,CDM,301,RC,84156,HCPCS,outpatient,,,$76.00 ,$57.00 ,,$69.92 ,92,,,$1.61 ,$73.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.61 ,$73.72 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$73.72 ,fee schedule,,44% of CMS Medicare lab fee schedule,$60.80 ,80,,,$1.61 ,$73.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,95,,,$1.61 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.20 ,95,,,$1.61 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.00 ,75,,,$1.61 ,$73.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.60 ,85,,,$1.61 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.60 ,85,,,$1.61 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.40 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.68 ,93,,,$1.61 ,$73.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein S,8042397,CDM,305,RC,85306,HCPCS,outpatient,,,,,,,,,,$6.74 ,$6.74 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$6.74 ,$6.74 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.74 ,$6.74 ,other,,Not applicable. No negotiated rates per contract,$6.74 ,44,,,$6.74 ,$6.74 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$6.74 ,$6.74 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$6.74 ,$6.74 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.74 ,$6.74 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.74 ,$6.74 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.74 ,$6.74 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$6.74 ,$6.74 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$6.74 ,$6.74 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Protein Tot & Prot Electro Interp QST,8046395,CDM,301,RC,84165,HCPCS,outpatient,,,$215.00 ,$161.25 ,,$197.80 ,92,,,$4.73 ,$208.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$208.55 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$208.55 ,fee schedule,,44% of CMS Medicare lab fee schedule,$172.00 ,80,,,$4.73 ,$208.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.25 ,75,,,$4.73 ,$208.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.95 ,93,,,$4.73 ,$208.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Tot & Prot Electro Interp QST,8048975,CDM,301,RC,84165,HCPCS,outpatient,,,$215.00 ,$161.25 ,,$197.80 ,92,,,$4.73 ,$208.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$208.55 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$208.55 ,fee schedule,,44% of CMS Medicare lab fee schedule,$172.00 ,80,,,$4.73 ,$208.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.25 ,75,,,$4.73 ,$208.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.95 ,93,,,$4.73 ,$208.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Tot & Prot Electro Interp QST,8186990,CDM,301,RC,84165,HCPCS,outpatient,,,$215.00 ,$161.25 ,,$197.80 ,92,,,$4.73 ,$208.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.73 ,$208.55 ,other,,Not applicable. No negotiated rates per contract,$4.73 ,44,,,$4.73 ,$208.55 ,fee schedule,,44% of CMS Medicare lab fee schedule,$172.00 ,80,,,$4.73 ,$208.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.25 ,95,,,$4.73 ,$208.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.25 ,75,,,$4.73 ,$208.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.55 ,97,,,$4.73 ,$208.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.75 ,85,,,$4.73 ,$208.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.50 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.25 ,90,,,$4.73 ,$208.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.25 ,55,,,$4.73 ,$208.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.95 ,93,,,$4.73 ,$208.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Total,633818,CDM,301,RC,84155,HCPCS,outpatient,,,$65.00 ,$48.75 ,,$59.80 ,92,,,$1.61 ,$63.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$35.75 ,55,,,$1.61 ,$63.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.61 ,$63.05 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$63.05 ,fee schedule,,44% of CMS Medicare lab fee schedule,$52.00 ,80,,,$1.61 ,$63.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$35.75 ,55,,,$1.61 ,$63.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.75 ,95,,,$1.61 ,$63.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.75 ,95,,,$1.61 ,$63.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.75 ,75,,,$1.61 ,$63.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$55.25 ,85,,,$1.61 ,$63.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.05 ,97,,,$1.61 ,$63.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.75 ,55,,,$1.61 ,$63.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.50 ,90,,,$1.61 ,$63.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.05 ,97,,,$1.61 ,$63.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.05 ,97,,,$1.61 ,$63.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.05 ,97,,,$1.61 ,$63.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.25 ,85,,,$1.61 ,$63.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.50 ,90,,,$1.61 ,$63.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.75 ,55,,,$1.61 ,$63.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.75 ,90,,,$1.61 ,$63.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.75 ,55,,,$1.61 ,$63.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.45 ,93,,,$1.61 ,$63.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Total & Electro U Interp QST,8049091,CDM,300,RC,84166,HCPCS,outpatient,,,$132.00 ,$99.00 ,,$121.44 ,92,,,$7.85 ,$128.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.60 ,55,,,$7.85 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.85 ,$128.04 ,other,,Not applicable. No negotiated rates per contract,$7.85 ,44,,,$7.85 ,$128.04 ,fee schedule,,44% of CMS Medicare lab fee schedule,$105.60 ,80,,,$7.85 ,$128.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.60 ,55,,,$7.85 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,95,,,$7.85 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.40 ,95,,,$7.85 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.00 ,75,,,$7.85 ,$128.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.20 ,85,,,$7.85 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.04 ,97,,,$7.85 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,55,,,$7.85 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.80 ,90,,,$7.85 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,97,,,$7.85 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$7.85 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$7.85 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,85,,,$7.85 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.80 ,90,,,$7.85 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$7.85 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,90,,,$7.85 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$7.85 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.76 ,93,,,$7.85 ,$128.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein Urine,4186691,CDM,301,RC,84156,HCPCS,outpatient,,,$76.00 ,$57.00 ,,$69.92 ,92,,,$1.61 ,$73.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.61 ,$73.72 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$73.72 ,fee schedule,,44% of CMS Medicare lab fee schedule,$60.80 ,80,,,$1.61 ,$73.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,95,,,$1.61 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.20 ,95,,,$1.61 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.00 ,75,,,$1.61 ,$73.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.60 ,85,,,$1.61 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$1.61 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.60 ,85,,,$1.61 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.40 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,90,,,$1.61 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$1.61 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.68 ,93,,,$1.61 ,$73.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Protein,8046365,CDM,300,RC,84155,HCPCS,outpatient,,,,,,,,,,$1.61 ,$1.61 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$1.61 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.61 ,$1.61 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Protein,8048965,CDM,300,RC,84155,HCPCS,outpatient,,,,,,,,,,$1.61 ,$1.61 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$1.61 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.61 ,$1.61 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Protein,8186977,CDM,300,RC,84155,HCPCS,outpatient,,,,,,,,,,$1.61 ,$1.61 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,,Not applicable. No negotiated rates per contract,$1.61 ,44,,,$1.61 ,$1.61 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$1.61 ,$1.61 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$1.61 ,$1.61 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$1.61 ,$1.61 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Proteinase-3 Antibody QST,8177893,CDM,300,RC,86021,HCPCS,outpatient,,,$563.00 ,$422.25 ,,$517.96 ,92,,,$6.62 ,$546.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.62 ,$546.11 ,other,,Not applicable. No negotiated rates per contract,$6.62 ,44,,,$6.62 ,$546.11 ,fee schedule,,44% of CMS Medicare lab fee schedule,$450.40 ,80,,,$6.62 ,$546.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.85 ,95,,,$6.62 ,$546.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$534.85 ,95,,,$6.62 ,$546.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$422.25 ,75,,,$6.62 ,$546.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$478.55 ,85,,,$6.62 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$506.70 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.11 ,97,,,$6.62 ,$546.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$478.55 ,85,,,$6.62 ,$546.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$506.70 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.85 ,90,,,$6.62 ,$546.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.65 ,55,,,$6.62 ,$546.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.59 ,93,,,$6.62 ,$546.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Quantiferon-TB Gold Plus,8042408,CDM,302,RC,86480,HCPCS,outpatient,,,,,,,,,,$27.27 ,$27.27 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$27.27 ,$27.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$27.27 ,$27.27 ,other,,Not applicable. No negotiated rates per contract,$27.27 ,44,,,$27.27 ,$27.27 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$27.27 ,$27.27 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$27.27 ,$27.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$27.27 ,$27.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$27.27 ,$27.27 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$27.27 ,$27.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$27.27 ,$27.27 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$27.27 ,$27.27 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
RMSF IgG QST,8048846,CDM,300,RC,86757,HCPCS,outpatient,,,$129.00 ,$96.75 ,,$118.68 ,92,,,$8.51 ,$125.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.51 ,$125.13 ,other,,Not applicable. No negotiated rates per contract,$8.51 ,44,,,$8.51 ,$125.13 ,fee schedule,,44% of CMS Medicare lab fee schedule,$103.20 ,80,,,$8.51 ,$125.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,95,,,$8.51 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.55 ,95,,,$8.51 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.75 ,75,,,$8.51 ,$125.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$109.65 ,85,,,$8.51 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.10 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.65 ,85,,,$8.51 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.10 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.97 ,93,,,$8.51 ,$125.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RMSF IgM QST,8048849,CDM,300,RC,86757,HCPCS,outpatient,,,$129.00 ,$96.75 ,,$118.68 ,92,,,$8.51 ,$125.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.51 ,$125.13 ,other,,Not applicable. No negotiated rates per contract,$8.51 ,44,,,$8.51 ,$125.13 ,fee schedule,,44% of CMS Medicare lab fee schedule,$103.20 ,80,,,$8.51 ,$125.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,95,,,$8.51 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.55 ,95,,,$8.51 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.75 ,75,,,$8.51 ,$125.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$109.65 ,85,,,$8.51 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.10 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$8.51 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.65 ,85,,,$8.51 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.10 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,90,,,$8.51 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$8.51 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.97 ,93,,,$8.51 ,$125.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RPR (Dx) w/ Rfx Titer And Confirmatory Testing QST,8147221,CDM,302,RC,86592,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$1.88 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.88 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$1.88 ,44,,,$1.88 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$1.88 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$1.88 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$1.88 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$1.88 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$1.88 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$1.88 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$1.88 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RPR (Monitor) w/ Rfx To Titer QST,8414492,CDM,302,RC,86592,HCPCS,outpatient,,,$94.00 ,$70.50 ,,$86.48 ,92,,,$1.88 ,$91.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.88 ,$91.18 ,other,,Not applicable. No negotiated rates per contract,$1.88 ,44,,,$1.88 ,$91.18 ,fee schedule,,44% of CMS Medicare lab fee schedule,$75.20 ,80,,,$1.88 ,$91.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,95,,,$1.88 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.30 ,95,,,$1.88 ,$91.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.50 ,75,,,$1.88 ,$91.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.90 ,85,,,$1.88 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.60 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.18 ,97,,,$1.88 ,$91.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.90 ,85,,,$1.88 ,$91.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.60 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.30 ,90,,,$1.88 ,$91.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,55,,,$1.88 ,$91.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.42 ,93,,,$1.88 ,$91.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Red Cell Count,3455493,CDM,305,RC,85041,HCPCS,outpatient,,,$53.00 ,$39.75 ,,$48.76 ,92,,,$1.33 ,$51.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.15 ,55,,,$1.33 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.33 ,$51.41 ,other,,Not applicable. No negotiated rates per contract,$1.33 ,44,,,$1.33 ,$51.41 ,fee schedule,,44% of CMS Medicare lab fee schedule,$42.40 ,80,,,$1.33 ,$51.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.15 ,55,,,$1.33 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,95,,,$1.33 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.35 ,95,,,$1.33 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.75 ,75,,,$1.33 ,$51.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.05 ,85,,,$1.33 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.41 ,97,,,$1.33 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.15 ,55,,,$1.33 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.70 ,90,,,$1.33 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.41 ,97,,,$1.33 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$1.33 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$1.33 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.05 ,85,,,$1.33 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.70 ,90,,,$1.33 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$1.33 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,90,,,$1.33 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$1.33 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.29 ,93,,,$1.33 ,$51.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Renal Pnl,1634883,CDM,301,RC,80069,HCPCS,outpatient,,,$196.00 ,$147.00 ,,$180.32 ,92,,,$3.82 ,$190.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$107.80 ,55,,,$3.82 ,$190.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.82 ,$190.12 ,other,,Not applicable. No negotiated rates per contract,$3.82 ,44,,,$3.82 ,$190.12 ,fee schedule,,44% of CMS Medicare lab fee schedule,$156.80 ,80,,,$3.82 ,$190.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$107.80 ,55,,,$3.82 ,$190.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.20 ,95,,,$3.82 ,$190.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.20 ,95,,,$3.82 ,$190.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$147.00 ,75,,,$3.82 ,$190.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$166.60 ,85,,,$3.82 ,$190.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.12 ,97,,,$3.82 ,$190.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.80 ,55,,,$3.82 ,$190.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.40 ,90,,,$3.82 ,$190.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.12 ,97,,,$3.82 ,$190.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.12 ,97,,,$3.82 ,$190.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.12 ,97,,,$3.82 ,$190.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.60 ,85,,,$3.82 ,$190.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.40 ,90,,,$3.82 ,$190.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.80 ,55,,,$3.82 ,$190.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.20 ,90,,,$3.82 ,$190.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.80 ,55,,,$3.82 ,$190.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.28 ,93,,,$3.82 ,$190.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Resp Pnl 2.1 (BioFire),8888380,CDM,306,RC,87633,HCPCS,outpatient,,,"$1,338.00 ","$1,003.50 ",,"$1,230.96 ",92,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.38 ,"$1,297.86 ",other,,Not applicable. No negotiated rates per contract,$183.38 ,44,,,$183.38 ,"$1,297.86 ",fee schedule,,44% of CMS Medicare lab fee schedule,"$1,070.40 ",80,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.10 ",95,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,271.10 ",95,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,003.50 ",75,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,137.30 ",85,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,204.20 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,137.30 ",85,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.20 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.10 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,244.34 ",93,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Respiratory Panel 2 (BioFire),8044906,CDM,306,RC,87633,HCPCS,outpatient,,,"$1,338.00 ","$1,003.50 ",,"$1,230.96 ",92,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.38 ,"$1,297.86 ",other,,Not applicable. No negotiated rates per contract,$183.38 ,44,,,$183.38 ,"$1,297.86 ",fee schedule,,44% of CMS Medicare lab fee schedule,"$1,070.40 ",80,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.10 ",95,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,271.10 ",95,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,003.50 ",75,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,137.30 ",85,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,204.20 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,297.86 ",97,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,137.30 ",85,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.20 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.10 ",90,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$735.90 ,55,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,244.34 ",93,,,$183.38 ,"$1,297.86 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Retic Cnt Auto,3455503,CDM,305,RC,85045,HCPCS,outpatient,,,$57.00 ,$42.75 ,,$52.44 ,92,,,$1.76 ,$55.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.35 ,55,,,$1.76 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.76 ,$55.29 ,other,,Not applicable. No negotiated rates per contract,$1.76 ,44,,,$1.76 ,$55.29 ,fee schedule,,44% of CMS Medicare lab fee schedule,$45.60 ,80,,,$1.76 ,$55.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.35 ,55,,,$1.76 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,95,,,$1.76 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.15 ,95,,,$1.76 ,$55.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,75,,,$1.76 ,$55.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.45 ,85,,,$1.76 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.29 ,97,,,$1.76 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.35 ,55,,,$1.76 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.30 ,90,,,$1.76 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.29 ,97,,,$1.76 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$1.76 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.29 ,97,,,$1.76 ,$55.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.45 ,85,,,$1.76 ,$55.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.30 ,90,,,$1.76 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$1.76 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.15 ,90,,,$1.76 ,$55.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.35 ,55,,,$1.76 ,$55.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.01 ,93,,,$1.76 ,$55.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Reticulocyte Count QST,8147214,CDM,305,RC,85045,HCPCS,outpatient,,,$56.00 ,$42.00 ,,$51.52 ,92,,,$1.76 ,$54.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.80 ,55,,,$1.76 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.76 ,$54.32 ,other,,Not applicable. No negotiated rates per contract,$1.76 ,44,,,$1.76 ,$54.32 ,fee schedule,,44% of CMS Medicare lab fee schedule,$44.80 ,80,,,$1.76 ,$54.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.80 ,55,,,$1.76 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,95,,,$1.76 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.20 ,95,,,$1.76 ,$54.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.00 ,75,,,$1.76 ,$54.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.60 ,85,,,$1.76 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.32 ,97,,,$1.76 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.80 ,55,,,$1.76 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.40 ,90,,,$1.76 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.32 ,97,,,$1.76 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$1.76 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.32 ,97,,,$1.76 ,$54.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.60 ,85,,,$1.76 ,$54.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.40 ,90,,,$1.76 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$1.76 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.20 ,90,,,$1.76 ,$54.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.80 ,55,,,$1.76 ,$54.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.08 ,93,,,$1.76 ,$54.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rheumatoid Factor QST,8147207,CDM,302,RC,86431,HCPCS,outpatient,,,$124.00 ,$93.00 ,,$114.08 ,92,,,$2.49 ,$120.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.49 ,$120.28 ,other,,Not applicable. No negotiated rates per contract,$2.49 ,44,,,$2.49 ,$120.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,$99.20 ,80,,,$2.49 ,$120.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,95,,,$2.49 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.80 ,95,,,$2.49 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.00 ,75,,,$2.49 ,$120.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.40 ,85,,,$2.49 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.60 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.40 ,85,,,$2.49 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.60 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.32 ,93,,,$2.49 ,$120.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rheumatoid Factor QST,8743200,CDM,302,RC,86431,HCPCS,outpatient,,,$124.00 ,$93.00 ,,$114.08 ,92,,,$2.49 ,$120.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.49 ,$120.28 ,other,,Not applicable. No negotiated rates per contract,$2.49 ,44,,,$2.49 ,$120.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,$99.20 ,80,,,$2.49 ,$120.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,95,,,$2.49 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.80 ,95,,,$2.49 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.00 ,75,,,$2.49 ,$120.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.40 ,85,,,$2.49 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.60 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$2.49 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.40 ,85,,,$2.49 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.60 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,90,,,$2.49 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$2.49 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.32 ,93,,,$2.49 ,$120.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ristocetin Cofactor QST,8042615,CDM,305,RC,85245,HCPCS,outpatient,,,$408.00 ,$306.00 ,,$375.36 ,92,,,$10.09 ,$395.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$224.40 ,55,,,$10.09 ,$395.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$10.09 ,$395.76 ,other,,Not applicable. No negotiated rates per contract,$10.09 ,44,,,$10.09 ,$395.76 ,fee schedule,,44% of CMS Medicare lab fee schedule,$326.40 ,80,,,$10.09 ,$395.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$224.40 ,55,,,$10.09 ,$395.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.60 ,95,,,$10.09 ,$395.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$387.60 ,95,,,$10.09 ,$395.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$306.00 ,75,,,$10.09 ,$395.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$346.80 ,85,,,$10.09 ,$395.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$395.76 ,97,,,$10.09 ,$395.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.40 ,55,,,$10.09 ,$395.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$367.20 ,90,,,$10.09 ,$395.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$395.76 ,97,,,$10.09 ,$395.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$395.76 ,97,,,$10.09 ,$395.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$395.76 ,97,,,$10.09 ,$395.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.80 ,85,,,$10.09 ,$395.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.20 ,90,,,$10.09 ,$395.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.40 ,55,,,$10.09 ,$395.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.60 ,90,,,$10.09 ,$395.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.40 ,55,,,$10.09 ,$395.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.44 ,93,,,$10.09 ,$395.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rubella Antibody (IgG) Diagnostic QST,8422697,CDM,302,RC,86762,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$186.76 ,92,,,$6.33 ,$196.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$196.91 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$196.91 ,fee schedule,,44% of CMS Medicare lab fee schedule,$162.40 ,80,,,$6.33 ,$196.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,95,,,$6.33 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.85 ,95,,,$6.33 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.25 ,75,,,$6.33 ,$196.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$172.55 ,85,,,$6.33 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.70 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.55 ,85,,,$6.33 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.70 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.79 ,93,,,$6.33 ,$196.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rubella Antibody (IgM) QST,8421863,CDM,302,RC,86762,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$186.76 ,92,,,$6.33 ,$196.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$196.91 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$196.91 ,fee schedule,,44% of CMS Medicare lab fee schedule,$162.40 ,80,,,$6.33 ,$196.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,95,,,$6.33 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.85 ,95,,,$6.33 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.25 ,75,,,$6.33 ,$196.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$172.55 ,85,,,$6.33 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.70 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$6.33 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.55 ,85,,,$6.33 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.70 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,90,,,$6.33 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$6.33 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.79 ,93,,,$6.33 ,$196.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
S Kappa Light Chain,8743202,CDM,301,RC,83520,HCPCS,outpatient,,,,,,,,,,$7.60 ,$7.60 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$7.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.60 ,$7.60 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
S Lambda Light Chain,8743203,CDM,301,RC,83520,HCPCS,outpatient,,,,,,,,,,$7.60 ,$7.60 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$7.60 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.60 ,$7.60 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.60 ,$7.60 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.60 ,$7.60 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SARS-CoV-2 (COVID-19) Antigen (Binax),9202840,CDM,306,RC,87811,HCPCS,outpatient,,,$37.00 ,$27.75 ,,$34.04 ,92,,,$20.35 ,$35.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,$29.60 ,80,,,$20.35 ,$35.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.75 ,75,,,$20.35 ,$35.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.41 ,93,,,$20.35 ,$35.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARS-CoV-2 (COVID-19) RNA (ID Now),8878919,CDM,306,RC,87635,HCPCS,outpatient,,,$132.00 ,$99.00 ,,$121.44 ,92,,,$22.58 ,$128.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.58 ,$128.04 ,other,,Not applicable. No negotiated rates per contract,$22.58 ,44,,,$22.58 ,$128.04 ,fee schedule,,44% of CMS Medicare lab fee schedule,$105.60 ,80,,,$22.58 ,$128.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,95,,,$22.58 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.40 ,95,,,$22.58 ,$128.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.00 ,75,,,$22.58 ,$128.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.20 ,85,,,$22.58 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.80 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,97,,,$22.58 ,$128.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.20 ,85,,,$22.58 ,$128.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.80 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.40 ,90,,,$22.58 ,$128.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.60 ,55,,,$22.58 ,$128.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.76 ,93,,,$22.58 ,$128.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARS-CoV-2 AB (IgG) SPIKE,8873257,CDM,302,RC,86769,HCPCS,outpatient,,,,,,,,,,$18.54 ,$18.54 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$18.54 ,$18.54 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.54 ,$18.54 ,other,,Not applicable. No negotiated rates per contract,$18.54 ,44,,,$18.54 ,$18.54 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$18.54 ,$18.54 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$18.54 ,$18.54 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.54 ,$18.54 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.54 ,$18.54 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.54 ,$18.54 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$18.54 ,$18.54 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$18.54 ,$18.54 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SARS-CoV-2 Antigen (BD Veritor),9140044,CDM,300,RC,87426,HCPCS,outpatient,,,$37.00 ,$27.75 ,,$34.04 ,92,,,$20.35 ,$35.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,$29.60 ,80,,,$20.35 ,$35.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.75 ,75,,,$20.35 ,$35.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.41 ,93,,,$20.35 ,$35.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARS-CoV-2 RNA (COVID-19),8867856,CDM,306,RC,87635,HCPCS,outpatient,,,,,,,,,,$22.58 ,$22.58 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$22.58 ,$22.58 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$22.58 ,$22.58 ,other,,Not applicable. No negotiated rates per contract,$22.58 ,44,,,$22.58 ,$22.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$22.58 ,$22.58 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$22.58 ,$22.58 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$22.58 ,$22.58 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$22.58 ,$22.58 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$22.58 ,$22.58 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$22.58 ,$22.58 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$22.58 ,$22.58 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STD Panel (PCR) Visby,10072397,CDM,306,RC,87491,HCPCS,outpatient,,,$79.00 ,$59.25 ,,$72.68 ,92,,,$15.44 ,$76.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$76.63 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$76.63 ,fee schedule,,44% of CMS Medicare lab fee schedule,$63.20 ,80,,,$15.44 ,$76.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.05 ,95,,,$15.44 ,$76.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.25 ,75,,,$15.44 ,$76.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.63 ,97,,,$15.44 ,$76.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.15 ,85,,,$15.44 ,$76.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.10 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.05 ,90,,,$15.44 ,$76.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.45 ,55,,,$15.44 ,$76.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.47 ,93,,,$15.44 ,$76.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Salicylate Level,1503768,CDM,300,RC,80179,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$229.08 ,92,,,$8.20 ,$241.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.95 ,55,,,$8.20 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.20 ,$241.53 ,other,,Not applicable. No negotiated rates per contract,$8.20 ,44,,,$8.20 ,$241.53 ,fee schedule,,44% of CMS Medicare lab fee schedule,$199.20 ,80,,,$8.20 ,$241.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.95 ,55,,,$8.20 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,95,,,$8.20 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.55 ,95,,,$8.20 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.75 ,75,,,$8.20 ,$241.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.65 ,85,,,$8.20 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.53 ,97,,,$8.20 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.95 ,55,,,$8.20 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.10 ,90,,,$8.20 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.53 ,97,,,$8.20 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$8.20 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$8.20 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.65 ,85,,,$8.20 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$224.10 ,90,,,$8.20 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.95 ,55,,,$8.20 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,90,,,$8.20 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.95 ,55,,,$8.20 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.57 ,93,,,$8.20 ,$241.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 1 (1) QST,8047013,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 12 (12F) QST,8047034,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 14 (14) QST,8047037,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 17 (17F) QST,8047040,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 19 (19F) QST,8047043,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 2 (2) QST,8047016,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 20 (20) QST,8047046,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 22 (22F) QST,8047049,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 23 (23F) QST,8047052,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 26 (6B) QST,8047055,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 3 (3) QST,8047019,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 34 (10A) QST,8047058,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 4 (4) QST,8047022,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 43 (11A) QST,8047061,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 5 (5) QST,8047025,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 51 (7F) QST,8047064,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 54 (15B) QST,8047067,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 56 (18C) QST,8047070,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 57 (19A) QST,8047073,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 68 (9V) QST,8047076,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 70 (33F) QST,8047079,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 8 (8) QST,8047028,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Serotype 9 (9N) QST,8047031,CDM,302,RC,86317,HCPCS,outpatient,,,$68.00 ,$51.00 ,,$62.56 ,92,,,$6.60 ,$65.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$65.96 ,other,,Not applicable. No negotiated rates per contract,$6.60 ,44,,,$6.60 ,$65.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$54.40 ,80,,,$6.60 ,$65.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.60 ,95,,,$6.60 ,$65.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.00 ,75,,,$6.60 ,$65.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.96 ,97,,,$6.60 ,$65.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.80 ,85,,,$6.60 ,$65.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.20 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.60 ,90,,,$6.60 ,$65.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.40 ,55,,,$6.60 ,$65.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.24 ,93,,,$6.60 ,$65.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sinus Culture HBL,8836666,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sjogren's Antibody (SS-A) QST,8049022,CDM,302,RC,86235,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$7.89 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.89 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$7.89 ,44,,,$7.89 ,$177.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,$146.40 ,80,,,$7.89 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$7.89 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$7.89 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sjogren's Antibody (SS-B) QST,8049023,CDM,302,RC,86235,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$7.89 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.89 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$7.89 ,44,,,$7.89 ,$177.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,$146.40 ,80,,,$7.89 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$7.89 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$7.89 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sm Antibody QST,8048960,CDM,302,RC,86235,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$7.89 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.89 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$7.89 ,44,,,$7.89 ,$177.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,$146.40 ,80,,,$7.89 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$7.89 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$7.89 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sm/RNP Antibody QST,8048961,CDM,302,RC,86235,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$7.89 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.89 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$7.89 ,44,,,$7.89 ,$177.51 ,fee schedule,,44% of CMS Medicare lab fee schedule,$146.40 ,80,,,$7.89 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$7.89 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$7.89 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$7.89 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$7.89 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$7.89 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$7.89 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$7.89 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sodium,633611,CDM,301,RC,84295,HCPCS,outpatient,,,$93.00 ,$69.75 ,,$85.56 ,92,,,$2.12 ,$90.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.15 ,55,,,$2.12 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.12 ,$90.21 ,other,,Not applicable. No negotiated rates per contract,$2.12 ,44,,,$2.12 ,$90.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$74.40 ,80,,,$2.12 ,$90.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.15 ,55,,,$2.12 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,95,,,$2.12 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.35 ,95,,,$2.12 ,$90.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.75 ,75,,,$2.12 ,$90.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.05 ,85,,,$2.12 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.21 ,97,,,$2.12 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.15 ,55,,,$2.12 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.70 ,90,,,$2.12 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.21 ,97,,,$2.12 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$2.12 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.21 ,97,,,$2.12 ,$90.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.05 ,85,,,$2.12 ,$90.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.70 ,90,,,$2.12 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$2.12 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.35 ,90,,,$2.12 ,$90.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.15 ,55,,,$2.12 ,$90.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.49 ,93,,,$2.12 ,$90.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sodium Level Urine,4185817,CDM,301,RC,84300,HCPCS,outpatient,,,$106.00 ,$79.50 ,,$97.52 ,92,,,$2.23 ,$102.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.30 ,55,,,$2.23 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.23 ,$102.82 ,other,,Not applicable. No negotiated rates per contract,$2.23 ,44,,,$2.23 ,$102.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$84.80 ,80,,,$2.23 ,$102.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.30 ,55,,,$2.23 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,95,,,$2.23 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.70 ,95,,,$2.23 ,$102.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.50 ,75,,,$2.23 ,$102.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.10 ,85,,,$2.23 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.82 ,97,,,$2.23 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.30 ,55,,,$2.23 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.40 ,90,,,$2.23 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.82 ,97,,,$2.23 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.23 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.82 ,97,,,$2.23 ,$102.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.10 ,85,,,$2.23 ,$102.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.40 ,90,,,$2.23 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.23 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.70 ,90,,,$2.23 ,$102.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.30 ,55,,,$2.23 ,$102.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.58 ,93,,,$2.23 ,$102.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Spinal Fluid Culture HBL,8836667,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sputum Culture HBL,8836668,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sterile Body Fluid Culture HBL,8836669,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Stone Analysis QST,8042498,CDM,300,RC,82365,HCPCS,outpatient,,,$159.00 ,$119.25 ,,$146.28 ,92,,,$5.68 ,$154.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$87.45 ,55,,,$5.68 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.68 ,$154.23 ,other,,Not applicable. No negotiated rates per contract,$5.68 ,44,,,$5.68 ,$154.23 ,fee schedule,,44% of CMS Medicare lab fee schedule,$127.20 ,80,,,$5.68 ,$154.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$87.45 ,55,,,$5.68 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.05 ,95,,,$5.68 ,$154.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$151.05 ,95,,,$5.68 ,$154.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.25 ,75,,,$5.68 ,$154.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$135.15 ,85,,,$5.68 ,$154.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.23 ,97,,,$5.68 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.45 ,55,,,$5.68 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.10 ,90,,,$5.68 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.23 ,97,,,$5.68 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.23 ,97,,,$5.68 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.23 ,97,,,$5.68 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.15 ,85,,,$5.68 ,$154.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.10 ,90,,,$5.68 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.45 ,55,,,$5.68 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.05 ,90,,,$5.68 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.45 ,55,,,$5.68 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.87 ,93,,,$5.68 ,$154.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Stratify JCV Ab (w/Indx) w/Rfx Inhib QST,8713362,CDM,300,RC,86711,HCPCS,outpatient,,,"$5,051.00 ","$3,788.25 ",,"$4,646.92 ",92,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,778.05 ",55,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.43 ,"$4,899.47 ",other,,Not applicable. No negotiated rates per contract,$7.43 ,44,,,$7.43 ,"$4,899.47 ",fee schedule,,44% of CMS Medicare lab fee schedule,"$4,040.80 ",80,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,778.05 ",55,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,798.45 ",95,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,798.45 ",95,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,788.25 ",75,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,293.35 ",85,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,899.47 ",97,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,778.05 ",55,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,545.90 ",90,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,899.47 ",97,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,899.47 ",97,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,899.47 ",97,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,293.35 ",85,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,545.90 ",90,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,778.05 ",55,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,798.45 ",90,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,778.05 ",55,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,697.43 ",93,,,$7.43 ,"$4,899.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Strep Screen HBL,8836670,CDM,306,RC,87081,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$2.92 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.92 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$2.92 ,44,,,$2.92 ,$119.31 ,fee schedule,,44% of CMS Medicare lab fee schedule,$98.40 ,80,,,$2.92 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$2.92 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$2.92 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$2.92 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$2.92 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.70 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$2.92 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$2.92 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$2.92 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$2.92 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$2.92 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Sureswab Candidiasis QST,8282391,CDM,300,RC,87481,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$15.44 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$15.44 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.44 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$321.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$264.80 ,80,,,$15.44 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$15.44 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$15.44 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$15.44 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$15.44 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$15.44 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$15.44 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$15.44 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$15.44 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$15.44 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$15.44 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$15.44 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$15.44 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$15.44 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$15.44 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$15.44 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$15.44 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$15.44 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
T3 AutoAb QST,8414487,CDM,301,RC,83519,HCPCS,outpatient,,,$725.00 ,$543.75 ,,$667.00 ,92,,,$8.10 ,$703.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.10 ,$703.25 ,other,,Not applicable. No negotiated rates per contract,$8.10 ,44,,,$8.10 ,$703.25 ,fee schedule,,44% of CMS Medicare lab fee schedule,$580.00 ,80,,,$8.10 ,$703.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$688.75 ,95,,,$8.10 ,$703.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$688.75 ,95,,,$8.10 ,$703.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.75 ,75,,,$8.10 ,$703.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$616.25 ,85,,,$8.10 ,$703.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.50 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$703.25 ,97,,,$8.10 ,$703.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$616.25 ,85,,,$8.10 ,$703.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$652.50 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$688.75 ,90,,,$8.10 ,$703.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.75 ,55,,,$8.10 ,$703.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.25 ,93,,,$8.10 ,$703.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
T3 Free,3170323,CDM,301,RC,84481,HCPCS,outpatient,,,$227.00 ,$170.25 ,,$208.84 ,92,,,$7.45 ,$220.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.85 ,55,,,$7.45 ,$220.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.45 ,$220.19 ,other,,Not applicable. No negotiated rates per contract,$7.45 ,44,,,$7.45 ,$220.19 ,fee schedule,,44% of CMS Medicare lab fee schedule,$181.60 ,80,,,$7.45 ,$220.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.85 ,55,,,$7.45 ,$220.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.65 ,95,,,$7.45 ,$220.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$215.65 ,95,,,$7.45 ,$220.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.25 ,75,,,$7.45 ,$220.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.95 ,85,,,$7.45 ,$220.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$220.19 ,97,,,$7.45 ,$220.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.85 ,55,,,$7.45 ,$220.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.30 ,90,,,$7.45 ,$220.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.19 ,97,,,$7.45 ,$220.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.19 ,97,,,$7.45 ,$220.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.19 ,97,,,$7.45 ,$220.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.95 ,85,,,$7.45 ,$220.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.30 ,90,,,$7.45 ,$220.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.85 ,55,,,$7.45 ,$220.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.65 ,90,,,$7.45 ,$220.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.85 ,55,,,$7.45 ,$220.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$211.11 ,93,,,$7.45 ,$220.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
T3,8042529,CDM,301,RC,84481,HCPCS,outpatient,,,,,,,,,,$7.45 ,$7.45 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.45 ,$7.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.45 ,$7.45 ,other,,Not applicable. No negotiated rates per contract,$7.45 ,44,,,$7.45 ,$7.45 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.45 ,$7.45 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.45 ,$7.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.45 ,$7.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.45 ,$7.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.45 ,$7.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.45 ,$7.45 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.45 ,$7.45 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
T4 (Thyroxine),8042732,CDM,301,RC,84436,HCPCS,outpatient,,,,,,,,,,$3.02 ,$3.02 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$3.02 ,$3.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.02 ,$3.02 ,other,,Not applicable. No negotiated rates per contract,$3.02 ,44,,,$3.02 ,$3.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$3.02 ,$3.02 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$3.02 ,$3.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.02 ,$3.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.02 ,$3.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.02 ,$3.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$3.02 ,$3.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$3.02 ,$3.02 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
TSH,633844,CDM,301,RC,84443,HCPCS,outpatient,,,$154.00 ,$115.50 ,,$141.68 ,92,,,$7.39 ,$149.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.70 ,55,,,$7.39 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.39 ,$149.38 ,other,,Not applicable. No negotiated rates per contract,$7.39 ,44,,,$7.39 ,$149.38 ,fee schedule,,44% of CMS Medicare lab fee schedule,$123.20 ,80,,,$7.39 ,$149.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.70 ,55,,,$7.39 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.30 ,95,,,$7.39 ,$149.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.30 ,95,,,$7.39 ,$149.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.50 ,75,,,$7.39 ,$149.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.90 ,85,,,$7.39 ,$149.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.38 ,97,,,$7.39 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.70 ,55,,,$7.39 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.60 ,90,,,$7.39 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.38 ,97,,,$7.39 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.38 ,97,,,$7.39 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.38 ,97,,,$7.39 ,$149.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.90 ,85,,,$7.39 ,$149.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.60 ,90,,,$7.39 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.70 ,55,,,$7.39 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.30 ,90,,,$7.39 ,$149.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.70 ,55,,,$7.39 ,$149.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.22 ,93,,,$7.39 ,$149.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Testosterone,8147237,CDM,301,RC,84402,HCPCS,outpatient,,,$167.00 ,$125.25 ,,$153.64 ,92,,,$11.21 ,$161.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.85 ,55,,,$11.21 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.21 ,$161.99 ,other,,Not applicable. No negotiated rates per contract,$11.21 ,44,,,$11.21 ,$161.99 ,fee schedule,,44% of CMS Medicare lab fee schedule,$133.60 ,80,,,$11.21 ,$161.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.85 ,55,,,$11.21 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,95,,,$11.21 ,$161.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.65 ,95,,,$11.21 ,$161.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.25 ,75,,,$11.21 ,$161.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.95 ,85,,,$11.21 ,$161.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.99 ,97,,,$11.21 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.85 ,55,,,$11.21 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.30 ,90,,,$11.21 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.99 ,97,,,$11.21 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$11.21 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.99 ,97,,,$11.21 ,$161.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.95 ,85,,,$11.21 ,$161.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.30 ,90,,,$11.21 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.85 ,55,,,$11.21 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.65 ,90,,,$11.21 ,$161.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.85 ,55,,,$11.21 ,$161.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$155.31 ,93,,,$11.21 ,$161.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Testosterone,8042370,CDM,301,RC,84403,HCPCS,outpatient,,,,,,,,,,$11.36 ,$11.36 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$11.36 ,$11.36 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$11.36 ,$11.36 ,other,,Not applicable. No negotiated rates per contract,$11.36 ,44,,,$11.36 ,$11.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$11.36 ,$11.36 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$11.36 ,$11.36 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$11.36 ,$11.36 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$11.36 ,$11.36 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$11.36 ,$11.36 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$11.36 ,$11.36 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$11.36 ,$11.36 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Tetanus Antitoxoid QST,8042631,CDM,300,RC,86774,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$103.04 ,92,,,$6.51 ,$108.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.51 ,$108.64 ,other,,Not applicable. No negotiated rates per contract,$6.51 ,44,,,$6.51 ,$108.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$89.60 ,80,,,$6.51 ,$108.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,95,,,$6.51 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.40 ,95,,,$6.51 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.00 ,75,,,$6.51 ,$108.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$95.20 ,85,,,$6.51 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.80 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.20 ,85,,,$6.51 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.80 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.16 ,93,,,$6.51 ,$108.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tetanus Antitoxoid QST,8178027,CDM,300,RC,86774,HCPCS,outpatient,,,$112.00 ,$84.00 ,,$103.04 ,92,,,$6.51 ,$108.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.51 ,$108.64 ,other,,Not applicable. No negotiated rates per contract,$6.51 ,44,,,$6.51 ,$108.64 ,fee schedule,,44% of CMS Medicare lab fee schedule,$89.60 ,80,,,$6.51 ,$108.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,95,,,$6.51 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.40 ,95,,,$6.51 ,$108.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.00 ,75,,,$6.51 ,$108.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$95.20 ,85,,,$6.51 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.80 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.64 ,97,,,$6.51 ,$108.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.20 ,85,,,$6.51 ,$108.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.80 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.40 ,90,,,$6.51 ,$108.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.60 ,55,,,$6.51 ,$108.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.16 ,93,,,$6.51 ,$108.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Throat Culture HBL,10678598,CDM,300,RC,87070,HCPCS,outpatient,,,$53.00 ,$39.75 ,,$48.76 ,92,,,$3.79 ,$51.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.15 ,55,,,$3.79 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$51.41 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$51.41 ,fee schedule,,44% of CMS Medicare lab fee schedule,$42.40 ,80,,,$3.79 ,$51.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.15 ,55,,,$3.79 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,95,,,$3.79 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.35 ,95,,,$3.79 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.75 ,75,,,$3.79 ,$51.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.05 ,85,,,$3.79 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.41 ,97,,,$3.79 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.15 ,55,,,$3.79 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.70 ,90,,,$3.79 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.41 ,97,,,$3.79 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$3.79 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$3.79 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.05 ,85,,,$3.79 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.70 ,90,,,$3.79 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$3.79 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,90,,,$3.79 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$3.79 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.29 ,93,,,$3.79 ,$51.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroglobulin Abs QST,8042461,CDM,302,RC,86800,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$7.00 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.00 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$7.00 ,44,,,$7.00 ,$165.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$136.80 ,80,,,$7.00 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$7.00 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$7.00 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroglobulin Antibodies QST,8047712,CDM,302,RC,86800,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$7.00 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.00 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$7.00 ,44,,,$7.00 ,$165.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$136.80 ,80,,,$7.00 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$7.00 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$7.00 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroglobulin Antibodies QST,8847971,CDM,302,RC,86800,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$7.00 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.00 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$7.00 ,44,,,$7.00 ,$165.87 ,fee schedule,,44% of CMS Medicare lab fee schedule,$136.80 ,80,,,$7.00 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$7.00 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$7.00 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$7.00 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$7.00 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$7.00 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$7.00 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$7.00 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroglobulin QST,8047713,CDM,300,RC,84432,HCPCS,outpatient,,,$117.00 ,$87.75 ,,$107.64 ,92,,,$7.07 ,$113.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.35 ,55,,,$7.07 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.07 ,$113.49 ,other,,Not applicable. No negotiated rates per contract,$7.07 ,44,,,$7.07 ,$113.49 ,fee schedule,,44% of CMS Medicare lab fee schedule,$93.60 ,80,,,$7.07 ,$113.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.35 ,55,,,$7.07 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.15 ,95,,,$7.07 ,$113.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.15 ,95,,,$7.07 ,$113.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.75 ,75,,,$7.07 ,$113.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$99.45 ,85,,,$7.07 ,$113.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.49 ,97,,,$7.07 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.35 ,55,,,$7.07 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.30 ,90,,,$7.07 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.49 ,97,,,$7.07 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.49 ,97,,,$7.07 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.49 ,97,,,$7.07 ,$113.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.45 ,85,,,$7.07 ,$113.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.30 ,90,,,$7.07 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.35 ,55,,,$7.07 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.15 ,90,,,$7.07 ,$113.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.35 ,55,,,$7.07 ,$113.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.81 ,93,,,$7.07 ,$113.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroid Peroxidase Abs QST,8042644,CDM,302,RC,86376,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$6.40 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.40 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$6.40 ,44,,,$6.40 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$6.40 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$6.40 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$6.40 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroid Peroxidase Antibodies QST,8847972,CDM,302,RC,86376,HCPCS,outpatient,,,$148.00 ,$111.00 ,,$136.16 ,92,,,$6.40 ,$143.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.40 ,$143.56 ,other,,Not applicable. No negotiated rates per contract,$6.40 ,44,,,$6.40 ,$143.56 ,fee schedule,,44% of CMS Medicare lab fee schedule,$118.40 ,80,,,$6.40 ,$143.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.60 ,95,,,$6.40 ,$143.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.00 ,75,,,$6.40 ,$143.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.56 ,97,,,$6.40 ,$143.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.80 ,85,,,$6.40 ,$143.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.20 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.60 ,90,,,$6.40 ,$143.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.40 ,55,,,$6.40 ,$143.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.64 ,93,,,$6.40 ,$143.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Thyroid Stimulating Hormone,9216163,CDM,301,RC,84443,HCPCS,outpatient,,,,,,,,,,$7.39 ,$7.39 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$7.39 ,$7.39 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.39 ,$7.39 ,other,,Not applicable. No negotiated rates per contract,$7.39 ,44,,,$7.39 ,$7.39 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$7.39 ,$7.39 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$7.39 ,$7.39 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.39 ,$7.39 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.39 ,$7.39 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.39 ,$7.39 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$7.39 ,$7.39 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$7.39 ,$7.39 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Tissue Culture HBL,8836672,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tissue Transglutaminase Ab,8042327,CDM,301,RC,83516,HCPCS,outpatient,,,$335.00 ,$251.25 ,,$308.20 ,92,,,$5.07 ,$324.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.07 ,$324.95 ,other,,Not applicable. No negotiated rates per contract,$5.07 ,44,,,$5.07 ,$324.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$268.00 ,80,,,$5.07 ,$324.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.25 ,75,,,$5.07 ,$324.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.55 ,93,,,$5.07 ,$324.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tissue Transglutaminase Ab,8042737,CDM,301,RC,83516,HCPCS,outpatient,,,$335.00 ,$251.25 ,,$308.20 ,92,,,$5.07 ,$324.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.07 ,$324.95 ,other,,Not applicable. No negotiated rates per contract,$5.07 ,44,,,$5.07 ,$324.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$268.00 ,80,,,$5.07 ,$324.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$318.25 ,95,,,$5.07 ,$324.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.25 ,75,,,$5.07 ,$324.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.95 ,97,,,$5.07 ,$324.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.75 ,85,,,$5.07 ,$324.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$301.50 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.25 ,90,,,$5.07 ,$324.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.25 ,55,,,$5.07 ,$324.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.55 ,93,,,$5.07 ,$324.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tissue Transglutaminase Ab,8225258,CDM,301,RC,83516,HCPCS,outpatient,,,,,,,,,,$5.07 ,$5.07 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.07 ,$5.07 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.07 ,$5.07 ,other,,Not applicable. No negotiated rates per contract,$5.07 ,44,,,$5.07 ,$5.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.07 ,$5.07 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.07 ,$5.07 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.07 ,$5.07 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.07 ,$5.07 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.07 ,$5.07 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.07 ,$5.07 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.07 ,$5.07 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Toxo Interp QST,8743292,CDM,300,RC,86777,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$6.33 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$393.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$324.80 ,80,,,$6.33 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$6.33 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$6.33 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Toxo Interpretation QST,8743286,CDM,300,RC,86777,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$6.33 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$393.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$324.80 ,80,,,$6.33 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$6.33 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$6.33 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Toxoplasma Interpretation QST,8743280,CDM,300,RC,86777,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$6.33 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$393.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$324.80 ,80,,,$6.33 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$6.33 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$6.33 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Toxoplasmosis Interp QST,8743274,CDM,300,RC,86777,HCPCS,outpatient,,,$406.00 ,$304.50 ,,$373.52 ,92,,,$6.33 ,$393.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$393.82 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$393.82 ,fee schedule,,44% of CMS Medicare lab fee schedule,$324.80 ,80,,,$6.33 ,$393.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.70 ,95,,,$6.33 ,$393.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.50 ,75,,,$6.33 ,$393.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.82 ,97,,,$6.33 ,$393.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$345.10 ,85,,,$6.33 ,$393.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.40 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.70 ,90,,,$6.33 ,$393.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$223.30 ,55,,,$6.33 ,$393.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.58 ,93,,,$6.33 ,$393.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Trichomonas Vaginalis RNA,8042410,CDM,306,RC,87661,HCPCS,outpatient,,,,,,,,,,$15.44 ,$15.44 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,,Not applicable. No negotiated rates per contract,$15.44 ,44,,,$15.44 ,$15.44 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$15.44 ,$15.44 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$15.44 ,$15.44 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$15.44 ,$15.44 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Triglycerides,633852,CDM,301,RC,84478,HCPCS,outpatient,,,$116.00 ,$87.00 ,,$106.72 ,92,,,$2.53 ,$112.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.80 ,55,,,$2.53 ,$112.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.53 ,$112.52 ,other,,Not applicable. No negotiated rates per contract,$2.53 ,44,,,$2.53 ,$112.52 ,fee schedule,,44% of CMS Medicare lab fee schedule,$92.80 ,80,,,$2.53 ,$112.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.80 ,55,,,$2.53 ,$112.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.20 ,95,,,$2.53 ,$112.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.20 ,95,,,$2.53 ,$112.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.00 ,75,,,$2.53 ,$112.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$98.60 ,85,,,$2.53 ,$112.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.52 ,97,,,$2.53 ,$112.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.80 ,55,,,$2.53 ,$112.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.40 ,90,,,$2.53 ,$112.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.52 ,97,,,$2.53 ,$112.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.52 ,97,,,$2.53 ,$112.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.52 ,97,,,$2.53 ,$112.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.60 ,85,,,$2.53 ,$112.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.40 ,90,,,$2.53 ,$112.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.80 ,55,,,$2.53 ,$112.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.20 ,90,,,$2.53 ,$112.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.80 ,55,,,$2.53 ,$112.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.88 ,93,,,$2.53 ,$112.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Troponin-I,1634892,CDM,301,RC,84484,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$161.00 ,92,,,$5.49 ,$169.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.49 ,$169.75 ,other,,Not applicable. No negotiated rates per contract,$5.49 ,44,,,$5.49 ,$169.75 ,fee schedule,,44% of CMS Medicare lab fee schedule,$140.00 ,80,,,$5.49 ,$169.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,95,,,$5.49 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.25 ,95,,,$5.49 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.25 ,75,,,$5.49 ,$169.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.75 ,85,,,$5.49 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.50 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$5.49 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.75 ,85,,,$5.49 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.50 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,90,,,$5.49 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$5.49 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.75 ,93,,,$5.49 ,$169.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Troponin-I High Sensitivity,9142423,CDM,300,RC,84484,HCPCS,outpatient,,,$159.00 ,$119.25 ,,$146.28 ,92,,,$5.49 ,$154.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$87.45 ,55,,,$5.49 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.49 ,$154.23 ,other,,Not applicable. No negotiated rates per contract,$5.49 ,44,,,$5.49 ,$154.23 ,fee schedule,,44% of CMS Medicare lab fee schedule,$127.20 ,80,,,$5.49 ,$154.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$87.45 ,55,,,$5.49 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.05 ,95,,,$5.49 ,$154.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$151.05 ,95,,,$5.49 ,$154.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.25 ,75,,,$5.49 ,$154.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$135.15 ,85,,,$5.49 ,$154.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.23 ,97,,,$5.49 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.45 ,55,,,$5.49 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.10 ,90,,,$5.49 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.23 ,97,,,$5.49 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.23 ,97,,,$5.49 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.23 ,97,,,$5.49 ,$154.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.15 ,85,,,$5.49 ,$154.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.10 ,90,,,$5.49 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.45 ,55,,,$5.49 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.05 ,90,,,$5.49 ,$154.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.45 ,55,,,$5.49 ,$154.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.87 ,93,,,$5.49 ,$154.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Tryptase QST,8042536,CDM,301,RC,83520,HCPCS,outpatient,,,$265.00 ,$198.75 ,,$243.80 ,92,,,$7.60 ,$257.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.60 ,$257.05 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$257.05 ,fee schedule,,44% of CMS Medicare lab fee schedule,$212.00 ,80,,,$7.60 ,$257.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.75 ,95,,,$7.60 ,$257.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.75 ,75,,,$7.60 ,$257.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.05 ,97,,,$7.60 ,$257.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.25 ,85,,,$7.60 ,$257.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.50 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.75 ,90,,,$7.60 ,$257.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.75 ,55,,,$7.60 ,$257.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.45 ,93,,,$7.60 ,$257.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UA Microscopic Only,633864,CDM,307,RC,81015,HCPCS,outpatient,,,$31.00 ,$23.25 ,,$28.52 ,92,,,$1.34 ,$30.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.05 ,55,,,$1.34 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.34 ,$30.07 ,other,,Not applicable. No negotiated rates per contract,$1.34 ,44,,,$1.34 ,$30.07 ,fee schedule,,44% of CMS Medicare lab fee schedule,$24.80 ,80,,,$1.34 ,$30.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.05 ,55,,,$1.34 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.45 ,95,,,$1.34 ,$30.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.45 ,95,,,$1.34 ,$30.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.25 ,75,,,$1.34 ,$30.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.35 ,85,,,$1.34 ,$30.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.07 ,97,,,$1.34 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.05 ,55,,,$1.34 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.90 ,90,,,$1.34 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.07 ,97,,,$1.34 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.07 ,97,,,$1.34 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.07 ,97,,,$1.34 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.35 ,85,,,$1.34 ,$30.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.90 ,90,,,$1.34 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.05 ,55,,,$1.34 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.45 ,90,,,$1.34 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.05 ,55,,,$1.34 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.83 ,93,,,$1.34 ,$30.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UA w Micro if Ind & Cult if Ind,8080781,CDM,307,RC,81001,HCPCS,outpatient,,,$72.00 ,$54.00 ,,$66.24 ,92,,,$1.39 ,$69.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.60 ,55,,,$1.39 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.39 ,$69.84 ,other,,Not applicable. No negotiated rates per contract,$1.39 ,44,,,$1.39 ,$69.84 ,fee schedule,,44% of CMS Medicare lab fee schedule,$57.60 ,80,,,$1.39 ,$69.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.60 ,55,,,$1.39 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,95,,,$1.39 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.40 ,95,,,$1.39 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.00 ,75,,,$1.39 ,$69.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.20 ,85,,,$1.39 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.84 ,97,,,$1.39 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.60 ,55,,,$1.39 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.80 ,90,,,$1.39 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.84 ,97,,,$1.39 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$1.39 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$1.39 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.20 ,85,,,$1.39 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.80 ,90,,,$1.39 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$1.39 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$1.39 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$1.39 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.96 ,93,,,$1.39 ,$69.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Uric Acid,633858,CDM,301,RC,84550,HCPCS,outpatient,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$1.99 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$1.99 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.99 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$1.99 ,44,,,$1.99 ,$98.94 ,fee schedule,,44% of CMS Medicare lab fee schedule,$81.60 ,80,,,$1.99 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$1.99 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$1.99 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$1.99 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$1.99 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$1.99 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$1.99 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$1.99 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.80 ,90,,,$1.99 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.94 ,97,,,$1.99 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$1.99 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$1.99 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$1.99 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$1.99 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$1.99 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$1.99 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$1.99 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$1.99 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urinalysis Dipstick,8080778,CDM,307,RC,81002,HCPCS,outpatient,,,$24.00 ,$18.00 ,,$22.08 ,92,,,$1.53 ,$23.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.20 ,55,,,$1.53 ,$23.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.53 ,$23.28 ,other,,Not applicable. No negotiated rates per contract,$1.53 ,44,,,$1.53 ,$23.28 ,fee schedule,,44% of CMS Medicare lab fee schedule,$19.20 ,80,,,$1.53 ,$23.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.20 ,55,,,$1.53 ,$23.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.80 ,95,,,$1.53 ,$23.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.80 ,95,,,$1.53 ,$23.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.00 ,75,,,$1.53 ,$23.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$20.40 ,85,,,$1.53 ,$23.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.28 ,97,,,$1.53 ,$23.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.20 ,55,,,$1.53 ,$23.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.60 ,90,,,$1.53 ,$23.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.28 ,97,,,$1.53 ,$23.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.28 ,97,,,$1.53 ,$23.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.28 ,97,,,$1.53 ,$23.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.40 ,85,,,$1.53 ,$23.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.60 ,90,,,$1.53 ,$23.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.20 ,55,,,$1.53 ,$23.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.80 ,90,,,$1.53 ,$23.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.20 ,55,,,$1.53 ,$23.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.32 ,93,,,$1.53 ,$23.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urine Culture HBL,8836673,CDM,306,RC,87088,HCPCS,outpatient,,,$99.00 ,$74.25 ,,$91.08 ,92,,,$3.56 ,$96.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$54.45 ,55,,,$3.56 ,$96.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.56 ,$96.03 ,other,,Not applicable. No negotiated rates per contract,$3.56 ,44,,,$3.56 ,$96.03 ,fee schedule,,44% of CMS Medicare lab fee schedule,$79.20 ,80,,,$3.56 ,$96.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$54.45 ,55,,,$3.56 ,$96.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.05 ,95,,,$3.56 ,$96.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.05 ,95,,,$3.56 ,$96.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.25 ,75,,,$3.56 ,$96.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$84.15 ,85,,,$3.56 ,$96.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.03 ,97,,,$3.56 ,$96.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.45 ,55,,,$3.56 ,$96.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.10 ,90,,,$3.56 ,$96.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.03 ,97,,,$3.56 ,$96.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.03 ,97,,,$3.56 ,$96.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.03 ,97,,,$3.56 ,$96.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.15 ,85,,,$3.56 ,$96.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.10 ,90,,,$3.56 ,$96.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.45 ,55,,,$3.56 ,$96.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.05 ,90,,,$3.56 ,$96.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.45 ,55,,,$3.56 ,$96.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.07 ,93,,,$3.56 ,$96.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VBG,633677,CDM,301,RC,82803,HCPCS,outpatient,,,$177.00 ,$132.75 ,,$162.84 ,92,,,$11.47 ,$171.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$11.47 ,$171.69 ,other,,Not applicable. No negotiated rates per contract,$11.47 ,44,,,$11.47 ,$171.69 ,fee schedule,,44% of CMS Medicare lab fee schedule,$141.60 ,80,,,$11.47 ,$171.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,95,,,$11.47 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.15 ,95,,,$11.47 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.75 ,75,,,$11.47 ,$171.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$150.45 ,85,,,$11.47 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.30 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$11.47 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.45 ,85,,,$11.47 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.30 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,90,,,$11.47 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$11.47 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.61 ,93,,,$11.47 ,$171.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VZV Culture Prelim QST,8620525,CDM,306,RC,87254,HCPCS,outpatient,,,$91.00 ,$68.25 ,,$83.72 ,92,,,$8.61 ,$88.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$8.61 ,$88.27 ,other,,Not applicable. No negotiated rates per contract,$8.61 ,44,,,$8.61 ,$88.27 ,fee schedule,,44% of CMS Medicare lab fee schedule,$72.80 ,80,,,$8.61 ,$88.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,95,,,$8.61 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.45 ,95,,,$8.61 ,$88.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.25 ,75,,,$8.61 ,$88.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.35 ,85,,,$8.61 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.90 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,97,,,$8.61 ,$88.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.35 ,85,,,$8.61 ,$88.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.90 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.45 ,90,,,$8.61 ,$88.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.05 ,55,,,$8.61 ,$88.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.63 ,93,,,$8.61 ,$88.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Valproic Acid QST,8282352,CDM,301,RC,80164,HCPCS,outpatient,,,$144.00 ,$108.00 ,,$132.48 ,92,,,$5.96 ,$139.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.20 ,55,,,$5.96 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.96 ,$139.68 ,other,,Not applicable. No negotiated rates per contract,$5.96 ,44,,,$5.96 ,$139.68 ,fee schedule,,44% of CMS Medicare lab fee schedule,$115.20 ,80,,,$5.96 ,$139.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.20 ,55,,,$5.96 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,95,,,$5.96 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.80 ,95,,,$5.96 ,$139.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.00 ,75,,,$5.96 ,$139.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.40 ,85,,,$5.96 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.68 ,97,,,$5.96 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.20 ,55,,,$5.96 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.60 ,90,,,$5.96 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.68 ,97,,,$5.96 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$5.96 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.68 ,97,,,$5.96 ,$139.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.40 ,85,,,$5.96 ,$139.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.60 ,90,,,$5.96 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$5.96 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,90,,,$5.96 ,$139.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.20 ,55,,,$5.96 ,$139.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.92 ,93,,,$5.96 ,$139.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Vancomycin Lvl,8166366,CDM,300,RC,80202,HCPCS,outpatient,,,$163.00 ,$122.25 ,,$149.96 ,92,,,$5.96 ,$158.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$89.65 ,55,,,$5.96 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.96 ,$158.11 ,other,,Not applicable. No negotiated rates per contract,$5.96 ,44,,,$5.96 ,$158.11 ,fee schedule,,44% of CMS Medicare lab fee schedule,$130.40 ,80,,,$5.96 ,$158.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$89.65 ,55,,,$5.96 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,95,,,$5.96 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$154.85 ,95,,,$5.96 ,$158.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$122.25 ,75,,,$5.96 ,$158.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$138.55 ,85,,,$5.96 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$158.11 ,97,,,$5.96 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.65 ,55,,,$5.96 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.70 ,90,,,$5.96 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.11 ,97,,,$5.96 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$5.96 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.11 ,97,,,$5.96 ,$158.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.55 ,85,,,$5.96 ,$158.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.70 ,90,,,$5.96 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$5.96 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.85 ,90,,,$5.96 ,$158.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.65 ,55,,,$5.96 ,$158.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.59 ,93,,,$5.96 ,$158.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Varicella Zoster Virus Ab (IgG) QST,8042614,CDM,300,RC,86787,HCPCS,outpatient,,,$157.00 ,$117.75 ,,$144.44 ,92,,,$5.67 ,$152.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$86.35 ,55,,,$5.67 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.67 ,$152.29 ,other,,Not applicable. No negotiated rates per contract,$5.67 ,44,,,$5.67 ,$152.29 ,fee schedule,,44% of CMS Medicare lab fee schedule,$125.60 ,80,,,$5.67 ,$152.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$86.35 ,55,,,$5.67 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,95,,,$5.67 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.15 ,95,,,$5.67 ,$152.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.75 ,75,,,$5.67 ,$152.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$133.45 ,85,,,$5.67 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.29 ,97,,,$5.67 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.35 ,55,,,$5.67 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.30 ,90,,,$5.67 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.29 ,97,,,$5.67 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$5.67 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.29 ,97,,,$5.67 ,$152.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.45 ,85,,,$5.67 ,$152.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.30 ,90,,,$5.67 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$5.67 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.15 ,90,,,$5.67 ,$152.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.35 ,55,,,$5.67 ,$152.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.01 ,93,,,$5.67 ,$152.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Varicella Zoster Virus Abs (IgG,8282402,CDM,301,RC,86787,HCPCS,outpatient,,,,,,,,,,$5.67 ,$5.67 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$5.67 ,$5.67 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.67 ,$5.67 ,other,,Not applicable. No negotiated rates per contract,$5.67 ,44,,,$5.67 ,$5.67 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$5.67 ,$5.67 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$5.67 ,$5.67 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.67 ,$5.67 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.67 ,$5.67 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.67 ,$5.67 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$5.67 ,$5.67 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$5.67 ,$5.67 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Vitamin B1 (Thiamine) WB LC/MS/MS QST,8147276,CDM,301,RC,84425,HCPCS,outpatient,,,$328.00 ,$246.00 ,,$301.76 ,92,,,$9.34 ,$318.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$180.40 ,55,,,$9.34 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$9.34 ,$318.16 ,other,,Not applicable. No negotiated rates per contract,$9.34 ,44,,,$9.34 ,$318.16 ,fee schedule,,44% of CMS Medicare lab fee schedule,$262.40 ,80,,,$9.34 ,$318.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$180.40 ,55,,,$9.34 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,95,,,$9.34 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$311.60 ,95,,,$9.34 ,$318.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.00 ,75,,,$9.34 ,$318.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$278.80 ,85,,,$9.34 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$318.16 ,97,,,$9.34 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.40 ,55,,,$9.34 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.20 ,90,,,$9.34 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$318.16 ,97,,,$9.34 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$9.34 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$318.16 ,97,,,$9.34 ,$318.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.80 ,85,,,$9.34 ,$318.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.20 ,90,,,$9.34 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.40 ,55,,,$9.34 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.60 ,90,,,$9.34 ,$318.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.40 ,55,,,$9.34 ,$318.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$305.04 ,93,,,$9.34 ,$318.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Vitamin B12 QST,8147203,CDM,301,RC,82607,HCPCS,outpatient,,,$168.00 ,$126.00 ,,$154.56 ,92,,,$6.64 ,$162.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$92.40 ,55,,,$6.64 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.64 ,$162.96 ,other,,Not applicable. No negotiated rates per contract,$6.64 ,44,,,$6.64 ,$162.96 ,fee schedule,,44% of CMS Medicare lab fee schedule,$134.40 ,80,,,$6.64 ,$162.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$92.40 ,55,,,$6.64 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,95,,,$6.64 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.60 ,95,,,$6.64 ,$162.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.00 ,75,,,$6.64 ,$162.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$142.80 ,85,,,$6.64 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.96 ,97,,,$6.64 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.40 ,55,,,$6.64 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$151.20 ,90,,,$6.64 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.96 ,97,,,$6.64 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$6.64 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.96 ,97,,,$6.64 ,$162.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.80 ,85,,,$6.64 ,$162.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.20 ,90,,,$6.64 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$6.64 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.60 ,90,,,$6.64 ,$162.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.40 ,55,,,$6.64 ,$162.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.24 ,93,,,$6.64 ,$162.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Vitamin B6,8042780,CDM,301,RC,84207,HCPCS,outpatient,,,$528.00 ,$396.00 ,,$485.76 ,92,,,$12.36 ,$512.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$290.40 ,55,,,$12.36 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$12.36 ,$512.16 ,other,,Not applicable. No negotiated rates per contract,$12.36 ,44,,,$12.36 ,$512.16 ,fee schedule,,44% of CMS Medicare lab fee schedule,$422.40 ,80,,,$12.36 ,$512.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$290.40 ,55,,,$12.36 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.60 ,95,,,$12.36 ,$512.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.60 ,95,,,$12.36 ,$512.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$396.00 ,75,,,$12.36 ,$512.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$448.80 ,85,,,$12.36 ,$512.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$512.16 ,97,,,$12.36 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.40 ,55,,,$12.36 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$475.20 ,90,,,$12.36 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$512.16 ,97,,,$12.36 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$512.16 ,97,,,$12.36 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$512.16 ,97,,,$12.36 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$448.80 ,85,,,$12.36 ,$512.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$475.20 ,90,,,$12.36 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.40 ,55,,,$12.36 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.60 ,90,,,$12.36 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.40 ,55,,,$12.36 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$491.04 ,93,,,$12.36 ,$512.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Vitamin D,8042379,CDM,301,RC,82306,HCPCS,outpatient,,,,,,,,,,$13.02 ,$13.02 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,,Not applicable. No negotiated rates per contract,$13.02 ,44,,,$13.02 ,$13.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$13.02 ,$13.02 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Vitamin D,8147196,CDM,300,RC,82306,HCPCS,outpatient,,,,,,,,,,$13.02 ,$13.02 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,,Not applicable. No negotiated rates per contract,$13.02 ,44,,,$13.02 ,$13.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,,,,,$13.02 ,$13.02 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.02 ,$13.02 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$13.02 ,$13.02 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Von Willebrand Factor Ag QST,8042633,CDM,305,RC,85246,HCPCS,outpatient,,,$241.00 ,$180.75 ,,$221.72 ,92,,,$10.09 ,$233.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.55 ,55,,,$10.09 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$10.09 ,$233.77 ,other,,Not applicable. No negotiated rates per contract,$10.09 ,44,,,$10.09 ,$233.77 ,fee schedule,,44% of CMS Medicare lab fee schedule,$192.80 ,80,,,$10.09 ,$233.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.55 ,55,,,$10.09 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,95,,,$10.09 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.95 ,95,,,$10.09 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.75 ,75,,,$10.09 ,$233.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.85 ,85,,,$10.09 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.77 ,97,,,$10.09 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.55 ,55,,,$10.09 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.90 ,90,,,$10.09 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.77 ,97,,,$10.09 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$10.09 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$10.09 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.85 ,85,,,$10.09 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.90 ,90,,,$10.09 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$10.09 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,90,,,$10.09 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$10.09 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.13 ,93,,,$10.09 ,$233.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
West Nile Virus Ab (IgG) QST,8048165,CDM,302,RC,86788,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$7.41 ,$187.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.15 ,55,,,$7.41 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.41 ,$187.21 ,other,,Not applicable. No negotiated rates per contract,$7.41 ,44,,,$7.41 ,$187.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$154.40 ,80,,,$7.41 ,$187.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.15 ,55,,,$7.41 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$7.41 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$7.41 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$7.41 ,$187.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$7.41 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$7.41 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.15 ,55,,,$7.41 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.70 ,90,,,$7.41 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$7.41 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$7.41 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$7.41 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$7.41 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$7.41 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$7.41 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$7.41 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$7.41 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.49 ,93,,,$7.41 ,$187.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
West Nile Virus Ab (IgM) QST,8048166,CDM,302,RC,86789,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$6.33 ,$187.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.15 ,55,,,$6.33 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.33 ,$187.21 ,other,,Not applicable. No negotiated rates per contract,$6.33 ,44,,,$6.33 ,$187.21 ,fee schedule,,44% of CMS Medicare lab fee schedule,$154.40 ,80,,,$6.33 ,$187.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.15 ,55,,,$6.33 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$6.33 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$6.33 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$6.33 ,$187.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$6.33 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$6.33 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.15 ,55,,,$6.33 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.70 ,90,,,$6.33 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$6.33 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$6.33 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$6.33 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$6.33 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$6.33 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$6.33 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$6.33 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$6.33 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.49 ,93,,,$6.33 ,$187.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
White Blood Cell Count,633873,CDM,305,RC,85048,HCPCS,outpatient,,,$47.00 ,$35.25 ,,$43.24 ,92,,,$1.12 ,$45.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.85 ,55,,,$1.12 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.12 ,$45.59 ,other,,Not applicable. No negotiated rates per contract,$1.12 ,44,,,$1.12 ,$45.59 ,fee schedule,,44% of CMS Medicare lab fee schedule,$37.60 ,80,,,$1.12 ,$45.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.85 ,55,,,$1.12 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,95,,,$1.12 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.65 ,95,,,$1.12 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,75,,,$1.12 ,$45.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.95 ,85,,,$1.12 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.59 ,97,,,$1.12 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.85 ,55,,,$1.12 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.30 ,90,,,$1.12 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.59 ,97,,,$1.12 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$1.12 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$1.12 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.95 ,85,,,$1.12 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.30 ,90,,,$1.12 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$1.12 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,90,,,$1.12 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$1.12 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.71 ,93,,,$1.12 ,$45.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Whole Blood Glucose POCT,4192199,CDM,305,RC,82948,HCPCS,outpatient,,,$14.00 ,$10.50 ,,$12.88 ,92,,,$2.22 ,$13.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$7.70 ,55,,,$2.22 ,$13.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.22 ,$13.58 ,other,,Not applicable. No negotiated rates per contract,$2.22 ,44,,,$2.22 ,$13.58 ,fee schedule,,44% of CMS Medicare lab fee schedule,$11.20 ,80,,,$2.22 ,$13.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$7.70 ,55,,,$2.22 ,$13.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$13.30 ,95,,,$2.22 ,$13.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$13.30 ,95,,,$2.22 ,$13.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$10.50 ,75,,,$2.22 ,$13.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$11.90 ,85,,,$2.22 ,$13.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$13.58 ,97,,,$2.22 ,$13.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$7.70 ,55,,,$2.22 ,$13.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$12.60 ,90,,,$2.22 ,$13.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.58 ,97,,,$2.22 ,$13.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.58 ,97,,,$2.22 ,$13.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.58 ,97,,,$2.22 ,$13.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.90 ,85,,,$2.22 ,$13.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$12.60 ,90,,,$2.22 ,$13.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$7.70 ,55,,,$2.22 ,$13.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$13.30 ,90,,,$2.22 ,$13.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$7.70 ,55,,,$2.22 ,$13.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$13.02 ,93,,,$2.22 ,$13.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Wound Culture HBL,8836674,CDM,306,RC,87070,HCPCS,outpatient,,,$166.00 ,$124.50 ,,$152.72 ,92,,,$3.79 ,$161.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$161.02 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$161.02 ,fee schedule,,44% of CMS Medicare lab fee schedule,$132.80 ,80,,,$3.79 ,$161.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.70 ,95,,,$3.79 ,$161.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.50 ,75,,,$3.79 ,$161.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,97,,,$3.79 ,$161.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.10 ,85,,,$3.79 ,$161.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.40 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.70 ,90,,,$3.79 ,$161.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.30 ,55,,,$3.79 ,$161.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.38 ,93,,,$3.79 ,$161.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Yeast Screen HBL,8836675,CDM,306,RC,87210,HCPCS,outpatient,,,$133.00 ,$99.75 ,,$122.36 ,92,,,$2.56 ,$129.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$73.15 ,55,,,$2.56 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$2.56 ,$129.01 ,other,,Not applicable. No negotiated rates per contract,$2.56 ,44,,,$2.56 ,$129.01 ,fee schedule,,44% of CMS Medicare lab fee schedule,$106.40 ,80,,,$2.56 ,$129.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$73.15 ,55,,,$2.56 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.35 ,95,,,$2.56 ,$129.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.35 ,95,,,$2.56 ,$129.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,75,,,$2.56 ,$129.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$113.05 ,85,,,$2.56 ,$129.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.01 ,97,,,$2.56 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.15 ,55,,,$2.56 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$2.56 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.01 ,97,,,$2.56 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.01 ,97,,,$2.56 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.01 ,97,,,$2.56 ,$129.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.05 ,85,,,$2.56 ,$129.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.70 ,90,,,$2.56 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.15 ,55,,,$2.56 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.35 ,90,,,$2.56 ,$129.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.15 ,55,,,$2.56 ,$129.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.69 ,93,,,$2.56 ,$129.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Zinc QST,8042789,CDM,301,RC,84630,HCPCS,outpatient,,,$174.00 ,$130.50 ,,$160.08 ,92,,,$5.01 ,$168.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.70 ,55,,,$5.01 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$5.01 ,$168.78 ,other,,Not applicable. No negotiated rates per contract,$5.01 ,44,,,$5.01 ,$168.78 ,fee schedule,,44% of CMS Medicare lab fee schedule,$139.20 ,80,,,$5.01 ,$168.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.70 ,55,,,$5.01 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,95,,,$5.01 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.30 ,95,,,$5.01 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.50 ,75,,,$5.01 ,$168.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.90 ,85,,,$5.01 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.78 ,97,,,$5.01 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.70 ,55,,,$5.01 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.60 ,90,,,$5.01 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.78 ,97,,,$5.01 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$5.01 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$5.01 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.90 ,85,,,$5.01 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.60 ,90,,,$5.01 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$5.01 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,90,,,$5.01 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$5.01 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.82 ,93,,,$5.01 ,$168.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
vWF Collagen Binding Assay QST,8713365,CDM,302,RC,83520,HCPCS,outpatient,,,$735.00 ,$551.25 ,,$676.20 ,92,,,$7.60 ,$712.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$404.25 ,55,,,$7.60 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$7.60 ,$712.95 ,other,,Not applicable. No negotiated rates per contract,$7.60 ,44,,,$7.60 ,$712.95 ,fee schedule,,44% of CMS Medicare lab fee schedule,$588.00 ,80,,,$7.60 ,$712.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$404.25 ,55,,,$7.60 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$698.25 ,95,,,$7.60 ,$712.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$698.25 ,95,,,$7.60 ,$712.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$551.25 ,75,,,$7.60 ,$712.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$624.75 ,85,,,$7.60 ,$712.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$712.95 ,97,,,$7.60 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.25 ,55,,,$7.60 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$661.50 ,90,,,$7.60 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$712.95 ,97,,,$7.60 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$712.95 ,97,,,$7.60 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$712.95 ,97,,,$7.60 ,$712.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$624.75 ,85,,,$7.60 ,$712.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$661.50 ,90,,,$7.60 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$404.25 ,55,,,$7.60 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$698.25 ,90,,,$7.60 ,$712.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$404.25 ,55,,,$7.60 ,$712.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.55 ,93,,,$7.60 ,$712.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
vWF Factor VIII Binding QST,8713370,CDM,305,RC,85246,HCPCS,outpatient,,,$251.00 ,$188.25 ,,$230.92 ,92,,,$10.09 ,$243.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$138.05 ,55,,,$10.09 ,$243.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$10.09 ,$243.47 ,other,,Not applicable. No negotiated rates per contract,$10.09 ,44,,,$10.09 ,$243.47 ,fee schedule,,44% of CMS Medicare lab fee schedule,$200.80 ,80,,,$10.09 ,$243.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$138.05 ,55,,,$10.09 ,$243.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.45 ,95,,,$10.09 ,$243.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.45 ,95,,,$10.09 ,$243.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.25 ,75,,,$10.09 ,$243.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$213.35 ,85,,,$10.09 ,$243.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.47 ,97,,,$10.09 ,$243.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.05 ,55,,,$10.09 ,$243.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.90 ,90,,,$10.09 ,$243.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$243.47 ,97,,,$10.09 ,$243.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.47 ,97,,,$10.09 ,$243.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.47 ,97,,,$10.09 ,$243.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$213.35 ,85,,,$10.09 ,$243.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.90 ,90,,,$10.09 ,$243.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.05 ,55,,,$10.09 ,$243.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.45 ,90,,,$10.09 ,$243.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.05 ,55,,,$10.09 ,$243.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.43 ,93,,,$10.09 ,$243.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Non Skilled Personal Care,8977481,CDM,570,RC,,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$15.40 ,$27.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$15.40 ,$27.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$15.40 ,$27.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$15.40 ,$27.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not separately reimbursable per table 3 referenced in contract
1695 IV Port Access Charge,8960407,CDM,272,RC,,HCPCS,outpatient,,,$373.00 ,$279.75 ,,$343.16 ,92,,,$205.15 ,$361.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.15 ,$361.81 ,other,,Not applicable. No negotiated rates per contract,$320.78 ,86,,,$205.15 ,$361.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$298.40 ,80,,,$205.15 ,$361.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.75 ,75,,,$205.15 ,$361.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.89 ,93,,,$205.15 ,$361.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36591 Blood Draw from Port Charge,8960411,CDM,761,RC,36591,HCPCS,outpatient,,,$341.00 ,$255.75 ,,$313.72 ,92,,,$187.55 ,$330.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$187.55 ,$330.77 ,other,,Not applicable. No negotiated rates per contract,$293.26 ,86,,,$187.55 ,$330.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$272.80 ,80,,,$187.55 ,$330.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.75 ,75,,,$187.55 ,$330.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.13 ,93,,,$187.55 ,$330.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36592 Blood Draw from PICC Charge,8960410,CDM,761,RC,36592,HCPCS,outpatient,,,$341.00 ,$255.75 ,,$313.72 ,92,,,$187.55 ,$330.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$187.55 ,$330.77 ,other,,Not applicable. No negotiated rates per contract,$293.26 ,86,,,$187.55 ,$330.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$272.80 ,80,,,$187.55 ,$330.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$323.95 ,95,,,$187.55 ,$330.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.75 ,75,,,$187.55 ,$330.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$330.77 ,97,,,$187.55 ,$330.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.85 ,85,,,$187.55 ,$330.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.90 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.95 ,90,,,$187.55 ,$330.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.55 ,55,,,$187.55 ,$330.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.13 ,93,,,$187.55 ,$330.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
90471 IMMUNIZATION ADMIN 1 VAC Charge,9263806,CDM,771,RC,90471,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
92977 THROMBOLYSIS CORONARY INTRAVENOUS INFUSION TechFee,8211359,CDM,361,RC,92977,HCPCS,outpatient,,,"$1,775.00 ","$1,331.25 ",,"$1,633.00 ",92,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$976.25 ,55,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$976.25 ,"$1,721.75 ",other,,Not applicable. No negotiated rates per contract,"$1,526.50 ",86,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,420.00 ",80,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$976.25 ,55,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,686.25 ",95,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,686.25 ",95,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,331.25 ",75,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,508.75 ",85,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,721.75 ",97,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$976.25 ,55,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,597.50 ",90,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,721.75 ",97,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,721.75 ",97,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,721.75 ",97,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,508.75 ",85,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,597.50 ",90,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$976.25 ,55,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,686.25 ",90,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$976.25 ,55,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,650.75 ",93,,,$976.25 ,"$1,721.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
96360 IV INF,8405304,CDM,260,RC,96360,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
96361 IV INFUSION HYDRATION EACH ADDITIONAL HOUR,8003307,CDM,260,RC,96361,HCPCS,outpatient,,,$125.00 ,$93.75 ,,$115.00 ,92,,,$68.75 ,$121.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.75 ,$121.25 ,other,,Not applicable. No negotiated rates per contract,$107.50 ,86,,,$68.75 ,$121.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.00 ,80,,,$68.75 ,$121.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.75 ,75,,,$68.75 ,$121.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.25 ,93,,,$68.75 ,$121.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96365 OP INFUSION INTIAL UP TO 1HR CHARGE,8368753,CDM,260,RC,96365,HCPCS,outpatient,,,$651.00 ,$488.25 ,,$598.92 ,92,,,$358.05 ,$631.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$358.05 ,55,,,$358.05 ,$631.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$358.05 ,$631.47 ,other,,Not applicable. No negotiated rates per contract,$559.86 ,86,,,$358.05 ,$631.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$520.80 ,80,,,$358.05 ,$631.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$358.05 ,55,,,$358.05 ,$631.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.45 ,95,,,$358.05 ,$631.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$618.45 ,95,,,$358.05 ,$631.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.25 ,75,,,$358.05 ,$631.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$553.35 ,85,,,$358.05 ,$631.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$631.47 ,97,,,$358.05 ,$631.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.05 ,55,,,$358.05 ,$631.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$585.90 ,90,,,$358.05 ,$631.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$631.47 ,97,,,$358.05 ,$631.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$631.47 ,97,,,$358.05 ,$631.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$631.47 ,97,,,$358.05 ,$631.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$553.35 ,85,,,$358.05 ,$631.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.90 ,90,,,$358.05 ,$631.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.05 ,55,,,$358.05 ,$631.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.45 ,90,,,$358.05 ,$631.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.05 ,55,,,$358.05 ,$631.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$605.43 ,93,,,$358.05 ,$631.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96366 OP INFUSION EACH ADDL HOUR CHARGE,8368756,CDM,260,RC,96366,HCPCS,outpatient,,,$125.00 ,$93.75 ,,$115.00 ,92,,,$68.75 ,$121.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.75 ,$121.25 ,other,,Not applicable. No negotiated rates per contract,$107.50 ,86,,,$68.75 ,$121.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.00 ,80,,,$68.75 ,$121.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.75 ,75,,,$68.75 ,$121.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.25 ,93,,,$68.75 ,$121.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96367 OP ADD SEQUENTIAL INFUS UP TO 1HR CHARGE,8368757,CDM,260,RC,96367,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$108.90 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$108.90 ,$192.06 ,other,,Not applicable. No negotiated rates per contract,$170.28 ,86,,,$108.90 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$108.90 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$108.90 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$108.90 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96368 Thera/Diag Concurrent Infusion,9090013,CDM,260,RC,96368,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96372 INJ IM OR SUBQ CHARGE,8115122,CDM,636,RC,J0897,HCPCS,both,,,"$4,608.00 ","$3,456.00 ",,"$4,239.36 ",92,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,534.40 ","$4,469.76 ",other,,Not applicable. No negotiated rates per contract,"$3,962.88 ",86,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,686.40 ",80,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,377.60 ",95,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,377.60 ",95,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,456.00 ",75,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,916.80 ",85,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,147.20 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,916.80 ",85,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,147.20 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,377.60 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,285.44 ",93,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,93% of total billed charges for outpatient setting
96372 INJECTION SQ OR IM CHARGE,8408036,CDM,260,RC,96372,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$25.00 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$25.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.00 ,$192.06 ,other,,Not applicable. No negotiated rates per contract,$170.28 ,86,,,$25.00 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$25.00 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$25.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.00 ,100,,,$25.00 ,$192.06 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$188.10 ,95,,,$25.00 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$25.00 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$25.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$25.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$25.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.20 ,90,,,$25.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.06 ,97,,,$25.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$25.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$25.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$25.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$25.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$25.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$25.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$25.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$25.00 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96374 OP INJ IV PUSH INITIAL CHARGE,8115123,CDM,260,RC,96374,HCPCS,outpatient,,,$305.00 ,$228.75 ,,$280.60 ,92,,,$167.75 ,$295.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$167.75 ,$295.85 ,other,,Not applicable. No negotiated rates per contract,$262.30 ,86,,,$167.75 ,$295.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$244.00 ,80,,,$167.75 ,$295.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$289.75 ,95,,,$167.75 ,$295.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.75 ,75,,,$167.75 ,$295.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.85 ,97,,,$167.75 ,$295.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.25 ,85,,,$167.75 ,$295.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.50 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.75 ,90,,,$167.75 ,$295.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.75 ,55,,,$167.75 ,$295.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.65 ,93,,,$167.75 ,$295.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96375 IV PUSH; EA ADDTL NEW DRUG/SUB CHARGE,8405302,CDM,260,RC,96375,HCPCS,outpatient,,,$125.00 ,$93.75 ,,$115.00 ,92,,,$68.75 ,$121.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.75 ,$121.25 ,other,,Not applicable. No negotiated rates per contract,$107.50 ,86,,,$68.75 ,$121.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.00 ,80,,,$68.75 ,$121.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.75 ,95,,,$68.75 ,$121.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.75 ,75,,,$68.75 ,$121.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.25 ,97,,,$68.75 ,$121.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.25 ,85,,,$68.75 ,$121.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.50 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.75 ,90,,,$68.75 ,$121.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.75 ,55,,,$68.75 ,$121.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.25 ,93,,,$68.75 ,$121.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96376 IV PUSH; EA ADDTL SAME DRUG >3 CHARGE,8405303,CDM,260,RC,96376,HCPCS,outpatient,,,$53.00 ,$39.75 ,,$48.76 ,92,,,$29.15 ,$51.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.15 ,55,,,$29.15 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.15 ,$51.41 ,other,,Not applicable. No negotiated rates per contract,$45.58 ,86,,,$29.15 ,$51.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.40 ,80,,,$29.15 ,$51.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.15 ,55,,,$29.15 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,95,,,$29.15 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.35 ,95,,,$29.15 ,$51.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.75 ,75,,,$29.15 ,$51.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.05 ,85,,,$29.15 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.41 ,97,,,$29.15 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.15 ,55,,,$29.15 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.70 ,90,,,$29.15 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.41 ,97,,,$29.15 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$29.15 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.41 ,97,,,$29.15 ,$51.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.05 ,85,,,$29.15 ,$51.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.70 ,90,,,$29.15 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$29.15 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.35 ,90,,,$29.15 ,$51.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.15 ,55,,,$29.15 ,$51.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.29 ,93,,,$29.15 ,$51.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96401 Chemo Subcut Injection Charge,8960409,CDM,331,RC,96401,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$108.90 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$108.90 ,$192.06 ,other,,Not applicable. No negotiated rates per contract,$170.28 ,86,,,$108.90 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$108.90 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.10 ,95,,,$108.90 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$108.90 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$108.90 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$108.90 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$108.90 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$108.90 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$108.90 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96409 CHEMO ADMIN IVP INITIAL CHARGE,8648419,CDM,331,RC,96409,HCPCS,outpatient,,,$775.00 ,$581.25 ,,$713.00 ,92,,,$426.25 ,$751.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$426.25 ,55,,,$426.25 ,$751.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$426.25 ,$751.75 ,other,,Not applicable. No negotiated rates per contract,$666.50 ,86,,,$426.25 ,$751.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$620.00 ,80,,,$426.25 ,$751.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$426.25 ,55,,,$426.25 ,$751.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$736.25 ,95,,,$426.25 ,$751.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$736.25 ,95,,,$426.25 ,$751.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$581.25 ,75,,,$426.25 ,$751.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$658.75 ,85,,,$426.25 ,$751.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$751.75 ,97,,,$426.25 ,$751.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$426.25 ,55,,,$426.25 ,$751.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$697.50 ,90,,,$426.25 ,$751.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$751.75 ,97,,,$426.25 ,$751.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$751.75 ,97,,,$426.25 ,$751.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$751.75 ,97,,,$426.25 ,$751.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$658.75 ,85,,,$426.25 ,$751.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$697.50 ,90,,,$426.25 ,$751.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$426.25 ,55,,,$426.25 ,$751.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$736.25 ,90,,,$426.25 ,$751.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$426.25 ,55,,,$426.25 ,$751.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$720.75 ,93,,,$426.25 ,$751.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96411 CHEMO ADMIN IVP ADD'L CHARGE,8648420,CDM,331,RC,96411,HCPCS,outpatient,,,$202.00 ,$151.50 ,,$185.84 ,92,,,$111.10 ,$195.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$111.10 ,$195.94 ,other,,Not applicable. No negotiated rates per contract,$173.72 ,86,,,$111.10 ,$195.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$161.60 ,80,,,$111.10 ,$195.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$151.50 ,75,,,$111.10 ,$195.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.86 ,93,,,$111.10 ,$195.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96415  MO IV INFUSION ADDL HR,8960288,CDM,335,RC,96415,HCPCS,outpatient,,,$253.00 ,$189.75 ,,$232.76 ,92,,,$139.15 ,$245.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.15 ,55,,,$139.15 ,$245.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.15 ,$245.41 ,other,,Not applicable. No negotiated rates per contract,$217.58 ,86,,,$139.15 ,$245.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$202.40 ,80,,,$139.15 ,$245.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.15 ,55,,,$139.15 ,$245.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.35 ,95,,,$139.15 ,$245.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.35 ,95,,,$139.15 ,$245.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.75 ,75,,,$139.15 ,$245.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.05 ,85,,,$139.15 ,$245.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$245.41 ,97,,,$139.15 ,$245.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.15 ,55,,,$139.15 ,$245.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$227.70 ,90,,,$139.15 ,$245.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.41 ,97,,,$139.15 ,$245.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.41 ,97,,,$139.15 ,$245.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.41 ,97,,,$139.15 ,$245.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.05 ,85,,,$139.15 ,$245.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$227.70 ,90,,,$139.15 ,$245.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.15 ,55,,,$139.15 ,$245.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.35 ,90,,,$139.15 ,$245.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.15 ,55,,,$139.15 ,$245.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.29 ,93,,,$139.15 ,$245.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96416 - CHEMOTX ADMN TQ INIT PROLNG CHEMOTX NFUS PMP,7997768,CDM,335,RC,96416,HCPCS,outpatient,,,"$1,013.00 ",$759.75 ,,$931.96 ,92,,,$557.15 ,$982.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$557.15 ,$982.61 ,other,,Not applicable. No negotiated rates per contract,$871.18 ,86,,,$557.15 ,$982.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$810.40 ,80,,,$557.15 ,$982.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$759.75 ,75,,,$557.15 ,$982.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.09 ,93,,,$557.15 ,$982.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96416 CADD Pump Initiation Charge,8960408,CDM,335,RC,96416,HCPCS,outpatient,,,"$1,013.00 ",$759.75 ,,$931.96 ,92,,,$557.15 ,$982.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$557.15 ,$982.61 ,other,,Not applicable. No negotiated rates per contract,$871.18 ,86,,,$557.15 ,$982.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$810.40 ,80,,,$557.15 ,$982.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$759.75 ,75,,,$557.15 ,$982.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.09 ,93,,,$557.15 ,$982.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96417  CHEMO IV INFUS EACH ADDL SEQ =<1 HR,8960289,CDM,335,RC,96417,HCPCS,outpatient,,,$350.00 ,$262.50 ,,$322.00 ,92,,,$192.50 ,$339.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$192.50 ,55,,,$192.50 ,$339.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$192.50 ,$339.50 ,other,,Not applicable. No negotiated rates per contract,$301.00 ,86,,,$192.50 ,$339.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$280.00 ,80,,,$192.50 ,$339.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$192.50 ,55,,,$192.50 ,$339.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.50 ,95,,,$192.50 ,$339.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$332.50 ,95,,,$192.50 ,$339.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$262.50 ,75,,,$192.50 ,$339.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$297.50 ,85,,,$192.50 ,$339.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$339.50 ,97,,,$192.50 ,$339.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.50 ,55,,,$192.50 ,$339.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.00 ,90,,,$192.50 ,$339.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$339.50 ,97,,,$192.50 ,$339.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.50 ,97,,,$192.50 ,$339.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.50 ,97,,,$192.50 ,$339.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$297.50 ,85,,,$192.50 ,$339.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$315.00 ,90,,,$192.50 ,$339.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.50 ,55,,,$192.50 ,$339.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.50 ,90,,,$192.50 ,$339.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$192.50 ,55,,,$192.50 ,$339.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$325.50 ,93,,,$192.50 ,$339.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV START WITH FLUIDS CHARGE,8960232,CDM,270,RC,,HCPCS,outpatient,,,$492.00 ,$369.00 ,,$452.64 ,92,,,$270.60 ,$477.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$270.60 ,$477.24 ,other,,Not applicable. No negotiated rates per contract,$423.12 ,86,,,$270.60 ,$477.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$393.60 ,80,,,$270.60 ,$477.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$467.40 ,95,,,$270.60 ,$477.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$369.00 ,75,,,$270.60 ,$477.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.24 ,97,,,$270.60 ,$477.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$418.20 ,85,,,$270.60 ,$477.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.80 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.40 ,90,,,$270.60 ,$477.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.60 ,55,,,$270.60 ,$477.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.56 ,93,,,$270.60 ,$477.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV START WITHOUT FLUIDS CHARGE,8960233,CDM,270,RC,,HCPCS,outpatient,,,$383.00 ,$287.25 ,,$352.36 ,92,,,$210.65 ,$371.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$210.65 ,$371.51 ,other,,Not applicable. No negotiated rates per contract,$329.38 ,86,,,$210.65 ,$371.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$306.40 ,80,,,$210.65 ,$371.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$287.25 ,75,,,$210.65 ,$371.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.19 ,93,,,$210.65 ,$371.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
M0220 Cilgavimab-tixagevimab 150 mg/1.5 ml-150 mg/1.5 ml Soln,9933486,CDM,771,RC,M0220,HCPCS,outpatient,,,$158.00 ,$118.50 ,,$145.36 ,92,,,$86.90 ,$153.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$86.90 ,55,,,$86.90 ,$153.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$86.90 ,$153.26 ,other,,Not applicable. No negotiated rates per contract,$135.88 ,86,,,$86.90 ,$153.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$126.40 ,80,,,$86.90 ,$153.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$86.90 ,55,,,$86.90 ,$153.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.10 ,95,,,$86.90 ,$153.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$150.10 ,95,,,$86.90 ,$153.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.50 ,75,,,$86.90 ,$153.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$134.30 ,85,,,$86.90 ,$153.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.26 ,97,,,$86.90 ,$153.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.90 ,55,,,$86.90 ,$153.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.20 ,90,,,$86.90 ,$153.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.26 ,97,,,$86.90 ,$153.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.26 ,97,,,$86.90 ,$153.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.26 ,97,,,$86.90 ,$153.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.30 ,85,,,$86.90 ,$153.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.20 ,90,,,$86.90 ,$153.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.90 ,55,,,$86.90 ,$153.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.10 ,90,,,$86.90 ,$153.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.90 ,55,,,$86.90 ,$153.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$86.90 ,$153.26 ,other,,Not separately reimbursable per table 2 referenced in contract
M0222 BEBTELOVIMAB INJECTION,10094950,CDM,771,RC,M0222,HCPCS,outpatient,,,$468.00 ,$351.00 ,,$430.56 ,92,,,$257.40 ,$453.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$257.40 ,55,,,$257.40 ,$453.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$257.40 ,$453.96 ,other,,Not applicable. No negotiated rates per contract,$402.48 ,86,,,$257.40 ,$453.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$374.40 ,80,,,$257.40 ,$453.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$257.40 ,55,,,$257.40 ,$453.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.60 ,95,,,$257.40 ,$453.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$444.60 ,95,,,$257.40 ,$453.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$351.00 ,75,,,$257.40 ,$453.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$397.80 ,85,,,$257.40 ,$453.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$453.96 ,97,,,$257.40 ,$453.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$257.40 ,55,,,$257.40 ,$453.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$421.20 ,90,,,$257.40 ,$453.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$453.96 ,97,,,$257.40 ,$453.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$453.96 ,97,,,$257.40 ,$453.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$453.96 ,97,,,$257.40 ,$453.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.80 ,85,,,$257.40 ,$453.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.20 ,90,,,$257.40 ,$453.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.40 ,55,,,$257.40 ,$453.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.60 ,90,,,$257.40 ,$453.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$257.40 ,55,,,$257.40 ,$453.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$257.40 ,$453.96 ,other,,Not separately reimbursable per table 2 referenced in contract
M0239 BAMLANIVIMAB INFUSION,9232159,CDM,940,RC,M0239,HCPCS,outpatient,,,$654.00 ,$490.50 ,,$601.68 ,92,,,$359.70 ,$634.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$359.70 ,55,,,$359.70 ,$634.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$359.70 ,$634.38 ,other,,Not applicable. No negotiated rates per contract,$562.44 ,86,,,$359.70 ,$634.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$523.20 ,80,,,$359.70 ,$634.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$359.70 ,55,,,$359.70 ,$634.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$621.30 ,95,,,$359.70 ,$634.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$621.30 ,95,,,$359.70 ,$634.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$490.50 ,75,,,$359.70 ,$634.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$555.90 ,85,,,$359.70 ,$634.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$634.38 ,97,,,$359.70 ,$634.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$359.70 ,55,,,$359.70 ,$634.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$588.60 ,90,,,$359.70 ,$634.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$634.38 ,97,,,$359.70 ,$634.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$634.38 ,97,,,$359.70 ,$634.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$634.38 ,97,,,$359.70 ,$634.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$555.90 ,85,,,$359.70 ,$634.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$588.60 ,90,,,$359.70 ,$634.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$359.70 ,55,,,$359.70 ,$634.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$621.30 ,90,,,$359.70 ,$634.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$359.70 ,55,,,$359.70 ,$634.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$608.22 ,93,,,$359.70 ,$634.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
M0243 casirivimab infusion,9250498,CDM,771,RC,M0243,HCPCS,outpatient,,,$486.00 ,$364.50 ,,$447.12 ,92,,,$267.30 ,$471.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$267.30 ,55,,,$267.30 ,$471.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$267.30 ,$471.42 ,other,,Not applicable. No negotiated rates per contract,$417.96 ,86,,,$267.30 ,$471.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$388.80 ,80,,,$267.30 ,$471.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$267.30 ,55,,,$267.30 ,$471.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$461.70 ,95,,,$267.30 ,$471.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$461.70 ,95,,,$267.30 ,$471.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$364.50 ,75,,,$267.30 ,$471.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$413.10 ,85,,,$267.30 ,$471.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$471.42 ,97,,,$267.30 ,$471.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.30 ,55,,,$267.30 ,$471.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.40 ,90,,,$267.30 ,$471.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$471.42 ,97,,,$267.30 ,$471.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$471.42 ,97,,,$267.30 ,$471.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$471.42 ,97,,,$267.30 ,$471.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.10 ,85,,,$267.30 ,$471.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$437.40 ,90,,,$267.30 ,$471.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.30 ,55,,,$267.30 ,$471.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$461.70 ,90,,,$267.30 ,$471.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.30 ,55,,,$267.30 ,$471.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$267.30 ,$471.42 ,other,,Not separately reimbursable per table 2 referenced in contract
M0244 - Casirivimab and Imdevimab JPH,9590237,CDM,771,RC,M0244,HCPCS,outpatient,,,$788.00 ,$591.00 ,,$724.96 ,92,,,$433.40 ,$764.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$433.40 ,55,,,$433.40 ,$764.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$433.40 ,$764.36 ,other,,Not applicable. No negotiated rates per contract,$677.68 ,86,,,$433.40 ,$764.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$630.40 ,80,,,$433.40 ,$764.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$433.40 ,55,,,$433.40 ,$764.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.60 ,95,,,$433.40 ,$764.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$748.60 ,95,,,$433.40 ,$764.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$591.00 ,75,,,$433.40 ,$764.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$669.80 ,85,,,$433.40 ,$764.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$764.36 ,97,,,$433.40 ,$764.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.40 ,55,,,$433.40 ,$764.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$709.20 ,90,,,$433.40 ,$764.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$764.36 ,97,,,$433.40 ,$764.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$764.36 ,97,,,$433.40 ,$764.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$764.36 ,97,,,$433.40 ,$764.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$669.80 ,85,,,$433.40 ,$764.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$709.20 ,90,,,$433.40 ,$764.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.40 ,55,,,$433.40 ,$764.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.60 ,90,,,$433.40 ,$764.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.40 ,55,,,$433.40 ,$764.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$433.40 ,$764.36 ,other,,Not separately reimbursable per table 2 referenced in contract
M0245 BAMLANIVIMAB AND ETESEVIMAB INFUSION,9458915,CDM,771,RC,M0245,HCPCS,outpatient,,,"$1,027.00 ",$770.25 ,,$944.84 ,92,,,$564.85 ,$996.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$564.85 ,$996.19 ,other,,Not applicable. No negotiated rates per contract,$883.22 ,86,,,$564.85 ,$996.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$821.60 ,80,,,$564.85 ,$996.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.65 ,95,,,$564.85 ,$996.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$975.65 ,95,,,$564.85 ,$996.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$770.25 ,75,,,$564.85 ,$996.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$872.95 ,85,,,$564.85 ,$996.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$924.30 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.19 ,97,,,$564.85 ,$996.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$872.95 ,85,,,$564.85 ,$996.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$924.30 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.65 ,90,,,$564.85 ,$996.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$564.85 ,55,,,$564.85 ,$996.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$564.85 ,$996.19 ,other,,Not separately reimbursable per table 2 referenced in contract
M0247 Intravenous infusion,9866966,CDM,771,RC,M0247,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not separately reimbursable per table 2 referenced in contract
M0248 Intravenous infusion,9866969,CDM,771,RC,M0248,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not separately reimbursable per table 2 referenced in contract
Injection,2726376,CDM,521,RC,11901,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
Injection,4612279,CDM,521,RC,11900,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
92585 NEWBORN HEARING SCREEN CHARGE,8730542,CDM,471,RC,92585,HCPCS,outpatient,,,$244.00 ,$183.00 ,,$224.48 ,92,,,$134.20 ,$236.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$134.20 ,55,,,$134.20 ,$236.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$134.20 ,$236.68 ,other,,Not applicable. No negotiated rates per contract,$209.84 ,86,,,$134.20 ,$236.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$195.20 ,80,,,$134.20 ,$236.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$134.20 ,55,,,$134.20 ,$236.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.80 ,95,,,$134.20 ,$236.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.80 ,95,,,$134.20 ,$236.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.00 ,75,,,$134.20 ,$236.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$207.40 ,85,,,$134.20 ,$236.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$236.68 ,97,,,$134.20 ,$236.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.20 ,55,,,$134.20 ,$236.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.60 ,90,,,$134.20 ,$236.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.68 ,97,,,$134.20 ,$236.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.68 ,97,,,$134.20 ,$236.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.68 ,97,,,$134.20 ,$236.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.40 ,85,,,$134.20 ,$236.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.60 ,90,,,$134.20 ,$236.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.20 ,55,,,$134.20 ,$236.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.80 ,90,,,$134.20 ,$236.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.20 ,55,,,$134.20 ,$236.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.92 ,93,,,$134.20 ,$236.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FETAL HEART MONITOR SETUP CHARGE,8951323,CDM,270,RC,,HCPCS,outpatient,,,$130.00 ,$97.50 ,,$119.60 ,92,,,$71.50 ,$126.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$71.50 ,55,,,$71.50 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$71.50 ,$126.10 ,other,,Not applicable. No negotiated rates per contract,$111.80 ,86,,,$71.50 ,$126.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$104.00 ,80,,,$71.50 ,$126.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$71.50 ,55,,,$71.50 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,95,,,$71.50 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.50 ,95,,,$71.50 ,$126.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$97.50 ,75,,,$71.50 ,$126.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$110.50 ,85,,,$71.50 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.10 ,97,,,$71.50 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.50 ,55,,,$71.50 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.00 ,90,,,$71.50 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.10 ,97,,,$71.50 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$71.50 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.10 ,97,,,$71.50 ,$126.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.50 ,85,,,$71.50 ,$126.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.00 ,90,,,$71.50 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$71.50 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.50 ,90,,,$71.50 ,$126.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.50 ,55,,,$71.50 ,$126.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.90 ,93,,,$71.50 ,$126.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
54150 Circumcision,2727012,CDM,521,RC,54150,HCPCS,outpatient,,,$487.00 ,$365.25 ,,$448.04 ,92,,,$197.64 ,$472.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$472.39 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$472.39 ,other,,Not applicable. No negotiated rates per contract,$418.82 ,86,,,$197.64 ,$472.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$389.60 ,80,,,$197.64 ,$472.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,95,,,$197.64 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$462.65 ,95,,,$197.64 ,$472.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$365.25 ,75,,,$197.64 ,$472.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$413.95 ,85,,,$197.64 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$472.39 ,97,,,$197.64 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$472.39 ,case rate,,100% of clinic case rate per visit,$438.30 ,90,,,$197.64 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.39 ,97,,,$197.64 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$197.64 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.39 ,97,,,$197.64 ,$472.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.95 ,85,,,$197.64 ,$472.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.30 ,90,,,$197.64 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.65 ,90,,,$197.64 ,$472.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$197.64 ,$472.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.64 ,$472.39 ,other,,Not separately reimbursable per table 3 referenced in contract
54160 Circumcision,5206139,CDM,521,RC,54160,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
54161 Circumcision,2727013,CDM,521,RC,54161,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
Bill Only Microbial Sensitivity,9386388,CDM,300,RC,87186,HCPCS,outpatient,,,$188.00 ,$141.00 ,,$172.96 ,92,,,$3.81 ,$182.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.40 ,55,,,$3.81 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.81 ,$182.36 ,other,,Not applicable. No negotiated rates per contract,$3.81 ,44,,,$3.81 ,$182.36 ,fee schedule,,44% of CMS Medicare lab fee schedule,$150.40 ,80,,,$3.81 ,$182.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.40 ,55,,,$3.81 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,95,,,$3.81 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.60 ,95,,,$3.81 ,$182.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.00 ,75,,,$3.81 ,$182.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$159.80 ,85,,,$3.81 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.36 ,97,,,$3.81 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.40 ,55,,,$3.81 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.20 ,90,,,$3.81 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.36 ,97,,,$3.81 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$3.81 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.36 ,97,,,$3.81 ,$182.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.80 ,85,,,$3.81 ,$182.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.20 ,90,,,$3.81 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$3.81 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.60 ,90,,,$3.81 ,$182.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.40 ,55,,,$3.81 ,$182.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.84 ,93,,,$3.81 ,$182.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Blood Culture,4122800,CDM,306,RC,87040,HCPCS,outpatient,,,$174.00 ,$130.50 ,,$160.08 ,92,,,$4.54 ,$168.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.70 ,55,,,$4.54 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$4.54 ,$168.78 ,other,,Not applicable. No negotiated rates per contract,$4.54 ,44,,,$4.54 ,$168.78 ,fee schedule,,44% of CMS Medicare lab fee schedule,$139.20 ,80,,,$4.54 ,$168.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.70 ,55,,,$4.54 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,95,,,$4.54 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.30 ,95,,,$4.54 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.50 ,75,,,$4.54 ,$168.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.90 ,85,,,$4.54 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.78 ,97,,,$4.54 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.70 ,55,,,$4.54 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.60 ,90,,,$4.54 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.78 ,97,,,$4.54 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$4.54 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$4.54 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.90 ,85,,,$4.54 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.60 ,90,,,$4.54 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$4.54 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,90,,,$4.54 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$4.54 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.82 ,93,,,$4.54 ,$168.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
0073A Pfizer Pediatric 10mcg/0.2ml - Third dose,9885634,CDM,771,RC,0073A,HCPCS,outpatient,,,$49.00 ,$36.75 ,,$45.08 ,92,,,$26.95 ,$47.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not applicable. No negotiated rates per contract,$42.14 ,86,,,$26.95 ,$47.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.20 ,80,,,$26.95 ,$47.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.55 ,95,,,$26.95 ,$47.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,75,,,$26.95 ,$47.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.53 ,97,,,$26.95 ,$47.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.65 ,85,,,$26.95 ,$47.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.10 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.55 ,90,,,$26.95 ,$47.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.95 ,55,,,$26.95 ,$47.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.95 ,$47.53 ,other,,Not separately reimbursable per table 2 referenced in contract
11600 EXC Mal Lesion Trunk,9076072,CDM,983,RC,11600,HCPCS,outpatient,,,,,,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursible per contract terms,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursible. Not contracted for physician rates,$245.24 ,100,,,$176.51 ,$245.24 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursable per contract terms,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$176.51 ,100,,,$176.51 ,$245.24 ,fee schedule,,100% Humana physician fee schedule,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursable per contract terms,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursable per contract terms,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursable per contract terms,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursable per contract terms,,,,,$176.51 ,$245.24 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.51 ,$245.24 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11601 Remove malig lesion,9076073,CDM,983,RC,11601,HCPCS,outpatient,,,,,,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursible per contract terms,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,$284.76 ,100,,,$216.23 ,$284.76 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$216.23 ,100,,,$216.23 ,$284.76 ,fee schedule,,100% Humana physician fee schedule,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$216.23 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.23 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11602 Remove malig lesion,9076074,CDM,983,RC,11602,HCPCS,outpatient,,,,,,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursible per contract terms,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$306.66 ,100,,,$236.25 ,$329.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursable per contract terms,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$236.25 ,100,,,$236.25 ,$329.95 ,fee schedule,,100% Humana physician fee schedule,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$329.95 ,100,,,$236.25 ,$329.95 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursable per contract terms,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursable per contract terms,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursable per contract terms,,,,,$236.25 ,$329.95 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$236.25 ,$329.95 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11603 Remove malig lesion,9076075,CDM,983,RC,11603,HCPCS,outpatient,,,,,,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursible per contract terms,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$349.18 ,100,,,$282.38 ,$394.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursable per contract terms,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$282.38 ,100,,,$282.38 ,$394.90 ,fee schedule,,100% Humana physician fee schedule,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$394.90 ,100,,,$282.38 ,$394.90 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursable per contract terms,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursable per contract terms,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursable per contract terms,,,,,$282.38 ,$394.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.38 ,$394.90 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11604 EXC Mal Lesion Trunk,9076076,CDM,983,RC,11604,HCPCS,outpatient,,,,,,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursible per contract terms,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursible. Not contracted for physician rates,$389.56 ,100,,,$311.49 ,$389.56 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursable per contract terms,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$311.49 ,100,,,$311.49 ,$389.56 ,fee schedule,,100% Humana physician fee schedule,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursable per contract terms,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursable per contract terms,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursable per contract terms,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursable per contract terms,,,,,$311.49 ,$389.56 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$311.49 ,$389.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11606 Exc Lesion Trunk,9076077,CDM,983,RC,11606,HCPCS,outpatient,,,,,,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursible per contract terms,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursible. Not contracted for physician rates,$557.06 ,100,,,$464.09 ,$557.06 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursable per contract terms,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$464.09 ,100,,,$464.09 ,$557.06 ,fee schedule,,100% Humana physician fee schedule,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursable per contract terms,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursable per contract terms,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursable per contract terms,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursable per contract terms,,,,,$464.09 ,$557.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$464.09 ,$557.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11644 Remove malig lision,9076088,CDM,983,RC,11644,HCPCS,outpatient,,,,,,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursible per contract terms,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$486.62 ,100,,,$413.73 ,$486.62 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursable per contract terms,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$413.73 ,100,,,$413.73 ,$486.62 ,fee schedule,,100% Humana physician fee schedule,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursable per contract terms,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursable per contract terms,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursable per contract terms,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursable per contract terms,,,,,$413.73 ,$486.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$413.73 ,$486.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11646 Remove malig lision,9076089,CDM,983,RC,11646,HCPCS,outpatient,,,,,,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursible per contract terms,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$632.65 ,100,,,$572.42 ,$632.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursable per contract terms,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$572.42 ,100,,,$572.42 ,$632.65 ,fee schedule,,100% Humana physician fee schedule,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursable per contract terms,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursable per contract terms,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursable per contract terms,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursable per contract terms,,,,,$572.42 ,$632.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$572.42 ,$632.65 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
99211 PROTIME CLINIC CHARGE,8728347,CDM,510,RC,99211,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$57.04 ,92,,,$21.73 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$21.73 ,$197.64 ,other,,Not seperately reimbursible per contract terms,$49.60 ,80,,,$21.73 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$58.90 ,95,,,$21.73 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.50 ,75,,,$21.73 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$52.70 ,85,,,$21.73 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$21.73 ,$197.64 ,case rate,,100% of clinic case rate per visit,$55.80 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.14 ,97,,,$21.73 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.00 ,100,,,$21.73 ,$197.64 ,case rate,,100% case rate for treatment room,$55.80 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.90 ,90,,,$21.73 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$21.73 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.66 ,93,,,$21.73 ,$197.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
23410 Repair of ruptured musculotendinous cuff,2726523,CDM,975,RC,23410,HCPCS,outpatient,,,,,,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,022.21 ",100,,,"$1,022.21 ","$1,202.64 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursable per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,202.64 ",100,,,"$1,022.21 ","$1,202.64 ",fee schedule,,100% Humana physician fee schedule,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursable per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursable per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursable per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursable per contract terms,,,,,"$1,022.21 ","$1,202.64 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,022.21 ","$1,202.64 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
24105 Excision,5206266,CDM,975,RC,24105,HCPCS,outpatient,,,"$1,191.00 ",$893.25 ,,$456.77 ,135,cms physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$376.65 ,"$1,131.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$442.39 ,100,,,$376.65 ,"$1,131.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$712.60 ,100,physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$546.14 ,145,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,131.45 ",95,,,$376.65 ,"$1,131.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$376.65 ,"$1,131.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$520.30 ,100,,,$376.65 ,"$1,131.45 ",fee schedule,,100% Humana physician fee schedule,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$376.65 ,"$1,131.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$376.65 ,"$1,131.45 ",other,,Not separately reimbursable per contract terms,$714.60 ,60,,,$376.65 ,"$1,131.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$714.60 ,60,,,$376.65 ,"$1,131.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$527.31 ,140,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$376.65 ,"$1,131.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,131.45 ",95,,,$376.65 ,"$1,131.45 ",percent of total billed charges,,95% of total billed charges,$376.65 ,100,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$469.88 ,124.753,CMS physician fee schedule,,$376.65 ,"$1,131.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
0001A Pfizer-Biontech Covid-19 Vaccine - 1st Dose,9243155,CDM,771,RC,0001A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0002A Pfizer-Biontech Covid-19 Vaccine - 2nd Dose,9243156,CDM,771,RC,0002A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0003A Pfizer-Biontech Covid-19 Vaccine - 3rd Dose,9666511,CDM,771,RC,0003A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0004A Pfizer-Biontech Covid-19 Booster,9712462,CDM,771,RC,0004A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0011A Moderna Vaccine 1st Dose: 100mcg,9248801,CDM,771,RC,0011A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0012A Moderna Vaccine 2nd Dose: 100mcg,9248802,CDM,771,RC,0012A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0013A Moderna Covid-19 Vaccine Admin 3rd Dose,9666512,CDM,771,RC,0013A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0064A  MODERNA COVID BOOSTER ADMIN,9928817,CDM,771,RC,52100,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0124A Pfizer ADM SARACV2 BVL 30MCG/.3ML Bivalent Booster,10591786,CDM,771,RC,0124A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
0134A Moderna ADM SARSCV2 BVL 50MCG/.5ML B Bivalent Booster,10588058,CDM,771,RC,0134A,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not separately reimbursable per table 2 referenced in contract
36568 PICC PLACEMENT FOR AGE <5 YEARS OLD CHARGE,8951329,CDM,982,RC,36568,HCPCS,outpatient,,,$254.00 ,$190.50 ,,$127.62 ,135,cms physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,135% of 2011 CMS physician fee schedule,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$92.10 ,$241.30 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.68 ,100,,,$92.10 ,$241.30 ,fee schedule,,100% of the Blue Cross physician fee schedule,$187.60 ,100,physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.55 ,145,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,145% CMS Medicare physician fee schedule ,$241.30 ,95,,,$92.10 ,$241.30 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$92.10 ,$241.30 ,other,,Not separately reimbursible. Not contracted for physician rates,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,$135.00 ,100,,,$92.10 ,$241.30 ,fee schedule,,100% Humana physician fee schedule,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$92.10 ,$241.30 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$92.10 ,$241.30 ,other,,Not separately reimbursable per contract terms,$152.40 ,60,,,$92.10 ,$241.30 ,percent of total billed charges,,60% of total billed charges for physician settings,$152.40 ,60,,,$92.10 ,$241.30 ,percent of total billed charges,,60% of total billed charges for physician settings,$128.94 ,140,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$92.10 ,$241.30 ,other,,Not separately reimbursible. Not contracted for physician rates,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,$241.30 ,95,,,$92.10 ,$241.30 ,percent of total billed charges,,95% of total billed charges,$92.10 ,100,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,100% CMS Medicare physician fee schedule ,$114.90 ,124.753,CMS physician fee schedule,,$92.10 ,$241.30 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36569 PICC PLACEMENT FOR AGE >5 YEARS OLD CHARGE,8951330,CDM,360,RC,36569,HCPCS,outpatient,,,$293.00 ,$219.75 ,,$269.56 ,92,,,$161.15 ,$284.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$161.15 ,55,,,$161.15 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$161.15 ,$284.21 ,other,,Not applicable. No negotiated rates per contract,$251.98 ,86,,,$161.15 ,$284.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$234.40 ,80,,,$161.15 ,$284.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$161.15 ,55,,,$161.15 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.35 ,95,,,$161.15 ,$284.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.35 ,95,,,$161.15 ,$284.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.75 ,75,,,$161.15 ,$284.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$249.05 ,85,,,$161.15 ,$284.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.21 ,97,,,$161.15 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.15 ,55,,,$161.15 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.70 ,90,,,$161.15 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$284.21 ,97,,,$161.15 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.21 ,97,,,$161.15 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.21 ,97,,,$161.15 ,$284.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.05 ,85,,,$161.15 ,$284.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.70 ,90,,,$161.15 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.15 ,55,,,$161.15 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.35 ,90,,,$161.15 ,$284.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.15 ,55,,,$161.15 ,$284.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.49 ,93,,,$161.15 ,$284.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36591 BLOOD SPEC ACCESS FROM PORT CHARGE,8951320,CDM,761,RC,36591,HCPCS,outpatient,,,$342.00 ,$256.50 ,,$314.64 ,92,,,$188.10 ,$331.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$188.10 ,$331.74 ,other,,Not applicable. No negotiated rates per contract,$294.12 ,86,,,$188.10 ,$331.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$273.60 ,80,,,$188.10 ,$331.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,95,,,$188.10 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.90 ,95,,,$188.10 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$256.50 ,75,,,$188.10 ,$331.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$290.70 ,85,,,$188.10 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.80 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.70 ,85,,,$188.10 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.80 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.06 ,93,,,$188.10 ,$331.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
36592 BLOOD SPEC ACCESS FROM PICC (OR OTHER) CHARGE,8951321,CDM,761,RC,36592,HCPCS,outpatient,,,$342.00 ,$256.50 ,,$314.64 ,92,,,$188.10 ,$331.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$188.10 ,$331.74 ,other,,Not applicable. No negotiated rates per contract,$294.12 ,86,,,$188.10 ,$331.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$273.60 ,80,,,$188.10 ,$331.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,95,,,$188.10 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.90 ,95,,,$188.10 ,$331.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$256.50 ,75,,,$188.10 ,$331.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$290.70 ,85,,,$188.10 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.80 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$331.74 ,97,,,$188.10 ,$331.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.70 ,85,,,$188.10 ,$331.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.80 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.90 ,90,,,$188.10 ,$331.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.10 ,55,,,$188.10 ,$331.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$318.06 ,93,,,$188.10 ,$331.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
59025 FETAL NON STRESS TEST CHARGE,8267946,CDM,920,RC,59025,HCPCS,outpatient,,,$548.00 ,$411.00 ,,$504.16 ,92,,,$301.40 ,$531.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$301.40 ,55,,,$301.40 ,$531.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$301.40 ,$531.56 ,other,,Not applicable. No negotiated rates per contract,$471.28 ,86,,,$301.40 ,$531.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$438.40 ,80,,,$301.40 ,$531.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$301.40 ,55,,,$301.40 ,$531.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$520.60 ,95,,,$301.40 ,$531.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$520.60 ,95,,,$301.40 ,$531.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$411.00 ,75,,,$301.40 ,$531.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$465.80 ,85,,,$301.40 ,$531.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$531.56 ,97,,,$301.40 ,$531.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$301.40 ,55,,,$301.40 ,$531.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$493.20 ,90,,,$301.40 ,$531.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.56 ,97,,,$301.40 ,$531.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.56 ,97,,,$301.40 ,$531.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.56 ,97,,,$301.40 ,$531.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$465.80 ,85,,,$301.40 ,$531.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$493.20 ,90,,,$301.40 ,$531.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$301.40 ,55,,,$301.40 ,$531.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$520.60 ,90,,,$301.40 ,$531.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$301.40 ,55,,,$301.40 ,$531.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.64 ,93,,,$301.40 ,$531.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
62321 Cervical/Thoracic Epidural Inj w/fluro,8970082,CDM,761,RC,62321,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
77001 PICC US GUIDANCE CHARGE,8951332,CDM,320,RC,77001,HCPCS,outpatient,,,$783.00 ,$587.25 ,,$720.36 ,92,,,$430.65 ,$759.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$430.65 ,55,,,$430.65 ,$759.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$430.65 ,$759.51 ,other,,Not applicable. No negotiated rates per contract,$673.38 ,86,,,$430.65 ,$759.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$626.40 ,80,,,$430.65 ,$759.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$430.65 ,55,,,$430.65 ,$759.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$743.85 ,95,,,$430.65 ,$759.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$743.85 ,95,,,$430.65 ,$759.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.25 ,75,,,$430.65 ,$759.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$665.55 ,85,,,$430.65 ,$759.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$759.51 ,97,,,$430.65 ,$759.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$430.65 ,55,,,$430.65 ,$759.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$704.70 ,90,,,$430.65 ,$759.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$759.51 ,97,,,$430.65 ,$759.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$759.51 ,97,,,$430.65 ,$759.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$759.51 ,97,,,$430.65 ,$759.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$665.55 ,85,,,$430.65 ,$759.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$704.70 ,90,,,$430.65 ,$759.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$430.65 ,55,,,$430.65 ,$759.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$743.85 ,90,,,$430.65 ,$759.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$430.65 ,55,,,$430.65 ,$759.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.19 ,93,,,$430.65 ,$759.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
86480 TB SKIN TEST IMMUN M CHARGE,8714190,CDM,302,RC,86480,HCPCS,outpatient,,,$261.00 ,$195.75 ,,$240.12 ,92,,,$27.27 ,$253.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.55 ,55,,,$27.27 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.27 ,$253.17 ,other,,Not applicable. No negotiated rates per contract,$27.27 ,44,,,$27.27 ,$253.17 ,fee schedule,,44% of CMS Medicare lab fee schedule,$208.80 ,80,,,$27.27 ,$253.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.55 ,55,,,$27.27 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.95 ,95,,,$27.27 ,$253.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.95 ,95,,,$27.27 ,$253.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.75 ,75,,,$27.27 ,$253.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.85 ,85,,,$27.27 ,$253.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$253.17 ,97,,,$27.27 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.55 ,55,,,$27.27 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.90 ,90,,,$27.27 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.17 ,97,,,$27.27 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.17 ,97,,,$27.27 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.17 ,97,,,$27.27 ,$253.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.85 ,85,,,$27.27 ,$253.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.90 ,90,,,$27.27 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.55 ,55,,,$27.27 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.95 ,90,,,$27.27 ,$253.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.55 ,55,,,$27.27 ,$253.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.73 ,93,,,$27.27 ,$253.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94640 UPDRAFT TREATMENT,8730591,CDM,410,RC,94640,HCPCS,outpatient,,,$282.00 ,$211.50 ,,$259.44 ,92,,,$155.10 ,$273.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.10 ,55,,,$155.10 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$155.10 ,$273.54 ,other,,Not applicable. No negotiated rates per contract,$242.52 ,86,,,$155.10 ,$273.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$225.60 ,80,,,$155.10 ,$273.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.10 ,55,,,$155.10 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.90 ,95,,,$155.10 ,$273.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.90 ,95,,,$155.10 ,$273.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$211.50 ,75,,,$155.10 ,$273.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$239.70 ,85,,,$155.10 ,$273.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$273.54 ,97,,,$155.10 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.10 ,55,,,$155.10 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$253.80 ,90,,,$155.10 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.54 ,97,,,$155.10 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.54 ,97,,,$155.10 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.54 ,97,,,$155.10 ,$273.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.70 ,85,,,$155.10 ,$273.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$253.80 ,90,,,$155.10 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.10 ,55,,,$155.10 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.90 ,90,,,$155.10 ,$273.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.10 ,55,,,$155.10 ,$273.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.26 ,93,,,$155.10 ,$273.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94761 MEASURE BLOOD OXYGEN LEVEL - MULTIPLE,8730598,CDM,460,RC,94761,HCPCS,outpatient,,,$39.00 ,$29.25 ,,$35.88 ,92,,,$21.45 ,$37.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.45 ,$37.83 ,other,,Not applicable. No negotiated rates per contract,$33.54 ,86,,,$21.45 ,$37.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.20 ,80,,,$21.45 ,$37.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.25 ,75,,,$21.45 ,$37.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.27 ,93,,,$21.45 ,$37.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96401 CHEMO ANTI-NEOPL SQ/IM CHARGE,8293214,CDM,331,RC,96401,HCPCS,outpatient,,,$199.00 ,$149.25 ,,$183.08 ,92,,,$109.45 ,$193.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$109.45 ,$193.03 ,other,,Not applicable. No negotiated rates per contract,$171.14 ,86,,,$109.45 ,$193.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$159.20 ,80,,,$109.45 ,$193.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,95,,,$109.45 ,$193.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.05 ,95,,,$109.45 ,$193.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$149.25 ,75,,,$109.45 ,$193.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$169.15 ,85,,,$109.45 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.10 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.03 ,97,,,$109.45 ,$193.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.15 ,85,,,$109.45 ,$193.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$179.10 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.05 ,90,,,$109.45 ,$193.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.45 ,55,,,$109.45 ,$193.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.07 ,93,,,$109.45 ,$193.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
96530 PORT MAINTENANCE CHARGE,8951841,CDM,260,RC,96523,HCPCS,outpatient,,,$190.00 ,$142.50 ,,$174.80 ,92,,,$104.50 ,$184.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.50 ,55,,,$104.50 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.50 ,$184.30 ,other,,Not applicable. No negotiated rates per contract,$163.40 ,86,,,$104.50 ,$184.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$152.00 ,80,,,$104.50 ,$184.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.50 ,55,,,$104.50 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,95,,,$104.50 ,$184.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.50 ,95,,,$104.50 ,$184.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,75,,,$104.50 ,$184.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$161.50 ,85,,,$104.50 ,$184.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$184.30 ,97,,,$104.50 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.50 ,55,,,$104.50 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$104.50 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.30 ,97,,,$104.50 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$104.50 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.30 ,97,,,$104.50 ,$184.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.50 ,85,,,$104.50 ,$184.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.00 ,90,,,$104.50 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.50 ,55,,,$104.50 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.50 ,90,,,$104.50 ,$184.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.50 ,55,,,$104.50 ,$184.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,93,,,$104.50 ,$184.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EXTENDED RECOVERY EA ADDL HOUR CHARGE,8769759,CDM,710,RC,,HCPCS,outpatient,,,$232.00 ,$174.00 ,,$213.44 ,92,,,$127.60 ,$225.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.60 ,$225.04 ,other,,Not applicable. No negotiated rates per contract,$199.52 ,86,,,$127.60 ,$225.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$185.60 ,80,,,$127.60 ,$225.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.00 ,75,,,$127.60 ,$225.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.76 ,93,,,$127.60 ,$225.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EXTENDED RECOVERY FIRST HOUR CHARGE,8769758,CDM,710,RC,,HCPCS,outpatient,,,$852.00 ,$639.00 ,,$783.84 ,92,,,$468.60 ,$826.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$468.60 ,55,,,$468.60 ,$826.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$468.60 ,$826.44 ,other,,Not applicable. No negotiated rates per contract,$732.72 ,86,,,$468.60 ,$826.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$681.60 ,80,,,$468.60 ,$826.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$468.60 ,55,,,$468.60 ,$826.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$809.40 ,95,,,$468.60 ,$826.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$809.40 ,95,,,$468.60 ,$826.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$639.00 ,75,,,$468.60 ,$826.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$724.20 ,85,,,$468.60 ,$826.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$826.44 ,97,,,$468.60 ,$826.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$468.60 ,55,,,$468.60 ,$826.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$766.80 ,90,,,$468.60 ,$826.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$826.44 ,97,,,$468.60 ,$826.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$826.44 ,97,,,$468.60 ,$826.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$826.44 ,97,,,$468.60 ,$826.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$724.20 ,85,,,$468.60 ,$826.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$766.80 ,90,,,$468.60 ,$826.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$468.60 ,55,,,$468.60 ,$826.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$809.40 ,90,,,$468.60 ,$826.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$468.60 ,55,,,$468.60 ,$826.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.36 ,93,,,$468.60 ,$826.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0260  INJ SACROILAC JT BI CHARGE,8720385,CDM,450,RC,G0260,HCPCS,outpatient,,,"$1,034.00 ",$775.50 ,,$951.28 ,92,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$568.70 ,55,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$568.70 ,"$1,002.98 ",other,,Not applicable. No negotiated rates per contract,$889.24 ,86,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$827.20 ,80,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$568.70 ,55,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$982.30 ,95,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$982.30 ,95,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$775.50 ,75,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$878.90 ,85,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,002.98 ",97,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$568.70 ,55,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$930.60 ,90,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,002.98 ",97,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,002.98 ",97,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,002.98 ",97,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$878.90 ,85,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$930.60 ,90,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$568.70 ,55,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$982.30 ,90,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$568.70 ,55,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$961.62 ,93,,,$568.70 ,"$1,002.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
G0260 INJ SACROILLIAC JT CHARGE,8720198,CDM,981,RC,G0260,HCPCS,outpatient,,,$725.00 ,$543.75 ,,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursible per contract terms,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$201.87 ,100,,,$201.87 ,$725.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursable per contract terms,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$688.75 ,95,,,$201.87 ,$725.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$725.00 ,100,,,$201.87 ,$725.00 ,fee schedule,,100% Humana physician fee schedule,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursable per contract terms,$435.00 ,60,,,$201.87 ,$725.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$435.00 ,60,,,$201.87 ,$725.00 ,percent of total billed charges,,60% of total billed charges for physician settings,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursable per contract terms,,,,,$201.87 ,$725.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$688.75 ,95,,,$201.87 ,$725.00 ,percent of total billed charges,,95% of total billed charges,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$201.87 ,$725.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
A9270 fosfomycin tromethamine 3gm packet [YUMA],9328311,CDM,250,RC,,HCPCS,outpatient,3,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
97802 MEDICAL NUTRITION THERAPY INITIAL 15 MIN CHARGE,8500717,CDM,942,RC,97802,HCPCS,outpatient,,,$72.00 ,$54.00 ,,$66.24 ,92,,,$39.60 ,$69.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.60 ,55,,,$39.60 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.60 ,$69.84 ,other,,Not applicable. No negotiated rates per contract,$61.92 ,86,,,$39.60 ,$69.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.60 ,80,,,$39.60 ,$69.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.60 ,55,,,$39.60 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,95,,,$39.60 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.40 ,95,,,$39.60 ,$69.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.00 ,75,,,$39.60 ,$69.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.20 ,85,,,$39.60 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.84 ,97,,,$39.60 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.60 ,55,,,$39.60 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.80 ,90,,,$39.60 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.84 ,97,,,$39.60 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$39.60 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,97,,,$39.60 ,$69.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.20 ,85,,,$39.60 ,$69.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.80 ,90,,,$39.60 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$39.60 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$39.60 ,$69.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.60 ,55,,,$39.60 ,$69.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.96 ,93,,,$39.60 ,$69.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ADL Training Charges,8123821,CDM,430,RC,97535,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Aquatic Charge,8123840,CDM,430,RC,97113,HCPCS,outpatient,,,$165.00 ,$123.75 ,,$151.80 ,92,,,$65.00 ,$160.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$160.05 ,other,,Not applicable. No negotiated rates per contract,$141.90 ,86,,,$65.00 ,$160.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.00 ,80,,,$65.00 ,$160.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.75 ,75,,,$65.00 ,$160.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$160.05 ,case rate,,100% case rate for initial eval or therapy,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.50 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.45 ,93,,,$65.00 ,$160.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Iontophoresis Charges,8123824,CDM,430,RC,97033,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$31.90 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.90 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$49.88 ,86,,,$31.90 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$31.90 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$31.90 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$31.90 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$31.90 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT ADL Training Assist Units,8743910,CDM,430,RC,97535,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Aquatic Assistant Charge,8743888,CDM,430,RC,97113,HCPCS,outpatient,,,$165.00 ,$123.75 ,,$151.80 ,92,,,$65.00 ,$160.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$160.05 ,other,,Not applicable. No negotiated rates per contract,$141.90 ,86,,,$65.00 ,$160.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.00 ,80,,,$65.00 ,$160.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.75 ,75,,,$65.00 ,$160.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$160.05 ,case rate,,100% case rate for initial eval or therapy,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.50 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.45 ,93,,,$65.00 ,$160.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Cog Ther Intervent,8740072,CDM,430,RC,97130,HCPCS,outpatient,,,,,,,,,,$65.00 ,$65.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$65.00 ,100,,,$65.00 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
OT Cog Ther Intervent,8740066,CDM,430,RC,97129,HCPCS,outpatient,,,,,,,,,,$65.00 ,$65.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$65.00 ,100,,,$65.00 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
OT High Complex Units,8123907,CDM,434,RC,97166,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$65.00 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$65.00 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$65.00 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$65.00 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$65.00 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$65.00 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$65.00 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$65.00 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$65.00 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$65.00 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$65.00 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$334.65 ,case rate,,100% case rate for initial eval or therapy,$334.65 ,97,,,$65.00 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$65.00 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$65.00 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$65.00 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$65.00 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$65.00 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$65.00 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$65.00 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$65.00 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Iontophoresis Assistant Units,8720927,CDM,430,RC,97033,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$31.90 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.90 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$49.88 ,86,,,$31.90 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$31.90 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$31.90 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$31.90 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$31.90 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Low Complex Units,8123903,CDM,430,RC,97165,HCPCS,outpatient,,,$147.00 ,$110.25 ,,$135.24 ,92,,,$65.00 ,$142.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$142.59 ,other,,Not applicable. No negotiated rates per contract,$126.42 ,86,,,$65.00 ,$142.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.60 ,80,,,$65.00 ,$142.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,95,,,$65.00 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.65 ,95,,,$65.00 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.25 ,75,,,$65.00 ,$142.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.95 ,85,,,$65.00 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$142.59 ,case rate,,100% case rate for initial eval or therapy,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.95 ,85,,,$65.00 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.30 ,90,,,$65.00 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,90,,,$65.00 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.71 ,93,,,$65.00 ,$142.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Manual Therapy Charge Units,750909,CDM,430,RC,97140,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$65.00 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$177.51 ,other,,Not applicable. No negotiated rates per contract,$157.38 ,86,,,$65.00 ,$177.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$146.40 ,80,,,$65.00 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$65.00 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$177.51 ,case rate,,100% case rate for initial eval or therapy,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$65.00 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Massage Assistant Units,8725599,CDM,430,RC,97124,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$33.55 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$33.55 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$52.46 ,86,,,$33.55 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.80 ,80,,,$33.55 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$33.55 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$33.55 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$33.55 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Massage Charge Units,1041799,CDM,430,RC,97124,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$33.55 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$33.55 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$52.46 ,86,,,$33.55 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.80 ,80,,,$33.55 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$33.55 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$33.55 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$33.55 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Moderate Complex Units,8123905,CDM,434,RC,97165,HCPCS,outpatient,,,$147.00 ,$110.25 ,,$135.24 ,92,,,$65.00 ,$142.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$142.59 ,other,,Not applicable. No negotiated rates per contract,$126.42 ,86,,,$65.00 ,$142.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.60 ,80,,,$65.00 ,$142.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,95,,,$65.00 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.65 ,95,,,$65.00 ,$142.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.25 ,75,,,$65.00 ,$142.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.95 ,85,,,$65.00 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$142.59 ,case rate,,100% case rate for initial eval or therapy,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,97,,,$65.00 ,$142.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.95 ,85,,,$65.00 ,$142.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.30 ,90,,,$65.00 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.65 ,90,,,$65.00 ,$142.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.85 ,55,,,$65.00 ,$142.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.71 ,93,,,$65.00 ,$142.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Neuromuscular Reeducation Charges,750905,CDM,430,RC,97112,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$186.76 ,92,,,$65.00 ,$196.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$196.91 ,other,,Not applicable. No negotiated rates per contract,$174.58 ,86,,,$65.00 ,$196.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.40 ,80,,,$65.00 ,$196.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.25 ,75,,,$65.00 ,$196.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$196.91 ,case rate,,100% case rate for initial eval or therapy,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.70 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.79 ,93,,,$65.00 ,$196.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Neuromuscular Reeducation Assist Unit,8725597,CDM,430,RC,97112,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$186.76 ,92,,,$65.00 ,$196.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$196.91 ,other,,Not applicable. No negotiated rates per contract,$174.58 ,86,,,$65.00 ,$196.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.40 ,80,,,$65.00 ,$196.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.25 ,75,,,$65.00 ,$196.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$196.91 ,case rate,,100% case rate for initial eval or therapy,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.70 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.79 ,93,,,$65.00 ,$196.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Paraffin Bath Assistant Units,8720893,CDM,430,RC,97018,HCPCS,outpatient,,,$146.00 ,$109.50 ,,$134.32 ,92,,,$65.00 ,$141.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$141.62 ,other,,Not applicable. No negotiated rates per contract,$125.56 ,86,,,$65.00 ,$141.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.80 ,80,,,$65.00 ,$141.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.50 ,75,,,$65.00 ,$141.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$141.62 ,case rate,,100% case rate for initial eval or therapy,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.40 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.78 ,93,,,$65.00 ,$141.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Paraffin Bath Charge,750917,CDM,430,RC,97018,HCPCS,outpatient,,,$146.00 ,$109.50 ,,$134.32 ,92,,,$65.00 ,$141.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$141.62 ,other,,Not applicable. No negotiated rates per contract,$125.56 ,86,,,$65.00 ,$141.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.80 ,80,,,$65.00 ,$141.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.50 ,75,,,$65.00 ,$141.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$141.62 ,case rate,,100% case rate for initial eval or therapy,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.40 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.78 ,93,,,$65.00 ,$141.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Phonophoresis Assistant Units,8744253,CDM,430,RC,97035,HCPCS,outpatient,,,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.30 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$39.56 ,86,,,$25.30 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.30 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT ReEval Units,8123910,CDM,434,RC,97167,HCPCS,outpatient,,,$307.00 ,$230.25 ,,$282.44 ,92,,,$65.00 ,$297.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$168.85 ,55,,,$65.00 ,$297.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$297.79 ,other,,Not applicable. No negotiated rates per contract,$264.02 ,86,,,$65.00 ,$297.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$245.60 ,80,,,$65.00 ,$297.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$168.85 ,55,,,$65.00 ,$297.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$291.65 ,95,,,$65.00 ,$297.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$291.65 ,95,,,$65.00 ,$297.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$230.25 ,75,,,$65.00 ,$297.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$260.95 ,85,,,$65.00 ,$297.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.79 ,97,,,$65.00 ,$297.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.85 ,55,,,$65.00 ,$297.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$297.79 ,case rate,,100% case rate for initial eval or therapy,$297.79 ,97,,,$65.00 ,$297.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$297.79 ,97,,,$65.00 ,$297.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$297.79 ,97,,,$65.00 ,$297.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.95 ,85,,,$65.00 ,$297.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$276.30 ,90,,,$65.00 ,$297.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.85 ,55,,,$65.00 ,$297.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$291.65 ,90,,,$65.00 ,$297.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.85 ,55,,,$65.00 ,$297.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.51 ,93,,,$65.00 ,$297.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Therapeutic Activities Charges,750903,CDM,430,RC,97530,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Therapeutic Exercise Assistant units,8725595,CDM,430,RC,97110,HCPCS,outpatient,,,$89.00 ,$66.75 ,,$81.88 ,92,,,$48.95 ,$86.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.95 ,$86.33 ,other,,Not applicable. No negotiated rates per contract,$76.54 ,86,,,$48.95 ,$86.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.20 ,80,,,$48.95 ,$86.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.75 ,75,,,$48.95 ,$86.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$48.95 ,$86.33 ,case rate,,100% case rate for initial eval or therapy,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.10 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.77 ,93,,,$48.95 ,$86.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Therapeutic Exercise Charges,750901,CDM,430,RC,97110,HCPCS,outpatient,,,$89.00 ,$66.75 ,,$81.88 ,92,,,$48.95 ,$86.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.95 ,$86.33 ,other,,Not applicable. No negotiated rates per contract,$76.54 ,86,,,$48.95 ,$86.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.20 ,80,,,$48.95 ,$86.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.75 ,75,,,$48.95 ,$86.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$48.95 ,$86.33 ,case rate,,100% case rate for initial eval or therapy,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.10 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.77 ,93,,,$48.95 ,$86.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT Ultrasound Assistant Units,8725592,CDM,430,RC,97035,HCPCS,outpatient,,,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.30 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$39.56 ,86,,,$25.30 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.30 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Phonophoresis Charge,8123856,CDM,430,RC,97035,HCPCS,outpatient,,,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.30 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$39.56 ,86,,,$25.30 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.30 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ultrasound Charges,8123832,CDM,430,RC,97035,HCPCS,outpatient,,,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.30 ,$65.00 ,other,,Not applicable. No negotiated rates per contract,$39.56 ,86,,,$25.30 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.30 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Wheelchair Charge,8123730,CDM,430,RC,97542,HCPCS,outpatient,,,$108.00 ,$81.00 ,,$99.36 ,92,,,$59.40 ,$104.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$59.40 ,55,,,$59.40 ,$104.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$59.40 ,$104.76 ,other,,Not applicable. No negotiated rates per contract,$92.88 ,86,,,$59.40 ,$104.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$86.40 ,80,,,$59.40 ,$104.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$59.40 ,55,,,$59.40 ,$104.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.60 ,95,,,$59.40 ,$104.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.60 ,95,,,$59.40 ,$104.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.00 ,75,,,$59.40 ,$104.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$91.80 ,85,,,$59.40 ,$104.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.76 ,97,,,$59.40 ,$104.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.40 ,55,,,$59.40 ,$104.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$59.40 ,$104.76 ,case rate,,100% case rate for initial eval or therapy,$104.76 ,97,,,$59.40 ,$104.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.76 ,97,,,$59.40 ,$104.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.76 ,97,,,$59.40 ,$104.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.80 ,85,,,$59.40 ,$104.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.20 ,90,,,$59.40 ,$104.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.40 ,55,,,$59.40 ,$104.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.60 ,90,,,$59.40 ,$104.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.40 ,55,,,$59.40 ,$104.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.44 ,93,,,$59.40 ,$104.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Wheelchair Charge,8201796,CDM,430,RC,97542,HCPCS,outpatient,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$56.10 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.10 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$87.72 ,86,,,$56.10 ,$98.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$81.60 ,80,,,$56.10 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$56.10 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$56.10 ,$98.94 ,case rate,,100% case rate for initial eval or therapy,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$56.10 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Wheelchair Charge,8202757,CDM,430,RC,97542,HCPCS,outpatient,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$56.10 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.10 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$87.72 ,86,,,$56.10 ,$98.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$81.60 ,80,,,$56.10 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$56.10 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$56.10 ,$98.94 ,case rate,,100% case rate for initial eval or therapy,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$56.10 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97129 OT-DEVEL COG SKILLS-1ST 15 MIN CHARGE,9559781,CDM,430,RC,97129,HCPCS,outpatient,,,$77.00 ,$57.75 ,,$70.84 ,92,,,$42.35 ,$74.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.35 ,$74.69 ,other,,Not applicable. No negotiated rates per contract,$66.22 ,86,,,$42.35 ,$74.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.60 ,80,,,$42.35 ,$74.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,95,,,$42.35 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.15 ,95,,,$42.35 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.75 ,75,,,$42.35 ,$74.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.45 ,85,,,$42.35 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$42.35 ,$74.69 ,case rate,,100% case rate for initial eval or therapy,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,85,,,$42.35 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.30 ,90,,,$42.35 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,90,,,$42.35 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.61 ,93,,,$42.35 ,$74.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97130 OT-DEVEL COG SKILLS-EA ADD 15 CHARGE,9559779,CDM,430,RC,97130,HCPCS,outpatient,,,$75.00 ,$56.25 ,,$69.00 ,92,,,$41.25 ,$72.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.25 ,55,,,$41.25 ,$72.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.25 ,$72.75 ,other,,Not applicable. No negotiated rates per contract,$64.50 ,86,,,$41.25 ,$72.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.00 ,80,,,$41.25 ,$72.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.25 ,55,,,$41.25 ,$72.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.25 ,95,,,$41.25 ,$72.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.25 ,95,,,$41.25 ,$72.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.25 ,75,,,$41.25 ,$72.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.75 ,85,,,$41.25 ,$72.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.75 ,97,,,$41.25 ,$72.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.25 ,55,,,$41.25 ,$72.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$41.25 ,$72.75 ,case rate,,100% case rate for initial eval or therapy,$72.75 ,97,,,$41.25 ,$72.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.75 ,97,,,$41.25 ,$72.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.75 ,97,,,$41.25 ,$72.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.75 ,85,,,$41.25 ,$72.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.50 ,90,,,$41.25 ,$72.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.25 ,55,,,$41.25 ,$72.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.25 ,90,,,$41.25 ,$72.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.25 ,55,,,$41.25 ,$72.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.75 ,93,,,$41.25 ,$72.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97530 OT Therapeutic Activities Charges,8897646,CDM,430,RC,97530,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Neuromuscular Reeducation Charges,8123830,CDM,430,RC,97112,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$186.76 ,92,,,$65.00 ,$196.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$196.91 ,other,,Not applicable. No negotiated rates per contract,$174.58 ,86,,,$65.00 ,$196.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.40 ,80,,,$65.00 ,$196.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.85 ,95,,,$65.00 ,$196.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.25 ,75,,,$65.00 ,$196.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$196.91 ,case rate,,100% case rate for initial eval or therapy,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.91 ,97,,,$65.00 ,$196.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.55 ,85,,,$65.00 ,$196.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.70 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.85 ,90,,,$65.00 ,$196.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.65 ,55,,,$65.00 ,$196.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.79 ,93,,,$65.00 ,$196.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OT ADL Training Charges,1366372,CDM,430,RC,97535,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$119.31 ,other,,Not applicable. No negotiated rates per contract,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Paraffin Bath Charge,8123831,CDM,430,RC,97018,HCPCS,outpatient,,,$146.00 ,$109.50 ,,$134.32 ,92,,,$65.00 ,$141.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.00 ,$141.62 ,other,,Not applicable. No negotiated rates per contract,$125.56 ,86,,,$65.00 ,$141.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.80 ,80,,,$65.00 ,$141.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.70 ,95,,,$65.00 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.50 ,75,,,$65.00 ,$141.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$141.62 ,case rate,,100% case rate for initial eval or therapy,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$65.00 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.10 ,85,,,$65.00 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.40 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,90,,,$65.00 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$65.00 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.78 ,93,,,$65.00 ,$141.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99499 DMV Employment Physical,8139934,CDM,521,RC,99499,HCPCS,outpatient,,,$140.00 ,$105.00 ,,$128.80 ,92,,,$105.00 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$105.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$105.00 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$120.40 ,86,,,$105.00 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$112.00 ,80,,,$105.00 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$105.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.00 ,100,,,$105.00 ,$197.64 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$133.00 ,95,,,$105.00 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.00 ,75,,,$105.00 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$119.00 ,85,,,$105.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.80 ,97,,,$105.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$105.00 ,$197.64 ,case rate,,100% of clinic case rate per visit,$126.00 ,90,,,$105.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.80 ,97,,,$105.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.80 ,97,,,$105.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.80 ,97,,,$105.00 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.00 ,85,,,$105.00 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.00 ,90,,,$105.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$105.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.00 ,90,,,$105.00 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$105.00 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.00 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
96413 - CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG,7997765,CDM,335,RC,96413,HCPCS,outpatient,,,$834.00 ,$625.50 ,,$767.28 ,92,,,$458.70 ,$808.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$458.70 ,55,,,$458.70 ,$808.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$458.70 ,$808.98 ,other,,Not applicable. No negotiated rates per contract,$717.24 ,86,,,$458.70 ,$808.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$667.20 ,80,,,$458.70 ,$808.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$458.70 ,55,,,$458.70 ,$808.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.30 ,95,,,$458.70 ,$808.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$792.30 ,95,,,$458.70 ,$808.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$625.50 ,75,,,$458.70 ,$808.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$708.90 ,85,,,$458.70 ,$808.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$808.98 ,97,,,$458.70 ,$808.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$458.70 ,55,,,$458.70 ,$808.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$750.60 ,90,,,$458.70 ,$808.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$808.98 ,97,,,$458.70 ,$808.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$808.98 ,97,,,$458.70 ,$808.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$808.98 ,97,,,$458.70 ,$808.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$708.90 ,85,,,$458.70 ,$808.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$750.60 ,90,,,$458.70 ,$808.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$458.70 ,55,,,$458.70 ,$808.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$792.30 ,90,,,$458.70 ,$808.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$458.70 ,55,,,$458.70 ,$808.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$775.62 ,93,,,$458.70 ,$808.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
20610 DRAIN/INJECT JOINT/BURSA CHARGE,8669087,CDM,975,RC,20610,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$66.26 ,135,cms physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$46.11 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$76.88 ,100,,,$46.11 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$92.40 ,100,physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$66.86 ,145,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$46.11 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$46.11 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$66.81 ,100,,,$46.11 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$46.11 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$92.59 ,100,,,$46.11 ,$288.80 ,fee schedule,,100% Midlands Choice physician fee schedule,$52.34 ,100,,,$46.11 ,$288.80 ,fee schedule,,100% Multiplan physician fee schedule,$52.34 ,100,,,$46.11 ,$288.80 ,fee schedule,,100% Multiplan physician fee schedule,$64.55 ,140,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$46.11 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$46.11 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$46.11 ,100,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$57.52 ,124.753,CMS physician fee schedule,,$46.11 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
Blood Glucose Monitoring POC,607617,CDM,300,RC,82962,HCPCS,outpatient,,,$30.00 ,$22.50 ,,$27.60 ,92,,,$1.44 ,$29.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.44 ,$29.10 ,other,,Not applicable. No negotiated rates per contract,$1.44 ,44,,,$1.44 ,$29.10 ,fee schedule,,44% of CMS Medicare lab fee schedule,$24.00 ,80,,,$1.44 ,$29.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,95,,,$1.44 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.50 ,95,,,$1.44 ,$29.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.50 ,75,,,$1.44 ,$29.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.50 ,85,,,$1.44 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.00 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.10 ,97,,,$1.44 ,$29.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.50 ,85,,,$1.44 ,$29.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.00 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.50 ,90,,,$1.44 ,$29.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.50 ,55,,,$1.44 ,$29.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.90 ,93,,,$1.44 ,$29.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hemoccult Stool POC,8528845,CDM,300,RC,82272,HCPCS,outpatient,,,$70.00 ,$52.50 ,,$64.40 ,92,,,$1.86 ,$67.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.50 ,55,,,$1.86 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$1.86 ,$67.90 ,other,,Not applicable. No negotiated rates per contract,$1.86 ,44,,,$1.86 ,$67.90 ,fee schedule,,44% of CMS Medicare lab fee schedule,$56.00 ,80,,,$1.86 ,$67.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.50 ,55,,,$1.86 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,95,,,$1.86 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.50 ,95,,,$1.86 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.50 ,75,,,$1.86 ,$67.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.50 ,85,,,$1.86 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.90 ,97,,,$1.86 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.50 ,55,,,$1.86 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.00 ,90,,,$1.86 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.90 ,97,,,$1.86 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$1.86 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$1.86 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.50 ,85,,,$1.86 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.00 ,90,,,$1.86 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$1.86 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,90,,,$1.86 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$1.86 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.10 ,93,,,$1.86 ,$67.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARS-CoV-2 (COVID-19) Antigen (Binax) POC (RE),9869860,CDM,306,RC,87811,HCPCS,outpatient,,,$37.00 ,$27.75 ,,$34.04 ,92,,,$20.35 ,$35.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,,,,,$20.35 ,$35.89 ,other,,Not seperately reimbursible per contract terms,$29.60 ,80,,,$20.35 ,$35.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.75 ,75,,,$20.35 ,$35.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.41 ,93,,,$20.35 ,$35.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urine Pregnancy Test POC,607621,CDM,300,RC,81025,HCPCS,outpatient,,,$47.00 ,$35.25 ,,$43.24 ,92,,,$3.79 ,$45.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.85 ,55,,,$3.79 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$3.79 ,$45.59 ,other,,Not applicable. No negotiated rates per contract,$3.79 ,44,,,$3.79 ,$45.59 ,fee schedule,,44% of CMS Medicare lab fee schedule,$37.60 ,80,,,$3.79 ,$45.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.85 ,55,,,$3.79 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,95,,,$3.79 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.65 ,95,,,$3.79 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,75,,,$3.79 ,$45.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.95 ,85,,,$3.79 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.59 ,97,,,$3.79 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.85 ,55,,,$3.79 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.30 ,90,,,$3.79 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.59 ,97,,,$3.79 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$3.79 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$3.79 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.95 ,85,,,$3.79 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.30 ,90,,,$3.79 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$3.79 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,90,,,$3.79 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$3.79 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.71 ,93,,,$3.79 ,$45.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Aquatic Therapy Charges,8111710,CDM,420,RC,97113,HCPCS,outpatient,,,$165.00 ,$123.75 ,,$151.80 ,92,,,$65.00 ,$160.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$160.05 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$141.90 ,86,,,$65.00 ,$160.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.00 ,80,,,$65.00 ,$160.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.75 ,75,,,$65.00 ,$160.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$160.05 ,case rate,,100% case rate for initial eval or therapy,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.50 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.45 ,93,,,$65.00 ,$160.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Attended E-Stim Charges,8111684,CDM,420,RC,97032,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.40 ,70,,,$28.60 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$44.72 ,86,,,$28.60 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.60 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Gait Training Charges,8111691,CDM,420,RC,97116,HCPCS,outpatient,,,$127.00 ,$95.25 ,,$116.84 ,92,,,$65.00 ,$123.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$123.19 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$109.22 ,86,,,$65.00 ,$123.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.60 ,80,,,$65.00 ,$123.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,95,,,$65.00 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.65 ,95,,,$65.00 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.25 ,75,,,$65.00 ,$123.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.95 ,85,,,$65.00 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$123.19 ,case rate,,100% case rate for initial eval or therapy,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.95 ,85,,,$65.00 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.30 ,90,,,$65.00 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,90,,,$65.00 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.11 ,93,,,$65.00 ,$123.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Infrared-Light Therapy Charge,8111743,CDM,420,RC,97026,HCPCS,outpatient,,,$51.00 ,$38.25 ,,$46.92 ,92,,,$28.05 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.70 ,70,,,$28.05 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$43.86 ,86,,,$28.05 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.80 ,80,,,$28.05 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,95,,,$28.05 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.45 ,95,,,$28.05 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.25 ,75,,,$28.05 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.05 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.90 ,90,,,$28.05 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,90,,,$28.05 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.43 ,93,,,$28.05 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Iontophoresis Charges,8111685,CDM,420,RC,97033,HCPCS,outpatient,,,$47.00 ,$35.25 ,,$43.24 ,92,,,$25.85 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.90 ,70,,,$25.85 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$40.42 ,86,,,$25.85 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.60 ,80,,,$25.85 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,95,,,$25.85 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.65 ,95,,,$25.85 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,75,,,$25.85 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.85 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$45.59 ,97,,,$25.85 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.30 ,90,,,$25.85 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,90,,,$25.85 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.71 ,93,,,$25.85 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Manual Therapy Charge Units,8111688,CDM,420,RC,97140,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$65.00 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$177.51 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$157.38 ,86,,,$65.00 ,$177.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$146.40 ,80,,,$65.00 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$65.00 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$177.51 ,case rate,,100% case rate for initial eval or therapy,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$65.00 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Mechanical Traction Charge,8111701,CDM,420,RC,97012,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$65.00 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$122.22 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$108.36 ,86,,,$65.00 ,$122.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.80 ,80,,,$65.00 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$65.00 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$65.00 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$65.00 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$65.00 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$122.22 ,case rate,,100% case rate for initial eval or therapy,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$65.00 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$65.00 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$65.00 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$65.00 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Neuromuscular Reeducation Charges,8111697,CDM,420,RC,97112,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$65.00 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$192.06 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$170.28 ,86,,,$65.00 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$65.00 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,95,,,$65.00 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.10 ,95,,,$65.00 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$65.00 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$65.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$192.06 ,case rate,,100% case rate for initial eval or therapy,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$65.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$65.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$65.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$65.00 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Non-Selective Debridement Charge,8111712,CDM,420,RC,97602,HCPCS,outpatient,,,$279.00 ,$209.25 ,,$256.68 ,92,,,$65.00 ,$270.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$270.63 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$239.94 ,86,,,$65.00 ,$270.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.20 ,80,,,$65.00 ,$270.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,95,,,$65.00 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$265.05 ,95,,,$65.00 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.25 ,75,,,$65.00 ,$270.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$237.15 ,85,,,$65.00 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$270.63 ,case rate,,100% case rate for initial eval or therapy,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.15 ,85,,,$65.00 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.10 ,90,,,$65.00 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,90,,,$65.00 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.47 ,93,,,$65.00 ,$270.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Aquatic Assistant Units,8720436,CDM,420,RC,97113,HCPCS,outpatient,,,$165.00 ,$123.75 ,,$151.80 ,92,,,$65.00 ,$160.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$160.05 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$141.90 ,86,,,$65.00 ,$160.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.00 ,80,,,$65.00 ,$160.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.75 ,95,,,$65.00 ,$160.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.75 ,75,,,$65.00 ,$160.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$160.05 ,case rate,,100% case rate for initial eval or therapy,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,97,,,$65.00 ,$160.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,85,,,$65.00 ,$160.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.50 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.75 ,90,,,$65.00 ,$160.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.75 ,55,,,$65.00 ,$160.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.45 ,93,,,$65.00 ,$160.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Attended E-Stim Assistant Units,8720422,CDM,420,RC,97032,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.40 ,70,,,$28.60 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$44.72 ,86,,,$28.60 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.60 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Canalith Repositioning Charge,8111752,CDM,420,RC,95992,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$161.00 ,92,,,$65.00 ,$169.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$169.75 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$150.50 ,86,,,$65.00 ,$169.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.00 ,80,,,$65.00 ,$169.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,95,,,$65.00 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.25 ,95,,,$65.00 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.25 ,75,,,$65.00 ,$169.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.75 ,85,,,$65.00 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$169.75 ,case rate,,100% case rate for initial eval or therapy,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.75 ,85,,,$65.00 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.50 ,90,,,$65.00 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,90,,,$65.00 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.75 ,93,,,$65.00 ,$169.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Canalith Repositioning Assist Units,8720420,CDM,420,RC,95992,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$161.00 ,92,,,$65.00 ,$169.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$169.75 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$150.50 ,86,,,$65.00 ,$169.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.00 ,80,,,$65.00 ,$169.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,95,,,$65.00 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.25 ,95,,,$65.00 ,$169.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.25 ,75,,,$65.00 ,$169.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.75 ,85,,,$65.00 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$169.75 ,case rate,,100% case rate for initial eval or therapy,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.75 ,97,,,$65.00 ,$169.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.75 ,85,,,$65.00 ,$169.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.50 ,90,,,$65.00 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.25 ,90,,,$65.00 ,$169.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.25 ,55,,,$65.00 ,$169.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.75 ,93,,,$65.00 ,$169.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Community,8720452,CDM,420,RC,97537,HCPCS,outpatient,,,$142.00 ,$106.50 ,,$130.64 ,92,,,$65.00 ,$137.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$137.74 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$122.12 ,86,,,$65.00 ,$137.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$113.60 ,80,,,$65.00 ,$137.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,95,,,$65.00 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.90 ,95,,,$65.00 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.50 ,75,,,$65.00 ,$137.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$120.70 ,85,,,$65.00 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$137.74 ,case rate,,100% case rate for initial eval or therapy,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.70 ,85,,,$65.00 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.80 ,90,,,$65.00 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,90,,,$65.00 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.06 ,93,,,$65.00 ,$137.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Community/Work Reintegration Charge,8111823,CDM,420,RC,97537,HCPCS,outpatient,,,$142.00 ,$106.50 ,,$130.64 ,92,,,$65.00 ,$137.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$137.74 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$122.12 ,86,,,$65.00 ,$137.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$113.60 ,80,,,$65.00 ,$137.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,95,,,$65.00 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.90 ,95,,,$65.00 ,$137.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.50 ,75,,,$65.00 ,$137.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$120.70 ,85,,,$65.00 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$137.74 ,case rate,,100% case rate for initial eval or therapy,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.74 ,97,,,$65.00 ,$137.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.70 ,85,,,$65.00 ,$137.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.80 ,90,,,$65.00 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.90 ,90,,,$65.00 ,$137.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.10 ,55,,,$65.00 ,$137.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.06 ,93,,,$65.00 ,$137.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Dry Needling Assistant Units,8736089,CDM,420,RC,97139,HCPCS,outpatient,,,$22.00 ,$16.50 ,,$20.24 ,92,,,$12.10 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.40 ,70,,,$12.10 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$18.92 ,86,,,$12.10 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.60 ,80,,,$12.10 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.90 ,95,,,$12.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.90 ,95,,,$12.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.50 ,75,,,$12.10 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.70 ,85,,,$12.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$12.10 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.70 ,85,,,$12.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.80 ,90,,,$12.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.90 ,90,,,$12.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.46 ,93,,,$12.10 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Dry Needling Units,8111678,CDM,420,RC,97139,HCPCS,outpatient,,,$22.00 ,$16.50 ,,$20.24 ,92,,,$12.10 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$15.40 ,70,,,$12.10 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$18.92 ,86,,,$12.10 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$17.60 ,80,,,$12.10 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.90 ,95,,,$12.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.90 ,95,,,$12.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$16.50 ,75,,,$12.10 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$18.70 ,85,,,$12.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$12.10 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.34 ,97,,,$12.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.70 ,85,,,$12.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$19.80 ,90,,,$12.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.90 ,90,,,$12.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$12.10 ,55,,,$12.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$20.46 ,93,,,$12.10 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Dry Needling,8740010,CDM,420,RC,20560,HCPCS,outpatient,,,,,,,,,,$65.00 ,$65.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$65.00 ,100,,,$65.00 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
PT Dry Needling,8740021,CDM,420,RC,20561,HCPCS,outpatient,,,,,,,,,,$65.00 ,$65.00 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,,Not seperately reimbursible per contract terms,,,,,$65.00 ,$65.00 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",$65.00 ,100,,,$65.00 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$65.00 ,$65.00 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$65.00 ,$65.00 ,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
PT Gait Training Assistant Units,8720438,CDM,420,RC,97116,HCPCS,outpatient,,,$127.00 ,$95.25 ,,$116.84 ,92,,,$65.00 ,$123.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$123.19 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$109.22 ,86,,,$65.00 ,$123.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.60 ,80,,,$65.00 ,$123.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,95,,,$65.00 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.65 ,95,,,$65.00 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.25 ,75,,,$65.00 ,$123.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.95 ,85,,,$65.00 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$123.19 ,case rate,,100% case rate for initial eval or therapy,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$65.00 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.95 ,85,,,$65.00 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.30 ,90,,,$65.00 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,90,,,$65.00 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$65.00 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.11 ,93,,,$65.00 ,$123.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT High Complex Units,8111852,CDM,424,RC,97163,HCPCS,outpatient,,,$257.00 ,$192.75 ,,$236.44 ,92,,,$65.00 ,$249.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.35 ,55,,,$65.00 ,$249.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$249.29 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$221.02 ,86,,,$65.00 ,$249.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$205.60 ,80,,,$65.00 ,$249.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.35 ,55,,,$65.00 ,$249.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.15 ,95,,,$65.00 ,$249.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$244.15 ,95,,,$65.00 ,$249.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.00 ,100,,,$65.00 ,$249.29 ,case rate,,100% case rate for initial eval,$218.45 ,85,,,$65.00 ,$249.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$249.29 ,97,,,$65.00 ,$249.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.35 ,55,,,$65.00 ,$249.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$249.29 ,case rate,,100% case rate for initial eval or therapy,$249.29 ,97,,,$65.00 ,$249.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.29 ,97,,,$65.00 ,$249.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.29 ,97,,,$65.00 ,$249.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.45 ,85,,,$65.00 ,$249.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$231.30 ,90,,,$65.00 ,$249.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.35 ,55,,,$65.00 ,$249.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.15 ,90,,,$65.00 ,$249.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.35 ,55,,,$65.00 ,$249.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.01 ,93,,,$65.00 ,$249.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Infrared-Light Assistant Units,8735291,CDM,420,RC,97026,HCPCS,outpatient,,,$51.00 ,$38.25 ,,$46.92 ,92,,,$28.05 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.70 ,70,,,$28.05 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$43.86 ,86,,,$28.05 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.80 ,80,,,$28.05 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,95,,,$28.05 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.45 ,95,,,$28.05 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.25 ,75,,,$28.05 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.05 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.47 ,97,,,$28.05 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.35 ,85,,,$28.05 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.90 ,90,,,$28.05 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.45 ,90,,,$28.05 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.05 ,55,,,$28.05 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.43 ,93,,,$28.05 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Iontophhoresis Assistant Units,8720424,CDM,420,RC,97033,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$31.90 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.60 ,70,,,$31.90 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$49.88 ,86,,,$31.90 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$31.90 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$31.90 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$31.90 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$31.90 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$31.90 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$31.90 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Low Complex Units,8111848,CDM,424,RC,97161,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$138.00 ,92,,,$65.00 ,$145.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$145.50 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$129.00 ,86,,,$65.00 ,$145.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.00 ,80,,,$65.00 ,$145.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.00 ,100,,,$65.00 ,$145.50 ,case rate,,100% case rate for initial eval,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$145.50 ,case rate,,100% case rate for initial eval or therapy,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.00 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.50 ,93,,,$65.00 ,$145.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Manual Therapy Assistant Units,8720442,CDM,420,RC,97140,HCPCS,outpatient,,,$183.00 ,$137.25 ,,$168.36 ,92,,,$65.00 ,$177.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$177.51 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$157.38 ,86,,,$65.00 ,$177.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$146.40 ,80,,,$65.00 ,$177.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.85 ,95,,,$65.00 ,$177.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.25 ,75,,,$65.00 ,$177.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$177.51 ,case rate,,100% case rate for initial eval or therapy,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.51 ,97,,,$65.00 ,$177.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.55 ,85,,,$65.00 ,$177.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.70 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.85 ,90,,,$65.00 ,$177.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.65 ,55,,,$65.00 ,$177.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.19 ,93,,,$65.00 ,$177.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Massage Assistant Units,8720440,CDM,420,RC,97124,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$33.55 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.70 ,70,,,$33.55 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$52.46 ,86,,,$33.55 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.80 ,80,,,$33.55 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$33.55 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$33.55 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$33.55 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Massage Charge Units,1042079,CDM,420,RC,97124,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$33.55 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.70 ,70,,,$33.55 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$52.46 ,86,,,$33.55 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.80 ,80,,,$33.55 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$33.55 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$33.55 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$33.55 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Mechanical Traction Assistant Units,8720392,CDM,420,RC,97012,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$115.92 ,92,,,$65.00 ,$122.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$122.22 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$108.36 ,86,,,$65.00 ,$122.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.80 ,80,,,$65.00 ,$122.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,95,,,$65.00 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.70 ,95,,,$65.00 ,$122.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.50 ,75,,,$65.00 ,$122.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.10 ,85,,,$65.00 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$122.22 ,case rate,,100% case rate for initial eval or therapy,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.22 ,97,,,$65.00 ,$122.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.10 ,85,,,$65.00 ,$122.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.40 ,90,,,$65.00 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.70 ,90,,,$65.00 ,$122.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.30 ,55,,,$65.00 ,$122.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.18 ,93,,,$65.00 ,$122.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Moderate Complex Units,8111850,CDM,424,RC,97162,HCPCS,outpatient,,,$206.00 ,$154.50 ,,$189.52 ,92,,,$65.00 ,$199.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$113.30 ,55,,,$65.00 ,$199.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$199.82 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$177.16 ,86,,,$65.00 ,$199.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$164.80 ,80,,,$65.00 ,$199.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$113.30 ,55,,,$65.00 ,$199.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.70 ,95,,,$65.00 ,$199.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.70 ,95,,,$65.00 ,$199.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.00 ,100,,,$65.00 ,$199.82 ,case rate,,100% case rate for initial eval,$175.10 ,85,,,$65.00 ,$199.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$199.82 ,97,,,$65.00 ,$199.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.30 ,55,,,$65.00 ,$199.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$199.82 ,case rate,,100% case rate for initial eval or therapy,$199.82 ,97,,,$65.00 ,$199.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.82 ,97,,,$65.00 ,$199.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.82 ,97,,,$65.00 ,$199.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.10 ,85,,,$65.00 ,$199.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$185.40 ,90,,,$65.00 ,$199.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.30 ,55,,,$65.00 ,$199.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.70 ,90,,,$65.00 ,$199.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.30 ,55,,,$65.00 ,$199.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.58 ,93,,,$65.00 ,$199.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Neuromuscular Reeducation Assist Unit,8720446,CDM,420,RC,97112,HCPCS,outpatient,,,$198.00 ,$148.50 ,,$182.16 ,92,,,$65.00 ,$192.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$192.06 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$170.28 ,86,,,$65.00 ,$192.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.40 ,80,,,$65.00 ,$192.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,95,,,$65.00 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$188.10 ,95,,,$65.00 ,$192.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.50 ,75,,,$65.00 ,$192.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.30 ,85,,,$65.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$192.06 ,case rate,,100% case rate for initial eval or therapy,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.06 ,97,,,$65.00 ,$192.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.30 ,85,,,$65.00 ,$192.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.20 ,90,,,$65.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.10 ,90,,,$65.00 ,$192.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.90 ,55,,,$65.00 ,$192.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.14 ,93,,,$65.00 ,$192.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT NonSelective Debride Assist Unit,8736298,CDM,420,RC,97602,HCPCS,outpatient,,,$279.00 ,$209.25 ,,$256.68 ,92,,,$65.00 ,$270.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$270.63 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$239.94 ,86,,,$65.00 ,$270.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.20 ,80,,,$65.00 ,$270.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,95,,,$65.00 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$265.05 ,95,,,$65.00 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.25 ,75,,,$65.00 ,$270.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$237.15 ,85,,,$65.00 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$270.63 ,case rate,,100% case rate for initial eval or therapy,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$65.00 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.15 ,85,,,$65.00 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.10 ,90,,,$65.00 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,90,,,$65.00 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$65.00 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.47 ,93,,,$65.00 ,$270.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Phonophoresis Assitant Units,8735300,CDM,420,RC,97035,HCPCS,outpatient,,,$45.00 ,$33.75 ,,$41.40 ,92,,,$24.75 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,70,,,$24.75 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$38.70 ,86,,,$24.75 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.00 ,80,,,$24.75 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,75,,,$24.75 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$24.75 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.85 ,93,,,$24.75 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT ReEval Units,8111855,CDM,420,RC,97164,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$223.56 ,92,,,$65.00 ,$235.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$133.65 ,55,,,$65.00 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$235.71 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$208.98 ,86,,,$65.00 ,$235.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$194.40 ,80,,,$65.00 ,$235.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$133.65 ,55,,,$65.00 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,95,,,$65.00 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$230.85 ,95,,,$65.00 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.25 ,75,,,$65.00 ,$235.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$206.55 ,85,,,$65.00 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.71 ,97,,,$65.00 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.65 ,55,,,$65.00 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$235.71 ,case rate,,100% case rate for initial eval or therapy,$235.71 ,97,,,$65.00 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$65.00 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$65.00 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.55 ,85,,,$65.00 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.70 ,90,,,$65.00 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$65.00 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,90,,,$65.00 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$65.00 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.99 ,93,,,$65.00 ,$235.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Selective Debridement Assistant Units,8736289,CDM,420,RC,97597,HCPCS,outpatient,,,$392.00 ,$294.00 ,,$360.64 ,92,,,$65.00 ,$380.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$380.24 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$337.12 ,86,,,$65.00 ,$380.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$313.60 ,80,,,$65.00 ,$380.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.40 ,95,,,$65.00 ,$380.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.40 ,95,,,$65.00 ,$380.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$294.00 ,75,,,$65.00 ,$380.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$333.20 ,85,,,$65.00 ,$380.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$380.24 ,case rate,,100% case rate for initial eval or therapy,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$333.20 ,85,,,$65.00 ,$380.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$352.80 ,90,,,$65.00 ,$380.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.40 ,90,,,$65.00 ,$380.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.56 ,93,,,$65.00 ,$380.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Selective Debridement Add Assist Unit,8736296,CDM,420,RC,97598,HCPCS,outpatient,,,$42.00 ,$31.50 ,,$38.64 ,92,,,$23.10 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.40 ,70,,,$23.10 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$36.12 ,86,,,$23.10 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.60 ,80,,,$23.10 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,95,,,$23.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.90 ,95,,,$23.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.50 ,75,,,$23.10 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.70 ,85,,,$23.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$23.10 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.70 ,85,,,$23.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.80 ,90,,,$23.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,90,,,$23.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.06 ,93,,,$23.10 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Sensory Integration Assistant Units,8720448,CDM,420,RC,97533,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$55.00 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$55.00 ,$97.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$86.00 ,86,,,$55.00 ,$97.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.00 ,80,,,$55.00 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$55.00 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$55.00 ,$97.00 ,case rate,,100% case rate for initial eval or therapy,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$55.00 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Sensory Integration Charges,8111757,CDM,420,RC,97533,HCPCS,outpatient,,,$100.00 ,$75.00 ,,$92.00 ,92,,,$55.00 ,$97.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$55.00 ,$97.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$86.00 ,86,,,$55.00 ,$97.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.00 ,80,,,$55.00 ,$97.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.00 ,95,,,$55.00 ,$97.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.00 ,75,,,$55.00 ,$97.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$55.00 ,$97.00 ,case rate,,100% case rate for initial eval or therapy,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.00 ,97,,,$55.00 ,$97.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.00 ,85,,,$55.00 ,$97.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.00 ,90,,,$55.00 ,$97.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.00 ,55,,,$55.00 ,$97.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.00 ,93,,,$55.00 ,$97.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Therapeutic Activity Assistant Units,8720444,CDM,420,RC,97530,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$119.31 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Therapeutic Exercise Assit Units,8735279,CDM,420,RC,97110,HCPCS,outpatient,,,$86.00 ,$64.50 ,,$79.12 ,92,,,$47.30 ,$83.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.30 ,55,,,$47.30 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.20 ,70,,,$47.30 ,$83.42 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$73.96 ,86,,,$47.30 ,$83.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.80 ,80,,,$47.30 ,$83.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.30 ,55,,,$47.30 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,95,,,$47.30 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.70 ,95,,,$47.30 ,$83.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.50 ,75,,,$47.30 ,$83.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.10 ,85,,,$47.30 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.42 ,97,,,$47.30 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.30 ,55,,,$47.30 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$47.30 ,$83.42 ,case rate,,100% case rate for initial eval or therapy,$83.42 ,97,,,$47.30 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$47.30 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.42 ,97,,,$47.30 ,$83.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.10 ,85,,,$47.30 ,$83.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.40 ,90,,,$47.30 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$47.30 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.70 ,90,,,$47.30 ,$83.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.30 ,55,,,$47.30 ,$83.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.98 ,93,,,$47.30 ,$83.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Ultrasound Assistant Units,8720430,CDM,420,RC,97035,HCPCS,outpatient,,,$46.00 ,$34.50 ,,$42.32 ,92,,,$25.30 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.20 ,70,,,$25.30 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$39.56 ,86,,,$25.30 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.80 ,80,,,$25.30 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.70 ,95,,,$25.30 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.50 ,75,,,$25.30 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$25.30 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.62 ,97,,,$25.30 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.10 ,85,,,$25.30 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.40 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.70 ,90,,,$25.30 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.30 ,55,,,$25.30 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.78 ,93,,,$25.30 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Ultraviolet Assistant Units,8735297,CDM,420,RC,97028,HCPCS,outpatient,,,$35.00 ,$26.25 ,,$32.20 ,92,,,$19.25 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.50 ,70,,,$19.25 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$30.10 ,86,,,$19.25 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.00 ,80,,,$19.25 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,95,,,$19.25 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.25 ,95,,,$19.25 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.25 ,75,,,$19.25 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$19.25 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.50 ,90,,,$19.25 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,90,,,$19.25 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.55 ,93,,,$19.25 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Unattended E-Stim Assistant Units,8720394,CDM,420,RC,97014,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.40 ,70,,,$28.60 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$44.72 ,86,,,$28.60 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.60 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Wheelchair Management Charges,1042083,CDM,420,RC,97542,HCPCS,outpatient,,,$104.00 ,$78.00 ,,$95.68 ,92,,,$57.20 ,$100.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$57.20 ,$100.88 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$89.44 ,86,,,$57.20 ,$100.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.20 ,80,,,$57.20 ,$100.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.00 ,75,,,$57.20 ,$100.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$57.20 ,$100.88 ,case rate,,100% case rate for initial eval or therapy,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.60 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.72 ,93,,,$57.20 ,$100.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Wheelchair management Assistant Units,8720454,CDM,420,RC,97542,HCPCS,outpatient,,,$104.00 ,$78.00 ,,$95.68 ,92,,,$57.20 ,$100.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$57.20 ,$100.88 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$89.44 ,86,,,$57.20 ,$100.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.20 ,80,,,$57.20 ,$100.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.00 ,75,,,$57.20 ,$100.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$57.20 ,$100.88 ,case rate,,100% case rate for initial eval or therapy,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.60 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.72 ,93,,,$57.20 ,$100.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PT Whirlpool,8720400,CDM,420,RC,97022,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$138.00 ,92,,,$65.00 ,$145.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$145.50 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$129.00 ,86,,,$65.00 ,$145.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.00 ,80,,,$65.00 ,$145.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.50 ,75,,,$65.00 ,$145.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$145.50 ,case rate,,100% case rate for initial eval or therapy,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.00 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.50 ,93,,,$65.00 ,$145.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Phonophoresis Charge,8111736,CDM,420,RC,97035,HCPCS,outpatient,,,$45.00 ,$33.75 ,,$41.40 ,92,,,$24.75 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,70,,,$24.75 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$38.70 ,86,,,$24.75 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.00 ,80,,,$24.75 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,75,,,$24.75 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$24.75 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.85 ,93,,,$24.75 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Selective Debridement Addition Charge,8111738,CDM,420,RC,97598,HCPCS,outpatient,,,$42.00 ,$31.50 ,,$38.64 ,92,,,$23.10 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.40 ,70,,,$23.10 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$36.12 ,86,,,$23.10 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.60 ,80,,,$23.10 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,95,,,$23.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.90 ,95,,,$23.10 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.50 ,75,,,$23.10 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.70 ,85,,,$23.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$23.10 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.74 ,97,,,$23.10 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.70 ,85,,,$23.10 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.80 ,90,,,$23.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,90,,,$23.10 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.10 ,55,,,$23.10 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.06 ,93,,,$23.10 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Selective Debridement Charge,8111711,CDM,420,RC,97597,HCPCS,outpatient,,,$392.00 ,$294.00 ,,$360.64 ,92,,,$65.00 ,$380.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$380.24 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$337.12 ,86,,,$65.00 ,$380.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$313.60 ,80,,,$65.00 ,$380.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.40 ,95,,,$65.00 ,$380.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.40 ,95,,,$65.00 ,$380.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$294.00 ,75,,,$65.00 ,$380.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$333.20 ,85,,,$65.00 ,$380.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$380.24 ,case rate,,100% case rate for initial eval or therapy,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$380.24 ,97,,,$65.00 ,$380.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$333.20 ,85,,,$65.00 ,$380.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$352.80 ,90,,,$65.00 ,$380.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.40 ,90,,,$65.00 ,$380.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$215.60 ,55,,,$65.00 ,$380.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.56 ,93,,,$65.00 ,$380.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Therapeutic Activities Charge,8111693,CDM,420,RC,97530,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$113.16 ,92,,,$65.00 ,$119.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$119.31 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$105.78 ,86,,,$65.00 ,$119.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.40 ,80,,,$65.00 ,$119.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.85 ,95,,,$65.00 ,$119.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,75,,,$65.00 ,$119.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$119.31 ,case rate,,100% case rate for initial eval or therapy,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.31 ,97,,,$65.00 ,$119.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.55 ,85,,,$65.00 ,$119.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.70 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.85 ,90,,,$65.00 ,$119.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.65 ,55,,,$65.00 ,$119.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,93,,,$65.00 ,$119.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Therapeutic Exercise Charges,8111702,CDM,420,RC,97110,HCPCS,outpatient,,,$89.00 ,$66.75 ,,$81.88 ,92,,,$48.95 ,$86.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.30 ,70,,,$48.95 ,$86.33 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$76.54 ,86,,,$48.95 ,$86.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.20 ,80,,,$48.95 ,$86.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.55 ,95,,,$48.95 ,$86.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.75 ,75,,,$48.95 ,$86.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$48.95 ,$86.33 ,case rate,,100% case rate for initial eval or therapy,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.33 ,97,,,$48.95 ,$86.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.65 ,85,,,$48.95 ,$86.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.10 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.55 ,90,,,$48.95 ,$86.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.95 ,55,,,$48.95 ,$86.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.77 ,93,,,$48.95 ,$86.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ultrasound Charges,8111698,CDM,420,RC,97035,HCPCS,outpatient,,,$45.00 ,$33.75 ,,$41.40 ,92,,,$24.75 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,70,,,$24.75 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$38.70 ,86,,,$24.75 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.00 ,80,,,$24.75 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.75 ,95,,,$24.75 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,75,,,$24.75 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$24.75 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.65 ,97,,,$24.75 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.25 ,85,,,$24.75 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.75 ,90,,,$24.75 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.75 ,55,,,$24.75 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.85 ,93,,,$24.75 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Ultraviolet charge,8111747,CDM,420,RC,97028,HCPCS,outpatient,,,$35.00 ,$26.25 ,,$32.20 ,92,,,$19.25 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.50 ,70,,,$19.25 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$30.10 ,86,,,$19.25 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.00 ,80,,,$19.25 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,95,,,$19.25 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.25 ,95,,,$19.25 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.25 ,75,,,$19.25 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$19.25 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.95 ,97,,,$19.25 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.75 ,85,,,$19.25 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.50 ,90,,,$19.25 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.25 ,90,,,$19.25 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.25 ,55,,,$19.25 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.55 ,93,,,$19.25 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Unattended Electrical Therapy Charge,1366412,CDM,420,RC,97014,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.40 ,70,,,$28.60 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$44.72 ,86,,,$28.60 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$28.60 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Whirlpool Full Body Charge,8111729,CDM,420,RC,97022,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$138.00 ,92,,,$65.00 ,$145.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$65.00 ,$145.50 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$129.00 ,86,,,$65.00 ,$145.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.00 ,80,,,$65.00 ,$145.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.50 ,95,,,$65.00 ,$145.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.50 ,75,,,$65.00 ,$145.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$65.00 ,$145.50 ,case rate,,100% case rate for initial eval or therapy,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.50 ,97,,,$65.00 ,$145.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.50 ,85,,,$65.00 ,$145.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.00 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.50 ,90,,,$65.00 ,$145.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.50 ,55,,,$65.00 ,$145.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.50 ,93,,,$65.00 ,$145.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ROOM/BED: IP - Telemetry,8528543,CDM,120,RC,,HCPCS,inpatient,,,"$3,164.00 ","$2,373.00 ",,"$2,910.88 ",92,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,92% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,373.00 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,,,,,"$2,373.00 ","$4,831.00 ",other,,Not separately reimbursable per contract terms for inpatient setting,"$2,721.04 ",86,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,86% of total billed charges for inpatient setting,"$2,531.20 ",80,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,80% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,373.00 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$3,005.80 ",95,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$3,005.80 ",95,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$2,373.00 ",75,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,75% of total billed charges for inpatient setting,"$2,689.40 ",85,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$3,069.08 ",97,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,373.00 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,847.60 ",90,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$3,069.08 ",97,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$3,069.08 ",97,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$3,069.08 ",97,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,689.40 ",85,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,847.60 ",90,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,373.00 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$3,005.80 ",95,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,373.00 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,942.52 ",93,,,"$2,373.00 ","$4,831.00 ",percent of total billed charges,,93% of total billed charges for inpatient setting
ROOM/BED: Inpatient,8404421,CDM,120,RC,,HCPCS,inpatient,,,"$3,035.00 ","$2,276.25 ",,"$2,792.20 ",92,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,92% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,276.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,,,,,"$2,276.25 ","$4,831.00 ",other,,Not separately reimbursable per contract terms for inpatient setting,"$2,610.10 ",86,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,86% of total billed charges for inpatient setting,"$2,428.00 ",80,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,80% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,276.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,883.25 ",95,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$2,883.25 ",95,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$2,276.25 ",75,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,75% of total billed charges for inpatient setting,"$2,579.75 ",85,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,943.95 ",97,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,276.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,731.50 ",90,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$2,943.95 ",97,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,943.95 ",97,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,943.95 ",97,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,579.75 ",85,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,731.50 ",90,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,276.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,883.25 ",95,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$2,276.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,822.55 ",93,,,"$2,276.25 ","$4,831.00 ",percent of total billed charges,,93% of total billed charges for inpatient setting
ROOM/BED: Newborn,8163847,CDM,170,RC,,HCPCS,inpatient,,,"$2,094.00 ","$1,570.50 ",,"$1,926.48 ",92,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,92% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,570.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,,,,,"$1,570.50 ","$4,831.00 ",other,,Not separately reimbursable per contract terms for inpatient setting,"$1,800.84 ",86,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,86% of total billed charges for inpatient setting,"$1,675.20 ",80,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,80% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,570.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$1,989.30 ",95,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$1,989.30 ",95,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$1,570.50 ",75,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,75% of total billed charges for inpatient setting,"$1,779.90 ",85,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,031.18 ",97,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,570.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$1,884.60 ",90,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$2,031.18 ",97,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,031.18 ",97,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,031.18 ",97,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$1,779.90 ",85,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$1,884.60 ",90,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,570.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$1,989.30 ",95,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,570.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$1,947.42 ",93,,,"$1,570.50 ","$4,831.00 ",percent of total billed charges,,93% of total billed charges for inpatient setting
ROOM/BED: OB,8163849,CDM,120,RC,,HCPCS,inpatient,,,"$2,663.00 ","$1,997.25 ",,"$2,449.96 ",92,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,92% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,997.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,,,,,"$1,997.25 ","$4,831.00 ",other,,Not separately reimbursable per contract terms for inpatient setting,"$2,290.18 ",86,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,86% of total billed charges for inpatient setting,"$2,130.40 ",80,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,80% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,997.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,529.85 ",95,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$2,529.85 ",95,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$1,997.25 ",75,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,75% of total billed charges for inpatient setting,"$2,263.55 ",85,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,583.11 ",97,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,997.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,396.70 ",90,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$2,583.11 ",97,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,583.11 ",97,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,583.11 ",97,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,263.55 ",85,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,396.70 ",90,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,997.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,529.85 ",95,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,997.25 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,476.59 ",93,,,"$1,997.25 ","$4,831.00 ",percent of total billed charges,,93% of total billed charges for inpatient setting
ROOM/BED: Observation,2120846,CDM,762,RC,G0378,HCPCS,outpatient,,,$127.00 ,$95.25 ,,$116.84 ,92,carve out,,$69.85 ,$123.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.85 ,55,,,$69.85 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.85 ,$123.19 ,other,,Not applicable. No negotiated rates per contract,$109.22 ,86,,,$69.85 ,$123.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.60 ,80,,,$69.85 ,$123.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.85 ,55,,,$69.85 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,95,,,$69.85 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.65 ,95,,,$69.85 ,$123.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.25 ,75,,,$69.85 ,$123.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.95 ,85,,,$69.85 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.19 ,97,,,$69.85 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.85 ,55,,,$69.85 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.30 ,90,,,$69.85 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.19 ,97,,,$69.85 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$69.85 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,97,,,$69.85 ,$123.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.95 ,85,,,$69.85 ,$123.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.30 ,90,,,$69.85 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$69.85 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.65 ,90,,,$69.85 ,$123.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.85 ,55,,,$69.85 ,$123.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.11 ,93,,,$69.85 ,$123.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ROOM/BED: Observation Telemetry,8952591,CDM,762,RC,G0378,HCPCS,outpatient,,,$136.00 ,$102.00 ,,$125.12 ,92,carve out,,$74.80 ,$131.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.80 ,55,,,$74.80 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$74.80 ,$131.92 ,other,,Not applicable. No negotiated rates per contract,$116.96 ,86,,,$74.80 ,$131.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$108.80 ,80,,,$74.80 ,$131.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.80 ,55,,,$74.80 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,95,,,$74.80 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$129.20 ,95,,,$74.80 ,$131.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.00 ,75,,,$74.80 ,$131.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$115.60 ,85,,,$74.80 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.92 ,97,,,$74.80 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.80 ,55,,,$74.80 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.40 ,90,,,$74.80 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.92 ,97,,,$74.80 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$74.80 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.92 ,97,,,$74.80 ,$131.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.60 ,85,,,$74.80 ,$131.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.40 ,90,,,$74.80 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$74.80 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.20 ,90,,,$74.80 ,$131.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.80 ,55,,,$74.80 ,$131.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.48 ,93,,,$74.80 ,$131.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ROOM/BED: Swingbed,8078891,CDM,120,RC,,HCPCS,inpatient,,,"$2,286.00 ","$1,714.50 ",,"$2,103.12 ",92,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,92% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,714.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,,,,,"$1,714.50 ","$4,831.00 ",other,,Not separately reimbursable per contract terms for inpatient setting,"$1,965.96 ",86,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,86% of total billed charges for inpatient setting,"$1,828.80 ",80,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,80% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,714.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,171.70 ",95,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$2,171.70 ",95,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$1,714.50 ",75,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,75% of total billed charges for inpatient setting,"$1,943.10 ",85,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,217.42 ",97,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,714.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,057.40 ",90,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$2,217.42 ",97,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,217.42 ",97,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$2,217.42 ",97,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,97% of total billed charges for inpatient setting,"$1,943.10 ",85,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,85% of total billed charges for inpatient setting,"$2,057.40 ",90,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,90% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,714.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,171.70 ",95,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,95% of total billed charges for inpatient setting,"$4,831.00 ",100,,,"$1,714.50 ","$4,831.00 ",per diem,per day rate,100% of CMS Medicare inpatient per diem rate,"$2,125.98 ",93,,,"$1,714.50 ","$4,831.00 ",percent of total billed charges,,93% of total billed charges for inpatient setting
00002-7510-01 - Insulin lispro 1 units inj [YUMA],9121722,CDM,637,RC,J1815,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7510-17 - Insulin lispro 1 units inj [YUMA],8618663,CDM,250,RC,J1815,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7589-01 - bebtelovimab 175 mg/2 mL inj=2ml [YUMA],10143373,CDM,250,RC,Q0222,HCPCS,outpatient,175,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7623-01 - pemetrexed inj 500mg vial (CHEMO) [YUMA],8776413,CDM,250,RC,J9305,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7640-01 - pemetrexed 100mg PWVL CHEMO [YUMA],8618814,CDM,250,RC,J9305,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7669-01 - ramucirumab inj 10 mg/mL inj=10ml CHEMO [YUMA],10777632,CDM,250,RC,J9308,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7678-01 - ramucirumab inj 10 mg/mL inj=50ml CHEMO [YUMA],10787212,CDM,250,RC,J9308,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7910-01 - bamlanivimab 700 mg/20 mL soln [YUMA],9276985,CDM,250,RC,,HCPCS,outpatient,700,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-7950-01 - etesevimab 700 mg/20 mL soln [YUMA],9391510,CDM,250,RC,,HCPCS,outpatient,700,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00002-8215-17 - Insulin REGULAR 1 units inj [YUMA],8618664,CDM,636,RC,J1815,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-0293-20 - triamcinolone acetonide 40mg/1ml  inj=5ml [YUMA],8848049,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-0893-21 - apixaban 2.5mg tablet [YUMA],8618401,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-2187-13 - abatacept 250 mg powder-inj [YUMA],10072476,CDM,250,RC,J0129,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-2327-11 - ipilimumab 5mg/ml  inj=10ml CHEMO [YUMA],8618665,CDM,250,RC,J9228,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-2328-22 - ipilimumab 5mg/ml  inj=40ml CHEMO [YUMA],8618666,CDM,250,RC,J9228,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-3734-13 - nivolumab 10mg/ml  inj=24ml CHEMO [YUMA],8618780,CDM,250,RC,J9299,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-3772-11 - nivolumab 10mg/ml  inj=4ml CHEMO [YUMA],8618779,CDM,250,RC,J9299,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00003-3774-12 - nivolumab 10mg/ml  inj=10ml CHEMO [YUMA],8618781,CDM,250,RC,J9299,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00004-0800-85 - oseltamivir 75mg capsule [YUMA],8742983,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00004-0801-85 - oseltamivir 45mg capsule [YUMA],8742995,CDM,250,RC,,HCPCS,outpatient,45,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00004-0822-05 - oseltamivir phosphate 6mg/ml  60ml suspension [YUMA],8742984,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00005-1971-02 - pneumococcal 13 conjugate 0.5ml  inj=0.5ml [YUMA],8618826,CDM,250,RC,90670,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00005-1971-05 - pneumococcal 13 conjugate 0.5ml  inj=0.5ml [YUMA],10228093,CDM,250,RC,90670,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00005-2000-10 - pneumococcal 20-valent conjugate vaccine [YUMA],10059398,CDM,250,RC,90677,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-0277-31 - sitaGLIPtin 100mg tablet [YUMA],8618876,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-3026-04 - pembrolizumab 25 mg/mL Sol [YUMA],9903712,CDM,636,RC,J9271,HCPCS,both,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-3061-00 - fosaprepitant 150mg PWVL CHEMO [YUMA],8618603,CDM,250,RC,J1453,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-3061-04 - fosaprepitant 150mg PWVL CHEMO [YUMA],8998168,CDM,250,RC,J1453,HCPCS,outpatient,1500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4047-41 - rotavirus vaccine pentavalent Sus [YUMA],8844696,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4095-02 - hepatitis A pediatric vaccine 25 units/0.5 mL [YUMA],8849163,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4119-03 - human papillomavirus vaccine HPV9 0.5ml [YUMA],8849166,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4121-02 - human papillomavirus vaccine HPV9 0.5ml [YUMA],8810023,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4171-00 - measles/mumps/rubella/varicella virus vaccine - inj=0.5ml [YUMA],8805585,CDM,250,RC,90710,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4681-00 - measles mumps rubella vaccine 0.5ml  inj=0.5ml [YUMA],8618724,CDM,250,RC,90707,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4827-00 - varicella virus vaccine  inj=0.5ml,8850217,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4831-41 - hepatitis A pediatric vaccine 25 units/0.5 mL [YUMA],8849164,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4837-03 - pneumococcal 23-polyvalent vaccine [YUMA],8705882,CDM,250,RC,90732,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4943-00 - pneumococcal 23-polyvalent vaccine [YUMA],8764457,CDM,250,RC,90732,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-4963-41 - zoster vaccine live  inj=0.65ml,8850222,CDM,250,RC,,HCPCS,outpatient,0.65,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00006-5423-12 - sugammadex 100 mg/mL Sol [YUMA],8631550,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-0016-12 - hydrocortisone sodium 500mg/4ml  inj=4ml [YUMA],8618645,CDM,250,RC,J1720,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-0039-32 - methylPREDNISolone SUCCINATE 40mg/ml  inj=1ml [YUMA],8618740,CDM,250,RC,J2920,HCPCS,outpatient,40,mg,$43.31 ,$32.48 ,,$39.85 ,92,,,$23.82 ,$42.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.82 ,55,,,$23.82 ,$42.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.82 ,$42.01 ,other,,Not applicable. No negotiated rates per contract,$37.25 ,86,,,$23.82 ,$42.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.65 ,80,,,$23.82 ,$42.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.82 ,55,,,$23.82 ,$42.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.14 ,95,,,$23.82 ,$42.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.14 ,95,,,$23.82 ,$42.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.48 ,75,,,$23.82 ,$42.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.81 ,85,,,$23.82 ,$42.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.01 ,97,,,$23.82 ,$42.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.82 ,55,,,$23.82 ,$42.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.98 ,90,,,$23.82 ,$42.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.01 ,97,,,$23.82 ,$42.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.01 ,97,,,$23.82 ,$42.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.01 ,97,,,$23.82 ,$42.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.81 ,85,,,$23.82 ,$42.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.98 ,90,,,$23.82 ,$42.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.82 ,55,,,$23.82 ,$42.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.14 ,90,,,$23.82 ,$42.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.82 ,55,,,$23.82 ,$42.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.28 ,93,,,$23.82 ,$42.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
00009-0047-26 - methylPREDNISolone SUCCINATE PF 125 mg/2ml  inj=2ml [YUMA],8803266,CDM,250,RC,J2930,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-0698-01 - methylPREDNISolone SUCCINATE 1000mg/16ml inj [YUMA],8764691,CDM,250,RC,J2930,HCPCS,outpatient,1000,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-0775-26 - clindamycin 600mg/4ml  inj=4ml [YUMA],8618494,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-0825-01 - hydrocortisone sodium 100mg/2ml  inj=2ml [YUMA],8618646,CDM,250,RC,J1720,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-3073-22 - methylPREDNISolone ACETATE 40mg/ml  inj=1ml [YUMA],8618738,CDM,250,RC,J1030,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-3475-22 - methylPREDNISolone ACETATE 80mg/ml  inj=1ml [YUMA],8618739,CDM,250,RC,J1040,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-4992-02 - linezolid 600mg/300ml IVPB [YUMA],8618707,CDM,250,RC,J2020,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-7529-03 - irinotecan hcl 20mg/ml  inj=5ml CHEMO [YUMA],8618668,CDM,250,RC,J9206,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00009-7529-04 - irinotecan hcl 20mg/ml  inj=2ml CHEMO [YUMA],8618669,CDM,250,RC,J9206,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00023-1145-01 - onabotulinumtoxina 100U powder vial [YUMA],8618792,CDM,250,RC,J0585,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00023-5858-01 - levonorgestrel 52 mg IUD device [YUMA],9201212,CDM,250,RC,J7298,HCPCS,outpatient,52,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00023-6082-10 - iron DEXTRAN complex 100mg/2ml  inj=2ml [YUMA],8618670,CDM,250,RC,J1750,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00024-5914-01 - dupilumab 300 mg/2 mL inj=2ml [YUMA],9089449,CDM,250,RC,,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00046-0749-05 - conjugated estrogens 25mg inj [YUMA],8618501,CDM,250,RC,J1410,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00049-0530-22 - penicillin G potassium 20000000 units inj [YUMA],8618816,CDM,250,RC,J2540,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-0010-21 - flecainide acetate 50mg tablet [YUMA],8618589,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-0018-20 - prednisone 20mg tablet [YUMA],8618840,CDM,250,RC,J7512,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-0327-56 - fluticasone/salmeterol INHALER 250-50mcg [YUMA],10662278,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-0517-44 - morphine sulfate solution 20mg/ml  30ml solution [YUMA],8618761,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-0544-18 - telmisartan 80mg tablet [YUMA],8764472,CDM,250,RC,,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-3176-44 - DEXAmethasone INTENSOL-ORAL 15mg/15ml solution [YUMA],8618517,CDM,250,RC,J8540,HCPCS,outpatient,15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-3532-44 - LORazepam Intensol 2mg/ml Elixir  30ml [YUMA],8618715,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-8179-25 - dexamethasone 0.5mg tablet [YUMA],8618516,CDM,250,RC,J8540,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-8297-25 - furosemide 20mg tablet [YUMA],9768533,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00054-8724-25 - prednisone 5mg tablet [YUMA],8618841,CDM,250,RC,J7512,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00056-0169-70 - warfarin 1mg tablet [YUMA],8918055,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00056-0169-75 - warfarin 1mg tablet [YUMA],8618936,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00056-0172-75 - warfarin 5mg tablet [YUMA],8618937,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00065-0741-14 - tetracaine OPTHALMIC 0.5%  4ml solution [YUMA],8618907,CDM,250,RC,,HCPCS,outpatient,4,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00065-0795-15 - balanced salt solution 15ml unit dose [YUMA],8618796,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00065-1795-04 - Balanced Salt Solution Ophth Irrigation 500ml [YUMA],8960990,CDM,250,RC,,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00065-8531-10 - ciproflox/hydroCORTISONE OTIC 10ml suspension [YUMA],8618488,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-0058-01 - heparin 1,8618637,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-0238-01 - riTUXimab pvvr 100mg/10ml soln [YUMA],9956095,CDM,636,RC,Q5119,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-0249-01 - riTUXimab pvvr 500mg/50ml soln [YUMA],9956096,CDM,636,RC,Q5119,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-0809-01 - inFLIXimab dyyb 100 mg pwdr [YUMA],9752288,CDM,636,RC,Q5103,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-3030-20 - DOXOrubicin 2mg/ml  inj=5ml CHEMO [YUMA],9352037,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-3032-20 - DOXOrubicin 2 mg/mL inj=25ml CHEMO [YUMA],9251857,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-5471-02 - fosphenytoin 50mg/ml  inj=2ml [YUMA],8618605,CDM,250,RC,Q2009,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-5474-02 - fosphenytoin 50mg/ml  inj=10ml [YUMA],8618606,CDM,250,RC,Q2009,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-6001-21 - fosphenytoin 50mg/ml  inj=10ml [YUMA],9007836,CDM,250,RC,Q2009,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00069-6001-25 - fosphenytoin 50mg/ml  inj=2ml [YUMA],9908994,CDM,636,RC,Q2009,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00071-1013-41 - pregabalin 50mg capsule [YUMA],8618842,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00071-1014-41 - pregabalin 75mg capsule [YUMA],8618843,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-2282-03 - leuprolide 11.25 mg/month Kit CHEMO [YUMA],10496808,CDM,250,RC,J1950,HCPCS,outpatient,11.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-3346-03 - leuprolide 22.5 mg/3 months Kit CHEMO  [YUMA],9606271,CDM,636,RC,J9217,HCPCS,both,22.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-3473-03 - leuprolide 45 mg/6 months Kit CHEMO [YUMA],11104531,CDM,250,RC,J9217,HCPCS,outpatient,45,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-3642-03 - leuprolide acetate 7.5mg kit CHEMO [YUMA],8618683,CDM,250,RC,J9217,HCPCS,outpatient,7.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-3799-02 - adalimumab 40mg  inj=0.8ml [YUMA],8618368,CDM,250,RC,J0135,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-4378-05 - cisatracurium 2 mg/mL Sol [YUMA],8631537,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00074-4456-51 - sevoflurane 100% Liq [YUMA],8631535,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00078-0674-61 - topotecan 4mg PWVL CHEMO [YUMA],8618913,CDM,250,RC,J9351,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00085-4320-01 - BETAmethasone 6mg/ml   inj=5ml [YUMA],9681708,CDM,636,RC,J0702,HCPCS,both,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00088-2220-33 - Insulin glargine 1 units inj [YUMA],8618662,CDM,250,RC,J1815,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00088-5021-01 - Insulin glargine 1 units inj [YUMA],8764453,CDM,250,RC,J1815,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-0018-06 - tolterodine tartrate 2mg tablet [YUMA],8618911,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-0053-01 - busPIRone 5mg tablet [YUMA],8746783,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-0319-01 - diltiazem 60mg capsule [YUMA],8746762,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-2275-34 - amoxicillin/pot clavulanate 875-125mg tablet [YUMA],8746807,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-3174-31 - albuterol 90mcg inhaler [YUMA],9084323,CDM,250,RC,,HCPCS,outpatient,90,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-4161-73 - amoxicillin 400mg/5ml suspension  100ml bottle [YUMA],8618394,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-4177-73 - cephalexin 250mg/5ml suspension  100ml [YUMA],8618477,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-5986-27 - epinephrine injector-ADULT   inj=0.3mg [YUMA],8764725,CDM,250,RC,J0171,HCPCS,outpatient,0.3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-6816-73 - budesonide 0.5mg/2ml unit dose [YUMA],8618439,CDM,636,RC,J7633,HCPCS,both,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00093-9702-01 - carbidopa/levodopa 25-100mg tablet [YUMA],10845287,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00115-1468-60 - lidocaine & prilocaine cream 5gm [YUMA],9230323,CDM,250,RC,,HCPCS,outpatient,5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00115-1694-49 - epinephrine injector-ADULT   inj=0.3mg [YUMA],10913322,CDM,250,RC,J0171,HCPCS,outpatient,0.3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0431-30 - magnesium hydroxide 2400mg/30ml suspension [YUMA],8618719,CDM,250,RC,,HCPCS,outpatient,2400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0489-00 - diphenhydraMINE 12.5mg/5ml unit dose [YUMA],8618535,CDM,250,RC,Q0163,HCPCS,outpatient,12.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0504-04 - acetaminophen/codeine 120-12mg/5ml [YUMA],8618130,CDM,250,RC,,HCPCS,outpatient,12,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0747-10 - sucralfate 1gm/10ml liquid UD [YUMA],9214422,CDM,250,RC,,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0747-40 - sucralfate 1gm/10ml liquid UD [YUMA],10382491,CDM,250,RC,,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0759-08 - prednisoLONE solution 30ml  15mg/5ml solution [YUMA],8618838,CDM,250,RC,J7510,HCPCS,outpatient,15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0775-04 - guaiFENesin codeine 100-10mg/5ml suspension  120ml [YUMA],8618499,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0867-20 - vancomycin hydrochloride 125mg capsule [YUMA],9579826,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0868-50 - nystatin 500000 units/5 mL Susp [YUMA],9699483,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0903-40 - lidocaine 2% VISCOUS SOLUTION 20mg/ml  15ml solution [YUMA],9410802,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-0974-94 - sucralfate 1gm/10ml liquid UD [YUMA],10527431,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-1744-00 - guaiFENesin 100 mg/5 mL unit dose [YUMA],10354868,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-1762-30 - mag/alum/simeth 400-400-40mg/5ml  30ml UD [YUMA],8618370,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-4577-15 - lactulose 10gm/15ml syrup [YUMA],8979780,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00121-4774-40 - ibuprofen UD 100mg/5ml suspension [YUMA],8618655,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00132-0081-12 - glycerin 1gm suppository [YUMA],8618625,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-2112-50 - doxycycline hyclate 100mg tablet [YUMA],8618547,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9262-25 - ceFAZolin 1 g Pow [YUMA],8850240,CDM,250,RC,J0690,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9298-10 - FERRIC GLUCONATE COMPLEX 62.5mg/5ml  inj=5ml [YUMA],8746795,CDM,250,RC,J2916,HCPCS,outpatient,62.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9300-10 - pantoprazole 40mg inj [YUMA],8618810,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9310-10 - etomidate 2mg/ml  inj=10ml [YUMA],8618574,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9315-24 - levofloxacin 250mg/50ml  inj=50ml [YUMA],8618688,CDM,250,RC,J1956,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9316-24 - levofloxacin 500mg/100ml  inj=100ml [YUMA],9362484,CDM,250,RC,J1956,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9317-24 - levofloxacin 750mg/150ml  inj=150ml [YUMA],8618691,CDM,250,RC,J1956,HCPCS,outpatient,750,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9331-10 - bupivacaine 0.5%  inj=10ml [YUMA],9914942,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9368-01 - leucovorin calcium 200mg PWVL CHEMO [YUMA],9696920,CDM,636,RC,J0640,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9369-01 - DOXOrubicin 2mg/ml  inj=5ml CHEMO [YUMA],9220152,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9370-01 - DOXOrubicin 2 mg/mL inj=10ml CHEMO [YUMA],9220153,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9371-01 - DOXOrubicin 2 mg/mL inj=25ml CHEMO [YUMA],8980902,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9508-10 - ketamine 50mg/ml  500mg/10ml inj [YUMA],8618673,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9509-10 - ketamine 100 mg/mL  500mg/5ml inj [YUMA],8805835,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9549-01 - DOXOrubicin 2mg/ml  inj=5ml CHEMO [YUMA],8618546,CDM,250,RC,J9000,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9553-01 - leucovorin calcium 200mg PWVL CHEMO [YUMA],9075955,CDM,636,RC,J0640,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9555-01 - leucovorin calcium 50mg PWVL CHEMO [YUMA],8618682,CDM,250,RC,J0640,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9568-25 - cefuroxime 750mg vial [YUMA],9220120,CDM,250,RC,J0697,HCPCS,outpatient,750,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9570-10 - FERRIC GLUCONATE COMPLEX 62.5mg/5ml  inj=5ml [YUMA],8618885,CDM,250,RC,J2916,HCPCS,outpatient,62.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9587-25 - glycopyrrolate 0.2mg/ml  inj=1ml [YUMA],8618626,CDM,250,RC,,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9622-01 - labetalol hcl 5mg/ml  100mg/20ml inj [YUMA],8618675,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9623-01 - labetalol hcl 5 mg/mL  200mg/40ml inj [YUMA],8805839,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9684-10 - flumazenil 0.1mg/ml  inj=5ml [YUMA],8618593,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9721-24 - levofloxacin 500mg/100ml  inj=100ml [YUMA],9699480,CDM,636,RC,J1956,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9722-24 - levofloxacin 250mg/50ml  inj=50ml [YUMA],9699478,CDM,636,RC,J1956,HCPCS,both,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9746-10 - terbutaline 1mg/ml  inj=1ml [YUMA],8746794,CDM,250,RC,J3105,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9784-10 - flumazenil 0.1mg/ml  inj=5ml [YUMA],8862632,CDM,250,RC,,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9787-10 - enalaprilat 1.25mg/1ml  inj=1ml [YUMA],8618552,CDM,250,RC,,HCPCS,outpatient,1.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9851-01 - methylPREDNISolone SUCCINATE 1000mg/16ml inj [YUMA],9807369,CDM,636,RC,J2930,HCPCS,both,1000,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9872-10 - propranolol 1mg/ml  inj=1ml [YUMA],9764135,CDM,636,RC,J1800,HCPCS,both,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9875-25 - amiodarone 50mg/1ml  inj=3ml [YUMA],8618388,CDM,250,RC,J0282,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9890-01 - ondansetron 4mg/2ml  inj=20ml CHEMO [YUMA],8741724,CDM,250,RC,J2405,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9924-90 - ceFAZolin 1 g Pow [YUMA],8631524,CDM,250,RC,J0690,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9927-01 - ciprofloxacin 250mg tablet [YUMA],8810048,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00143-9981-50 - amoxicillin/pot clavulanate 200-28.5mg/5ml suspension [YUMA],9049287,CDM,250,RC,,HCPCS,outpatient,28.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00168-0035-04 - vitamin A & D topical - Oint 120 g [YUMA],8802645,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00168-0357-55 - lidocaine & prilocaine cream 5gm [YUMA],8618706,CDM,250,RC,,HCPCS,outpatient,5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00169-3687-12 - Insulin-Detemir 100units/ml  1 units inj [YUMA],8618661,CDM,250,RC,J1815,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00172-5728-60 - famotidine 20mg tablet [YUMA],8947923,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0682-20 - albuterol 90mcg inhaler [YUMA],8992548,CDM,250,RC,,HCPCS,outpatient,90,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0682-24 - albuterol 90mcg inhaler [YUMA],8618373,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0696-04 - fluticasone/salmeterol INHALER 250-50mcg [YUMA],8618600,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0712-15 - dutasteride 0.5mg capsule [YUMA],8618551,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0719-20 - fluticasone MDI Inhaler 110mcg [YUMA],8618597,CDM,250,RC,,HCPCS,outpatient,110,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0720-20 - fluticasone MDI Inhaler 220mcg [YUMA],8618598,CDM,250,RC,,HCPCS,outpatient,220,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00173-0901-86 - sotrovimab 500mg/8ml soln [YUMA],9865429,CDM,636,RC,Q0247,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00185-5050-01 - metolazone 2.5mg tablet [YUMA],8756229,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00186-0370-28 - budesonide/formoterol 160mcg inhaler [YUMA],8618440,CDM,250,RC,,HCPCS,outpatient,160,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00223-1760-01 - sodium chloride 1 g Tab [YUMA],8774239,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00225-0800-47 - phenylephrine 0.25% nasal spray 15ml [YUMA],9252705,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00228-2127-10 - cloNIDine 0.1mg tablet [YUMA],10698645,CDM,250,RC,,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00245-5319-01 - potassium chloride 20mEq tablet [YUMA],8618834,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00245-5326-30 - potassium bicarb effervescent 25mEq tab [YUMA],8618829,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00264-1510-32 - Dextrose 5%/Water 100 mL [YUMA],9670441,CDM,636,RC,J7060,HCPCS,both,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00264-7520-20 - Dextrose 10% in Water IV Sol 250 mL [YUMA],8861876,CDM,250,RC,,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00264-7800-10 - Sodium Chloride 0.9% 500mL Excel Bag [YUMA],8755619,CDM,250,RC,J7040,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00264-7800-20 - Sodium Chloride 0.9% 250ml EXCEL Bag [YUMA],9396625,CDM,636,RC,J7050,HCPCS,both,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00264-9594-20 - lidocaine in D5W PREMIX 4mg/ml  250ml IVPB [YUMA],8618697,CDM,250,RC,J2001,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00270-1412-15 - iopamidol 61% soln  inj=15ml [YUMA],9042424,CDM,250,RC,Q9967,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00280-2100-12 - aspirin 81mg Enteric Coated [YUMA],9908990,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-0720-10 - fulvestrant 50mg/ml  inj=10ml CHEMO [YUMA],8618607,CDM,250,RC,J9395,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-1830-30 - benralizumab 30 mg/mL inj=1ml [YUMA],8862658,CDM,250,RC,J0517,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-4500-12 - durvalumab 50mg/ml  inj=2.4ml (120mg) CHEMO [YUMA],8618550,CDM,250,RC,J9173,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-4611-50 - durvalumab 50mg/ml  inj=10ml (500mg) CHEMO [YUMA],8618549,CDM,250,RC,J9173,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-7442-02 - cilgavimab-tixagevimab 150 mg/1.5 mL-150 mg/1.5 mL soln [YUMA],9916131,CDM,636,RC,M0220,HCPCS,both,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00310-7720-10 - fulvestrant 50mg/ml  inj=10ml CHEMO [YUMA],8873474,CDM,250,RC,J9395,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0017-48 - Dextrose 5%/Water 100 mL [YUMA],8764631,CDM,250,RC,J7060,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0049-02 - Sodium Chloride 0.9% 250ml [YUMA],8631555,CDM,636,RC,J7050,HCPCS,both,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0054-03 - Sodium Chloride 3% IV Sol 500 mL [YUMA],8631518,CDM,250,RC,J7131,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0072-25 - ketorolac (IV) 30mg/ml  inj=1ml [YUMA],9663890,CDM,636,RC,J1885,HCPCS,both,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0409-03 - lidocaine in D5W PREMIX 4mg/ml  250ml IVPB [YUMA],9181822,CDM,250,RC,J2001,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0503-48 - gentamicin PREMIX 80mg/100ml  inj=100ml [YUMA],8618616,CDM,250,RC,J1580,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0519-58 - fat emulsion,8802401,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0553-11 - Sodium Chloride 0.9% 50ml [YUMA],8631551,CDM,636,RC,J7040,HCPCS,both,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0553-18 - Sodium Chloride 0.9% 100ml Baxter [YUMA],8726014,CDM,636,RC,J7040,HCPCS,both,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-0703-41 - potassium chloride 20mEq/50ml  inj=50ml [YUMA],9207323,CDM,250,RC,J3480,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-1047-02 - nitroglycerin PREMIX bottle 25mg/250ml  inj=250ml [YUMA],8618776,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00338-5197-41 - famotidine 20mg/50ml CHEMO [YUMA],8618577,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-0317-01 - cimetidine 300mg tablet [YUMA],8618486,CDM,250,RC,,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-0781-91 - fexofenadine 60mg tablet [YUMA],8618585,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-0871-99 - cloNIDine 0.1mg/24hr patch [YUMA],8618495,CDM,250,RC,,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-1807-77 - levothyroxine 88mcg tablet [YUMA],8618695,CDM,250,RC,,HCPCS,outpatient,88,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-6470-99 - scopolamine 1.5 mg Fil [YUMA],8631520,CDM,250,RC,,HCPCS,outpatient,1.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-6993-93 - levalbuterol 1.25mg/0.5ml unit dose [YUMA],10063032,CDM,636,RC,J7612,HCPCS,both,1.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-8270-55 - albuterol 2.5mg unit dose  inh=3ml [YUMA],9691290,CDM,636,RC,J7613,HCPCS,both,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-9119-98 - fentaNYL patch 12mcg/hr [YUMA],8618580,CDM,250,RC,,HCPCS,outpatient,12,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00378-9321-32 - fluticasone/salmeterol INHALER 250-50mcg [YUMA],8746748,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00386-0001-02 - ethyl chloride spray [YUMA],8618573,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00386-0001-11 - ethyl chloride spray [YUMA],9699490,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00406-0123-62 - HYDROcodone/acetamin 5/325mg tablet [YUMA],8618132,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00406-0512-62 - oxyCODONE 5 acetaminophen 325 tablet [YUMA],9271638,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00406-0552-62 - oxyCODONE IR 5mg tablet [YUMA],8787112,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00406-1142-01 - methylphenidate 5mg tablet [YUMA],8618735,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-0366-01 - docetaxel inj 20mg/ml  inj=1ml (CHEMO) [YUMA],8776412,CDM,250,RC,J9171,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1159-01 - bupivacaine 0.25%  inj=10ml [YUMA],8618444,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1159-02 - bupivacaine 0.25%  inj=30ml [YUMA],9265879,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1162-01 - bupivacaine 0.5%  inj=10ml [YUMA],10104319,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1162-10 - bupivacaine 0.5% PF soln  inj=30ml [YUMA],9951214,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1178-30 - meperidine 50mg/ml  inj=1ml [YUMA],8618729,CDM,250,RC,J2175,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1180-69 - meperidine 100mg/ml  inj=1ml [YUMA],8618728,CDM,250,RC,J2175,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1207-25 - gentamicin sulfate 80mg/2ml  inj=2ml [YUMA],8618617,CDM,250,RC,J1580,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1273-32 - diazepam 10mg/2ml inj [YUMA],8618520,CDM,250,RC,J3360,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1283-31 - HYDROmorphone 1mg/ml  inj=1ml [YUMA],8618649,CDM,636,RC,J1170,HCPCS,both,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1283-37 - HYDROmorphone 1mg/ml  inj=1ml [YUMA],10472703,CDM,250,RC,J1170,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1323-05 - lidocaine 2% Cardiac 20mg/ml  inj=5ml [YUMA],8618696,CDM,250,RC,J2001,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1412-04 - bumetanide 0.25mg/ml  inj=4ml [YUMA],9438668,CDM,636,RC,S0171,HCPCS,both,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1630-10 - atropine 0.1mg/ml  inj=10ml [YUMA],8618410,CDM,250,RC,J0461,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1631-10 - calcium chloride 10%  inj=10ml [YUMA],8618453,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1631-40 - calcium chloride 10%  inj=10ml [YUMA],8957470,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1638-02 - dexmedetomidine 200 mcg/2mL Inj [YUMA],9243169,CDM,250,RC,,HCPCS,outpatient,200,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1778-05 - metorpolol TARTRATE 5mg/5ml  inj=5ml [YUMA],8618745,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1890-01 - morphine sulfate 2 mg/ml PF  inj=1ml [YUMA],9265882,CDM,250,RC,J2274,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1890-23 - morphine sulfate 2 mg/ml PF  inj=1ml [YUMA],10038208,CDM,636,RC,J2274,HCPCS,both,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1966-07 - sodium chloride 0.9%  30ml vial [YUMA],8618883,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-1985-30 - LORazepam 2mg/ml  inj=1ml [YUMA],10369318,CDM,250,RC,J2060,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2267-20 - labetalol hcl 5mg/ml  100mg/20ml inj [YUMA],9285865,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2305-50 - midazolam 5mg/5ml   inj=5ml [YUMA],8618752,CDM,250,RC,J2250,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2308-49 - midazolam 5mg/1ml  inj=1ml [YUMA],8618751,CDM,250,RC,J2250,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2339-34 - labetalol IV PUSH 5mg/ml  inj=4ml [YUMA],8618676,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2344-01 - DOBUTamine hcl 250mg  inj=20ml [YUMA],8618539,CDM,250,RC,J1250,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2344-02 - DOBUTamine hcl 250mg  inj=20ml [YUMA],9007806,CDM,250,RC,J1250,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2552-01 - HYDROmorphone 1mg/ml  inj=1ml [YUMA],8764502,CDM,250,RC,J1170,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2634-01 - HYDROmorphone PCA 10mg/1ml inj [YUMA],8618650,CDM,250,RC,J1170,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2721-01 - heparin 10,9827347,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-2757-01 - DAPTOmycin 500mg inj [YUMA],9365261,CDM,636,RC,J0878,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3178-02 - lidocaine 1% with Epi  inj=30ml [YUMA],8618566,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3182-01 - lidocaine 2% with Epi  inj=20ml [YUMA],8741728,CDM,250,RC,,HCPCS,outpatient,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3308-03 - acetylcysteine 20%  200mg/ml  inh=30ml [YUMA],8618365,CDM,250,RC,J7608,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3356-01 - HYDROmorphone 2mg/ml  inj=1ml [YUMA],8618651,CDM,250,RC,J1170,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3365-10 - HYDROmorphone 2mg/ml  inj=1ml [YUMA],10662285,CDM,250,RC,J1170,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3375-04 - norepinephrine bitartrate 1mg/ml  inj=4ml [YUMA],10038616,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3414-01 - metoclopramide 10mg/2ml  inj=2ml [YUMA],8618741,CDM,250,RC,J2765,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-3977-03 - water BACTERIOSTATIC 30ml vial [YUMA],8618894,CDM,250,RC,A4216,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4011-01 - verapamil 2.5mg/ml  inj=2ml [YUMA],8878760,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4031-01 - mannitol 25% 250mg/ml  inj=50ml [YUMA],8618723,CDM,250,RC,J2150,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4276-16 - lidocaine 1%  inj=20ml [YUMA],8741053,CDM,636,RC,J2001,HCPCS,both,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4277-01 - lidocaine 2%  inj=20ml [YUMA],9007825,CDM,250,RC,J2001,HCPCS,outpatient,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4278-01 - lidocaine 0.5% PF inj= 50mL [YUMA],8802399,CDM,250,RC,J2001,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4279-02 - lidocaine 1% PF inj=30ml [YUMA],9042671,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4283-01 - lidocaine 4%  inj=5ml [YUMA],8618703,CDM,250,RC,J2001,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4887-10 - water STERILE vial [YUMA],8618893,CDM,250,RC,A4217,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4887-20 - water STERILE vial [YUMA],9189577,CDM,250,RC,A4217,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4888-10 - sodium chloride PRESERVE FREE 0.9%  10ml vial [YUMA],8618882,CDM,250,RC,A4216,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4888-20 - sodium chloride 0.9% Sol 20 mL [YUMA],8631521,CDM,250,RC,A4216,HCPCS,outpatient,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4911-34 - atropine 0.1mg/ml  inj=10ml [YUMA],8740612,CDM,250,RC,J0461,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4921-34 - EPINEPHrine 0.1mg/ml  inj=10ml [YUMA],8740616,CDM,250,RC,J0171,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-4933-01 - EPINEPHrine 0.1mg/ml  inj=10ml [YUMA],9486757,CDM,637,RC,J0171,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-5555-01 - sodium bicarbonate 0.5mEq/ml  inj=5ml [YUMA],9458274,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-5555-02 - sodium bicarbonate 0.5mEq/ml  inj=5ml [YUMA],9345758,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-5922-01 - aminophylline 25mg/ml  inj=20ml [YUMA],8618384,CDM,250,RC,J0280,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6102-04 - furosemide 40mg/4ml  inj=4ml [YUMA],8618610,CDM,250,RC,J1940,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6102-25 - furosemide 20mg/2ml  inj=2ml [YUMA],8618608,CDM,636,RC,J1940,HCPCS,both,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6102-26 - furosemide 40mg/4ml  inj=4ml [YUMA],8773092,CDM,250,RC,J1940,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6533-31 - vancomycin 1gm vial [YUMA],9765023,CDM,636,RC,J3370,HCPCS,both,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6609-02 - sodium bicarbonate 0.48mEq/ml   inj=5ml [YUMA],8618877,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6625-02 - sodium bicarb 8.4% 1mEq/ml  inj=50ml [YUMA],8740620,CDM,250,RC,,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6637-34 - sodium bicarb 8.4% 1mEq/ml  inj=50ml [YUMA],8618878,CDM,250,RC,,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6651-06 - potassium chloride 20mEq/10ml  inj=10ml [YUMA],9386205,CDM,636,RC,J3480,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-6730-13 - magnesium sulfate PREMIX 4gm/50ml  inj=50ml [YUMA],8618720,CDM,250,RC,J3475,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7077-14 - potassium chloride 20mEq/50ml  inj=50ml [YUMA],8618831,CDM,636,RC,J3480,HCPCS,both,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7332-01 - cefTRIAXone 1gm vial [YUMA],10104320,CDM,250,RC,J0696,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7332-20 - cefTRIAXone 1gm vial [YUMA],8618471,CDM,250,RC,J0696,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7335-03 - cefTRIAXone 2gm vial [YUMA],8726012,CDM,250,RC,J0696,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7335-20 - cefTRIAXone 2gm vial [YUMA],8618472,CDM,250,RC,J0696,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7517-16 - dextrose 50% 0.5mg/ml  inj=50ml [YUMA],8618623,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7793-62 - heparin PREMIX 100units/ml  inj=250ml [YUMA],8618635,CDM,250,RC,J1644,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7809-22 - DOPamine Premix 400mg/250ml  inj=250ml [YUMA],8618544,CDM,250,RC,J1265,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7811-24 - metroNIDAZOLE 500mg/100ml  inj=100ml [YUMA],8618749,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7902-09 - Potassium Cl/D5/0.45% NaCl 1000ml [YUMA],8631558,CDM,250,RC,J3480,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7922-03 - Dextrose 5%/Water 500ml [YUMA],8631561,CDM,250,RC,J7060,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7924-09 - Dextrose 5%/0.225% NaCl 1000ml [YUMA],8631560,CDM,250,RC,,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7926-09 - Dextrose 5%/0.45% NaCl 1000ml [YUMA],8631559,CDM,250,RC,,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7929-09 - Dextrose 5%/LR 1000ml [YUMA],8631562,CDM,250,RC,J7121,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7930-02 - Dextrose 10% in Water IV Sol 250 mL [YUMA],8631512,CDM,250,RC,,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7953-09 - Lactated Ringers 1000ml [YUMA],8631563,CDM,250,RC,J7120,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7953-09 - Lactated Ringers 1000 mL BOLUS [YUMA],8712205,CDM,250,RC,J7120,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7983-03 - Sodium Chloride 0.9% 500ml [YUMA],8631556,CDM,250,RC,,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7983-09 - Sodium Chloride% 0.9 1000ml [YUMA],8631557,CDM,258,RC,,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7983-09 - Sodium Chloride 1000 mL BOLUS [YUMA],8712204,CDM,636,RC,J7030,HCPCS,both,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7984-36 - Sodium Chloride 0.9% 50ml [YUMA],8631552,CDM,250,RC,J7040,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7984-37 - Sodium Chloride 0.9% 100ml [YUMA],8631553,CDM,250,RC,,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-7985-09 - Sodium Chloride 0.45% 1000ml [YUMA],8631564,CDM,258,RC,,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9042-10 - bupivacaine-epinephrine 0.25%-1:200,8631523,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9094-22 - fentanyl 100mcg/2ml  inj=2ml [YUMA],8618583,CDM,250,RC,J3010,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9157-01 - vitamin K-INFANT 1mg/0.5ml  inj=0.5ml [YUMA],8618821,CDM,250,RC,J3430,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9158-01 - vitamin K-ADULT 10mg/1ml  inj=1ml [YUMA],8618822,CDM,250,RC,J3430,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9558-49 - rocuronium 50 mg/5 mL Sol [YUMA],8631534,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00409-9558-50 - rocuronium 100mg/10ml soln inj=10ml [YUMA],8863532,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00430-0170-15 - darifenacin 7.5mg tablet [YUMA],8618510,CDM,250,RC,,HCPCS,outpatient,7.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00436-0936-16 - sodium hypochlorite topical 0.25% Sol [YUMA],8631527,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00456-0600-10 - ceftaroline 600mg vial [YUMA],8618470,CDM,250,RC,J0712,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00456-0600-10 - ceftaroline 600 mg pwdr [YUMA],9815420,CDM,636,RC,J0712,HCPCS,both,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00456-1120-30 - vilazodone Hcl 20mg tablet [YUMA],8618934,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00456-1402-30 - nebivolol 2.5mg tablet [YUMA],8618768,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00456-4300-01 - fosfomycin tromethamine 3gm packet [YUMA],8618604,CDM,250,RC,,HCPCS,outpatient,3,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00472-0343-56 - hydrocortisone 1% cream  28gm [YUMA],8618647,CDM,250,RC,,HCPCS,outpatient,28,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00487-5901-99 - racepinephrine 2.25%  0.5ml unit dose [YUMA],8618858,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00487-9301-03 - sodium chloride 0.9% inh solution  3ml [YUMA],8618879,CDM,250,RC,,HCPCS,outpatient,3,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00487-9501-03 - albuterol 2.5mg unit dose  inh=3ml [YUMA],9707762,CDM,636,RC,J7613,HCPCS,both,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00487-9501-60 - albuterol 2.5mg unit dose  inh=3ml [YUMA],8618372,CDM,637,RC,,HCPCS,outpatient,,,$12.00 ,$9.00 ,,$11.04 ,92,,,$6.60 ,$11.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$11.64 ,other,,Not applicable. No negotiated rates per contract,$10.32 ,86,,,$6.60 ,$11.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$9.60 ,80,,,$6.60 ,$11.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$9.00 ,75,,,$6.60 ,$11.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.16 ,93,,,$6.60 ,$11.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
00487-9801-60 - ipratropium 0.5mg unit dose [YUMA],8618667,CDM,250,RC,J7644,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-0031-25 - cyanocobalamin 1000mcg/1ml inj [YUMA],8618503,CDM,250,RC,J3420,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-0374-05 - methylene blue 5 mg/mL Sol [YUMA],8631532,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-0650-01 - ferric carboxymaltose 50 mg/mL inj=15ml [YUMA],10004192,CDM,636,RC,J1439,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-0720-01 - BETAmethasone 6mg/ml   inj=5ml [YUMA],8618430,CDM,250,RC,J0702,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-0740-20 - methylergonovine maleate 0.2mg/ml  inj=1ml [YUMA],8746547,CDM,250,RC,J2210,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-1980-05 - dicyclomine 20mg/2ml   inj=2ml [YUMA],8618525,CDM,250,RC,J0500,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-2340-10 - iron SUCROSE 20mg/ml  inj=5ml [YUMA],8618671,CDM,250,RC,J1756,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00517-7604-25 - acetylcysteine 20% 200mg/ml  inh=4ml [YUMA],8618364,CDM,250,RC,J7608,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1007-15 - calcium carbonate 500mg tablet [YUMA],8618451,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1008-36 - aspirin 81mg Chewable [YUMA],8741727,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1086-91 - lanolin/mineral oil/petroleum 3.5gm ointment [YUMA],8764712,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1142-63 - levonorgestrel 1.5mg tablet [YUMA],10913323,CDM,250,RC,,HCPCS,outpatient,1.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1182-97 - guaiFENesin 100mg/5ml suspension  120ml [YUMA],10091389,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1234-41 - aspirin 81mg Enteric Coated [YUMA],8823722,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1294-34 - diclofenac topical 1% gel 50gm [YUMA],10966670,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-1325-94 - polyvinyl alcohol solution 15ml drops [YUMA],10104321,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-3313-01 - aspirin 325mg Enteric Coated [YUMA],8755815,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-3426-08 - calcium carbonate 600mg tablet [YUMA],8618452,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-3556-01 - cyanocobalamin 1000 mcg Tab [YUMA],8853661,CDM,250,RC,,HCPCS,outpatient,1000,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-4306-08 - calcium polycarbophil 625mg tablet [YUMA],8618827,CDM,250,RC,,HCPCS,outpatient,625,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-5090-08 - vitamin A/C/E/minerals tablet [YUMA],8618764,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-5896-53 - nicotine patch 21mg/24hr [YUMA],8764423,CDM,250,RC,,HCPCS,outpatient,21,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00536-5896-88 - nicotine patch 21mg/24hr [YUMA],8618770,CDM,250,RC,,HCPCS,outpatient,21,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00548-5400-00 - medroxyprogesterone inj susp 150mg SDV [YUMA],8774204,CDM,250,RC,J1050,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00562-7805-01 - rho(D) immune globulin 300mcg inj [YUMA],8618861,CDM,250,RC,J2790,HCPCS,outpatient,300,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0120-76 - charcoal sorbitol 50gm susp [YUMA],8618479,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0121-76 - charcoal activated 50gm susp [YUMA],8769771,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0129-01 - clindamycin 75mg/5ml solution  100ml [YUMA],8764720,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0292-01 - aMILoride 5mg tablet  [YUMA],8618383,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0520-76 - charcoal sorbitol 50gm susp [YUMA],9699487,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0521-76 - charcoal activated 50gm susp [YUMA],10038623,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0815-30 - acetylcysteine 6GM/30ml  inj=30ml [YUMA],8618363,CDM,250,RC,J0132,HCPCS,outpatient,6,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-0850-05 - DHE-dihydroergotamine mesylate 1mg/1ml  inj=1ml [YUMA],8618529,CDM,250,RC,J1110,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-7034-12 - aspirin 300 mg Supp [YUMA],8805692,CDM,250,RC,,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00574-7050-12 - bisacodyl 10mg suppository [YUMA],8753438,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00591-0794-01 - dicyclomine HCL 10mg capsule [YUMA],8618524,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00591-2679-30 - lidocaine topical 5% Film [YUMA],8705881,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00591-3525-30 - lidocaine topical 5% Film [YUMA],9707764,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00597-0024-02 - albuterol & ipratropium inhaler 100-20mcg [YUMA],8618374,CDM,250,RC,,HCPCS,outpatient,20,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00597-0041-37 - telmisartan 80mg tablet [YUMA],8618902,CDM,250,RC,,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00597-0075-75 - tiotropium 18mcg capsule [YUMA],8618910,CDM,250,RC,,HCPCS,outpatient,18,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00597-0260-10 - glucagon 1mg  inj=1ml [YUMA],9009221,CDM,250,RC,J1610,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00597-0355-09 - dabiGATRAN etexilate 75mg capsule [YUMA],8618507,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-0121-25 - HYDROmorphone 2mg/ml  inj=1ml [YUMA],8764418,CDM,250,RC,J1170,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-0367-21 - DEXAmethasone 10 mg/mL inj=1ml [YUMA],9121004,CDM,250,RC,J1100,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-0367-25 - DEXAmethasone 10 mg/mL inj=1ml [YUMA],8769762,CDM,250,RC,J1100,HCPCS,outpatient,10,mg,$12.00 ,$9.00 ,,$11.04 ,92,,,$6.60 ,$11.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$6.60 ,$11.64 ,other,,Not applicable. No negotiated rates per contract,$10.32 ,86,,,$6.60 ,$11.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$9.60 ,80,,,$6.60 ,$11.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$11.40 ,95,,,$6.60 ,$11.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$9.00 ,75,,,$6.60 ,$11.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$11.64 ,97,,,$6.60 ,$11.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$10.20 ,85,,,$6.60 ,$11.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$10.80 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.40 ,90,,,$6.60 ,$11.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$6.60 ,55,,,$6.60 ,$11.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$11.16 ,93,,,$6.60 ,$11.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
00641-0376-25 - diphenhydramine 50mg/ml  inj=2ml CHEMO [YUMA],8618537,CDM,250,RC,J1200,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-0928-21 - promethazine 25mg/1ml  inj=1ml [YUMA],10674402,CDM,250,RC,J2550,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-0955-25 - promethazine 25mg/1ml  inj=1ml [YUMA],8618845,CDM,250,RC,J2550,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-1397-35 - chlorpromazine 25mg/1ml  inj=1ml [YUMA],8618481,CDM,250,RC,J3230,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-1410-31 - digoxin 0.25mg/ml  inj=2ml [YUMA],9951184,CDM,636,RC,J1160,HCPCS,both,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6006-10 - atropine 0.4mg/ml  inj=20ml [YUMA],8618411,CDM,250,RC,J0461,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6008-10 - bumetanide 0.25mg/ml  inj=4ml [YUMA],8618442,CDM,250,RC,S0171,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6013-10 - diltiazem 5mg/ml  inj=5ml [YUMA],8876686,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6015-10 - diltiazem 5mg/ml  inj=25ml [YUMA],8618532,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6022-25 - famotidine 10 mg/mL Sol [YUMA],8773116,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6027-25 - fentanyl 100mcg/2ml  inj=2ml [YUMA],8764698,CDM,250,RC,J3010,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6044-25 - LORazepam 2mg/ml  inj=1ml [YUMA],8618714,CDM,250,RC,J2060,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6048-25 - LORazepam 2mg/ml  inj=1ml [YUMA],8764454,CDM,250,RC,J2060,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6057-25 - midazolam 2mg/2ml inj=2ml [YUMA],8863178,CDM,250,RC,J2250,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6127-25 - morphine sulfate 10mg/ml  inj=1ml [YUMA],8618759,CDM,250,RC,J2274,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6145-25 - DEXAmethasone INJECTABLE 4mg/1ml  inj=1ml [YUMA],8618518,CDM,250,RC,J1100,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6151-25 - HYDROmorphone 2mg/ml  inj=1ml [YUMA],9017483,CDM,636,RC,J1170,HCPCS,both,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-6161-01 - bumetanide 0.25mg/ml  inj=4ml [YUMA],8741010,CDM,250,RC,,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-9217-10 - diltiazem 5mg/ml  inj=5ml [YUMA],8618533,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00641-9219-10 - diltiazem 5mg/ml  inj=25ml [YUMA],8764449,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0031-04 - methylPREDNISolone ACETATE 40mg/ml  inj=1ml [YUMA],9200604,CDM,250,RC,J1030,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0051-01 - methylPREDNISolone ACETATE 80mg/ml  inj=1ml [YUMA],8810047,CDM,250,RC,J1040,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0051-04 - methylPREDNISolone ACETATE 80mg/ml  inj=1ml [YUMA],9570401,CDM,636,RC,J1040,HCPCS,both,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0125-01 - DAPTOmycin 500mg inj [YUMA],8618508,CDM,250,RC,J0878,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0241-01 - triamcinolone acetonide 40mg/1ml  inj=1ml [YUMA],8858739,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-0243-01 - triamcinolone acetonide 40mg/1ml  inj=5ml [YUMA],9573221,CDM,636,RC,J3301,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-5075-01 - dacarbazine 200 mg powder CHEMO [YUMA],8980950,CDM,250,RC,J9130,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-5140-01 - leucovorin calcium 100mg PWVL CHEMO [YUMA],9040930,CDM,250,RC,J0640,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-5145-01 - leucovorin calcium 350mg PWVL CHEMO [YUMA],9075882,CDM,250,RC,J0640,HCPCS,outpatient,350,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-5145-91 - leucovorin calcium 350mg PWVL CHEMO [YUMA],8776408,CDM,250,RC,J0640,HCPCS,outpatient,350,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-8530-23 - enoxaparin 30mg  inj=0.3ml [YUMA],9121720,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-8540-23 - enoxaparin 40mg  inj=0.4ml [YUMA],9526234,CDM,636,RC,J1650,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-8560-21 - enoxaparin 60mg  inj=0.6ml [YUMA],9606195,CDM,636,RC,J1650,HCPCS,both,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-8560-23 - enoxaparin 60mg  inj=0.6ml [YUMA],9607461,CDM,636,RC,J1650,HCPCS,both,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00703-8580-23 - enoxaparin 100mg  inj=1ml [YUMA],9530479,CDM,636,RC,J1650,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00713-0109-12 - bisacodyl 10mg suppository [YUMA],8755816,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00713-0165-12 - acetaminophen 650mg suppository [YUMA],8756228,CDM,250,RC,,HCPCS,outpatient,650,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00713-0526-12 - promethazine 25mg suppository [YUMA],8618846,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-2020-01 - amoxicillin 250mg capsule [YUMA],8618392,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3059-95 - digoxin 0.25mg/ml  inj=2ml [YUMA],8618527,CDM,250,RC,J1160,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3156-95 - acetaminophen 10mg/ml 100ml inj [YUMA],10986129,CDM,250,RC,J0131,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3208-95 - cefTRIAXone 1gm vial [YUMA],10038617,CDM,250,RC,J0696,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3209-95 - cefTRIAXone 2gm vial [YUMA],8998170,CDM,250,RC,J0696,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3232-95 - pantoprazole 40mg inj [YUMA],10115048,CDM,250,RC,S0164,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3246-64 - enoxaparin 40mg  inj=0.4ml [YUMA],9881579,CDM,636,RC,J1650,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3268-69 - enoxaparin 100mg  inj=1ml [YUMA],9670403,CDM,636,RC,J1650,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3415-75 - palonosetron hcl 0.05mg/ml  inj=5ml CHEMO [YUMA],9696921,CDM,636,RC,J2469,HCPCS,both,0.05,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-3440-95 - cosyntropin 0.25mg/1ml  inj=1ml [YUMA],8618502,CDM,250,RC,J0834,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-5690-31 - ezetimibe 10mg tablet [YUMA],8618576,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-6023-52 - clarithromycin 250mg/5ml suspension   50ml [YUMA],8618491,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-6041-58 - amoxicillin 250mg/5ml suspension 80ml bottle [YUMA],8618393,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-6172-86 - desflurane 100% Liq for inh [YUMA],8850237,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-7296-85 - albuterol 90mcg inhaler [YUMA],9677767,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9124-95 - nafcillin sodium 1gm vial [YUMA],8618766,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9210-95 - piperacillin tazobactam 2.25gm vial [YUMA],8741055,CDM,250,RC,J2543,HCPCS,outpatient,2.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9213-95 - piperacillin tazobactam 3.375gm vial [YUMA],8764506,CDM,250,RC,J2543,HCPCS,outpatient,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9315-70 - oxaliplatin 5 mg/mL  inj=10 mL CHEMO [YUMA],8774696,CDM,250,RC,J9263,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9317-80 - oxaliplatin 100mg/20ml  inj=20ml CHEMO [YUMA],8750334,CDM,250,RC,J9263,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00781-9404-95 - ampicillin 1gm inj [YUMA],8618397,CDM,250,RC,J0290,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00832-0038-00 - oxybutynin 5mg tablet [YUMA],8618802,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00832-0465-30 - nystatin 100MU/GM powder  30gm [YUMA],8618784,CDM,250,RC,,HCPCS,outpatient,30,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00832-1211-01 - warfarin 1mg tablet [YUMA],9220125,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00832-1216-01 - warfarin 5mg tablet [YUMA],9252704,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-0201-61 - amitriptyline 25mg tablet [YUMA],8618390,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-0274-60 - vitamin E 400 IU Cap [YUMA],8853660,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-0523-61 - vitamin C 500mg tablet [YUMA],8618403,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-0530-61 - multivitamin tablet [YUMA],9467560,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-0644-52 - nitroglycerin ER 6.5mg capsule [YUMA],8618777,CDM,250,RC,,HCPCS,outpatient,6.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-1453-61 - metroNIDAZOLE 250mg tablet [YUMA],8618748,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-2725-61 - sulfameth/trimeth 800-160mg DS tablet [YUMA],8618898,CDM,250,RC,,HCPCS,outpatient,160,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-3854-61 - carBAMazepine 100mg chewable tablet [YUMA],8618456,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-3865-75 - saline nasal spray 0.65% spray [YUMA],8618884,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-4040-73 - aspirin 81mg Chewable [YUMA],8618405,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-4213-60 - acidophilus with pectin capsule [YUMA],8618679,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5306-61 - diphenhydraMINE 25mg capsules [YUMA],8618536,CDM,250,RC,Q0163,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5502-61 - enalapril maleate 5mg tablet [YUMA],8618553,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5524-61 - doxazosin 4mg tablet [YUMA],8618545,CDM,250,RC,,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5656-61 - cloNIDine 0.1mg tablet [YUMA],8741726,CDM,250,RC,,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5684-61 - omeprazole 20mg capsule [YUMA],8618791,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5784-61 - FLUoxetine 10mg capsule [YUMA],8618596,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5791-46 - acetaminophen 80mg chewable tablet [YUMA],8618129,CDM,250,RC,,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5823-60 - vitamin D 400 IU tablet [YUMA],8618483,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5824-60 - vitamin D 1000 IU tablet [YUMA],8618482,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5853-61 - ibuprofen 400mg tablet [YUMA],8857848,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5854-61 - ibuprofen 600mg tablet [YUMA],8618657,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5880-61 - diazepam 5mg tablet [YUMA],8618522,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5892-61 - pravastatin 20mg tablet [YUMA],8618837,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5921-61 - digoxin 0.125mg tablet [YUMA],8618526,CDM,250,RC,,HCPCS,outpatient,0.125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5929-61 - labetalol 200mg tablet [YUMA],8618678,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-5959-61 - clindamycin 150mg capsule [YUMA],8618492,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6007-61 - LORazepam 0.5mg tablet [YUMA],8618713,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6051-61 - KEPPRA 250mg tablet [YUMA],8618685,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6052-61 - KEPPRA 500mg tablet [YUMA],8618687,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6082-61 - zolpidem 5mg tablet [YUMA],8618941,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6084-61 - citalopram 10mg tablet [YUMA],8618489,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6237-61 - carbidopa/levodopa 25-100mg tablet [YUMA],8618458,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6238-61 - carbidopa/levodopa 25-250mg tablet [YUMA],8618459,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6283-61 - olanzapine 2.5mg tablet [YUMA],8618789,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6290-61 - atorvaSTATIN 10mg tablet [YUMA],8742993,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6294-61 - CLOPIdogrel 75mg tablet [YUMA],8618497,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6300-61 - carvedilol 3.125mg tablet [YUMA],8618464,CDM,250,RC,,HCPCS,outpatient,3.125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6302-61 - carvedilol 12.5mg tablet [YUMA],8618463,CDM,250,RC,,HCPCS,outpatient,12.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6323-61 - metoprolol SUCCINATE 50mg tablet [YUMA],8618747,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6339-61 - senna/docusate 8.6-50mg tablet [YUMA],8764433,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6340-61 - metoprolol TARTRATE 25mg tablet [YUMA],8618744,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6351-61 - levofloxacin 250mg tablet [YUMA],8618689,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6358-61 - risperiDONE 0.5mg tablet [YUMA],9362486,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6363-61 - divalproex sodium 250 mg ER Tab [YUMA],8773113,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6365-61 - traMADol 50mg tablet [YUMA],8618914,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6370-61 - amlodipine besylate 5mg tablet [YUMA],8618391,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6391-61 - losartan potassium 25mg tablet [YUMA],8853588,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6401-61 - tamsulosin 0.4mg capsule [YUMA],8618901,CDM,250,RC,,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6407-61 - bisacodyl 5mg tablet [YUMA],8618434,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6426-61 - escitaloprim 10mg tablet [YUMA],8618571,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6437-61 - oxyCODONE 5 acetaminophen 325 tablet [YUMA],8618133,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6440-61 - hydralazine 10mg tablet [YUMA],8618641,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6444-61 - oxyCODONE IR 5mg tablet [YUMA],8618804,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6449-61 - isosorbide mononitrate 30 mg Tab UD [YUMA],8764634,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6455-61 - docusate sodium 100mg capsule [YUMA],8618541,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6461-61 - promethazine 25mg tablet [YUMA],8618847,CDM,250,RC,Q0169,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6475-61 - baclofen 10mg tablet [YUMA],8618421,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6492-35 - polyvinyl alcohol solution 15ml drops [YUMA],8746773,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6502-61 - celecoxib 100 mg Cap [YUMA],9040951,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6516-61 - meclizine 12.5mg tablet [YUMA],8618725,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6519-61 - mirtazapine 15mg tablet [YUMA],8618754,CDM,250,RC,,HCPCS,outpatient,15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6522-61 - senna 8.6mg tablet [YUMA],8618870,CDM,250,RC,,HCPCS,outpatient,8.6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6550-61 - propranolol 10mg tablet [YUMA],8618849,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6556-61 - amiodarone 200mg tablet [YUMA],8618389,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6557-61 - morphine sulfate ER 15mg tablet [YUMA],8618758,CDM,250,RC,,HCPCS,outpatient,15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6564-61 - benzonatate 100mg capsule [YUMA],8618428,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6571-61 - allopurinol 100mg tablet [YUMA],8618376,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6585-61 - buPROPion ER 150mg tablet [YUMA],8618445,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6608-61 - acidophilus with pectin capsule [YUMA],8806309,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6617-61 - hydrOXYzine 25mg tablet [YUMA],8618654,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6630-61 - amantadine 100mg capsules [YUMA],8618381,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6635-61 - buPROPion 75mg tablet [YUMA],8618446,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6637-61 - glipiZIDE 5mg tablet [YUMA],8618621,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6638-61 - QUEtiapine 25mg tablet [YUMA],8618854,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6665-61 - gabapentin 100mg capsule [YUMA],8618612,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6689-61 - metFORMIN 500mg tablet [YUMA],8618731,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6708-06 - azithromycin 250mg tablet [YUMA],8743075,CDM,250,RC,Q0144,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6713-18 - aspirin 81mg Enteric Coated [YUMA],8743071,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6717-61 - cetirizine 10mg tablet [YUMA],8618478,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6718-39 - guaiFENesin ER 600mg tablet [YUMA],8618631,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6720-59 - acetaminophen 500mg tablet [YUMA],8618127,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6723-61 - senna/docusate 8.6-50mg tablet [YUMA],8618542,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6730-60 - acetaminophen 500mg tablet [YUMA],8856031,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6730-61 - acetaminophen 500mg tablet [YUMA],8741590,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6732-04 - colchicine 0.6 mg cap [YUMA],9865457,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6761-30 - oxymetazoline HCL 0.05%  30ml nasal [YUMA],8618805,CDM,250,RC,,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6773-61 - acetaminophen 325mg tablet [YUMA],8618126,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6790-61 - benztropine 1mg tab [YUMA],8618429,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6797-61 - lisinopril 5mg tablet [YUMA],9089507,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6799-61 - lisinopril 20mg tablet [YUMA],8618709,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6817-06 - midodrine 2.5mg tab [YUMA],9796821,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6823-61 - gabapentin 600mg tab [YUMA],9182505,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6824-61 - HYDROcodone/acetamin 5/325mg tablet [YUMA],8764501,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6825-61 - HYDROcodone/acetamin 10/325mg tablet [YUMA],8755803,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6839-73 - mag/alum/simeth 400-400-40mg/5ml  30ml UD [YUMA],9535137,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6846-73 - magnesium hydroxide 2400mg/30ml suspension [YUMA],8764507,CDM,250,RC,,HCPCS,outpatient,2400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6852-61 - loratadine 10mg tablet [YUMA],8618712,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6868-61 - traZADone 50mg tablet [YUMA],9252697,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6916-61 - metolazone 2.5mg tablet [YUMA],9455930,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6917-61 - omeprazole 20mg capsule [YUMA],9271637,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6925-61 - sertraline hcl 50mg tablet [YUMA],10733740,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6927-61 - spironolactone 25mg tablet [YUMA],8832286,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6931-76 - polyethylene UD 17gm powder [YUMA],8859588,CDM,250,RC,,HCPCS,outpatient,17,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6950-61 - levothyroxine 50mcg tablet  [YUMA],9161146,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6954-61 - levothyroxine 112mcg tablet [YUMA],9468256,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6966-61 - oxyCODONE IR 5mg tablet [YUMA],9246547,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6992-61 - pregabalin 50mg capsule [YUMA],9699496,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6993-61 - amiodarone 200mg tablet [YUMA],9909460,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-6994-46 - simethicone 125mg softgels [YUMA],9089509,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7000-61 - pregabalin 75mg capsule [YUMA],9181790,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7041-61 - allopurinol 100mg tablet [YUMA],10059313,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7047-61 - losartan potassium 25mg tablet [YUMA],9181258,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7061-87 - potassium chloride 10% UD 20mEq/15ml solution [YUMA],9977670,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7086-61 - potassium chloride 20mEq tablet [YUMA],10195928,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7123-61 - KEPPRA 250mg tablet [YUMA],10067712,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7124-61 - KEPPRA 500mg tablet [YUMA],10793867,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7127-61 - prednisone 20mg tablet [YUMA],10621217,CDM,250,RC,J7512,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7177-61 - furosemide 20mg tablet [YUMA],10063473,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7179-61 - traMADol 50mg tablet [YUMA],10198669,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7183-61 - docusate sodium 100mg capsule [YUMA],10067711,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7187-61 - atenolol 25mg tablet [YUMA],10913325,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7193-61 - famotidine 20mg tablet [YUMA],10735007,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7217-61 - diltiazem ER 120mg capsule [YUMA],10846481,CDM,250,RC,,HCPCS,outpatient,120,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7237-61 - diphenhydraMINE 25mg capsules [YUMA],11149498,CDM,250,RC,Q0163,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7276-92 - nystatin 500000 units/5 mL Susp [YUMA],10846813,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7591-61 - ferrous sulfate 325mg tablet [YUMA],8618584,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7623-31 - hydrocortisone 1% cream  28gm [YUMA],8753437,CDM,250,RC,,HCPCS,outpatient,28,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7725-24 - loperamide 2mg tablet [YUMA],9397768,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7809-61 - cyclobenzaprine 10mg tablet [YUMA],8618504,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00904-7914-61 - ibuprofen 200 mg Tab [YUMA],8848051,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7077-14 - potassium chloride 20mEq/50ml  inj=50ml [YUMA],9075873,CDM,250,RC,J3480,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7902-09 - Potassium Cl/D5/0.45% NaCl 1000ml [YUMA],9055052,CDM,250,RC,J3480,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7929-09 - Dextrose 5%/LR 1000ml [YUMA],10109284,CDM,250,RC,J7121,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7953-09 - Lactated Ringers 1000ml [YUMA],9603988,CDM,636,RC,J7120,HCPCS,both,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7983-03 - Sodium Chloride 0.9% 500ml [YUMA],9017482,CDM,250,RC,,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7983-09 - Sodium Chloride 1000 mL BOLUS [YUMA],8938666,CDM,636,RC,J7030,HCPCS,both,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7983-09 - Sodium Chloride% 0.9 1000ml [YUMA],8938667,CDM,258,RC,,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7984-36 - Sodium Chloride 0.9% 50ml [YUMA],9177282,CDM,250,RC,J7040,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
00990-7984-37 - Sodium Chloride 0.9% 100ml [YUMA],9207859,CDM,250,RC,J7040,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
01490-0039-04 - bismuth subsalicylate 262mg/15ml suspension [YUMA],8618435,CDM,250,RC,,HCPCS,outpatient,262,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
01490-0039-42 - bismuth subsalicylate 262mg/15ml suspension [YUMA],8764482,CDM,250,RC,,HCPCS,outpatient,262,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
05732-0868-93 - phenyleph/pram/glycerin/petrolatum oint 26gm [YUMA],8859611,CDM,250,RC,,HCPCS,outpatient,26,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
08290-3064-24 - heparin lock flush 100units/ml  inj=5ml [YUMA],9816211,CDM,636,RC,J1642,HCPCS,both,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
08290-3065-44 - sodium chloride FLUSH 0.9%  3ml syringe [YUMA],8618880,CDM,272,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
08290-3065-46 - sodium chloride FLUSH 0.9%  10ml syringe [YUMA],8618881,CDM,272,RC,A4216,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
09958-0033-61 - leptospermum honey oint 1.5 oz [YUMA],8859610,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10006-0700-28 - magnesium oxide 400 mg Tab [YUMA],9075952,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10006-0700-33 - vitamin D 1000 IU tablet [YUMA],8837826,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10006-0700-34 - vitamin E 400 IU Cap [YUMA],8853659,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10006-0730-43 - cyanocobalamin 1000 mcg Tab [YUMA],9220126,CDM,250,RC,,HCPCS,outpatient,1000,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10019-0553-03 - scopolamine 1.5 mg Fil [YUMA],8756232,CDM,250,RC,,HCPCS,outpatient,1.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10019-0938-01 - cyclophosphamide 500mg PWVL CHEMO [YUMA],8618505,CDM,250,RC,J9070,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10019-0957-01 - cyclophosphamide 2gm PWVL CHEMO [YUMA],9220154,CDM,250,RC,J9070,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10122-0325-10 - niCARdipine 40 mg/200 mL-NaCl 0.83% Sol [YUMA],8631519,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10223-0201-03 - benzocaine/tetracine 14-2-2% spray [YUMA],8618426,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
10223-0201-04 - benzocaine/tetracine 14-2-2% spray [YUMA],10913324,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11523-7268-08 - polyethylene UD 17gm powder [YUMA],8618828,CDM,250,RC,,HCPCS,outpatient,17,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11704-0370-01 - CYANOKIT hydroxocobalamin 5gm inj [YUMA],8618653,CDM,250,RC,,HCPCS,outpatient,5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11704-0620-01 - atropine-pralidoxime 2.1 mg/0.7 mL-600 mg/2 mL Sol [YUMA],8808744,CDM,250,RC,,HCPCS,outpatient,2.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
12870-0001-01 - silver nitrate sticks 75units applicator [YUMA],8618872,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
12870-0001-02 - silver nitrate sticks 75units applicator [YUMA],8833468,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13107-0154-30 - PARoxetine 10mg tablet [YUMA],8618811,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0318-01 - Rabies Immune Globulin 300units/1ml  inj=1ml [YUMA],8618856,CDM,636,RC,90375,HCPCS,both,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0318-05 - Rabies Immune Globulin 300units/1ml  inj=5ml [YUMA],8618855,CDM,636,RC,90375,HCPCS,both,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0631-02 - RHo (D) immune globulin 1500 intl units Sol [YUMA],8773109,CDM,250,RC,J2790,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0634-02 - Tetanus Immune Globulin 250 units syringe [YUMA],8618905,CDM,250,RC,J1670,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0636-03 - hepatitis B immune globulin 110U/0.5ml  inj=0.5ml [YUMA],8618639,CDM,250,RC,J1571,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0800-12 - immune globulin 10% soln 1GM/10ml [YUMA],9712230,CDM,636,RC,J1561,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0800-20 - immune globulin 10% soln 5GM/50ml [YUMA],9712237,CDM,636,RC,J1561,HCPCS,both,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0800-24 - immune globulin 10% soln 20Gm/200ml [YUMA],9002110,CDM,250,RC,J1561,HCPCS,outpatient,200,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0800-40 - immune globulin 10% soln 40Gm/400ml [YUMA],8975937,CDM,250,RC,J1561,HCPCS,outpatient,400,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
13533-0800-71 - immune globulin 10% soln 10Gm/100 ml [YUMA],8868251,CDM,250,RC,J1561,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
14789-0104-05 - succinylcholine 200mg/10ml  inj=10ml [YUMA],10102501,CDM,250,RC,J0330,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
15054-0043-01 - irinotecan liposome inj 43mg/10ml (CHEMO) [YUMA],8776415,CDM,250,RC,J9205,HCPCS,outpatient,43,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0004-15 - simvaSTATIN 10mg tablet [YUMA],9252266,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0035-10 - anastrozole 1mg tablet [YUMA],8618398,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0035-15 - anastrozole 1mg tablet CHEMO [YUMA],8618399,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0090-10 - finasteride 5mg tablet [YUMA],8618587,CDM,250,RC,S0138,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0114-31 - etoposide 20mg/ml  inj=5ml CHEMO [YUMA],8618575,CDM,250,RC,J9181,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0183-01 - hydroCHLOROthiazide 25mg tablet [YUMA],8746758,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0267-64 - docetaxel 20mg/ml  inj=4ml CHEMO [YUMA],8618540,CDM,250,RC,J9171,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0276-38 - fluorouracil inj 50mg/ml inj=100ml vial (CHEMO) [YUMA],8774738,CDM,636,RC,J9190,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0276-68 - fluorouracil 50mg/ml  inj=10ml CHEMO [YUMA],8755618,CDM,250,RC,J9190,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0295-31 - carboplatin 10mg/ml  inj=5ml CHEMO [YUMA],8618461,CDM,250,RC,J9045,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0295-34 - carboplatin 10mg/ml  inj=45ml CHEMO [YUMA],8618460,CDM,250,RC,J9045,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0298-05 - ondansetron 4mg/2ml  inj=20ml CHEMO [YUMA],8618795,CDM,250,RC,J2405,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0332-03 - oxaliplatin 5 mg/mL  inj=10 mL CHEMO [YUMA],8809397,CDM,250,RC,J9263,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0332-05 - oxaliplatin 100mg/20ml  inj=20ml CHEMO [YUMA],8848582,CDM,250,RC,J9263,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0426-05 - gemcitabine 100mg/ml  inj=20ml CHEMO [YUMA],8618613,CDM,250,RC,J9201,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0471-08 - glycopyrrolate 0.2mg/ml  inj=1ml [YUMA],9468251,CDM,250,RC,,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0493-45 - succinylcholine 200mg/10ml  inj=10ml [YUMA],9478722,CDM,636,RC,J0330,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0512-43 - atropine 0.4mg/ml  inj=20ml [YUMA],10104322,CDM,250,RC,J0461,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16729-0533-08 - cyanocobalamin 1000mcg/1ml inj [YUMA],10887633,CDM,250,RC,J3420,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
16837-0855-14 - famotidine 20mg tablet [YUMA],9084324,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17238-0900-11 - fluorescein strips [YUMA],9337889,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0060-12 - polyvinyl alcohol solution 15ml drops [YUMA],8618786,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0062-35 - lanolin/mineral oil/petroleum 3.5gm ointment [YUMA],8618787,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0102-12 - tropicamide ophthalmic 1% Sol [YUMA],8631536,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0171-30 - levalbuterol 1.25mg/0.5ml unit dose [YUMA],8618684,CDM,250,RC,J7612,HCPCS,outpatient,1.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0201-02 - phenylephrine hcl opth soln 2.5% [YUMA],8774241,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0201-15 - phenylephrine hcl opth soln 2.5% [YUMA],9078920,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0206-05 - phenylephrine hcl opth soln 10% 5ml [YUMA],8802359,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0215-02 - atropine sulfate-EYES 1% solution 2ml [YUMA],8618412,CDM,250,RC,,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0284-35 - gentamicin EYES 0.3% ointment 3.5gm [YUMA],8618619,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0404-01 - fluorescein strips [YUMA],8618594,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0542-02 - adenosine 3mg/ml  inj=2ml [YUMA],8755802,CDM,250,RC,J0153,HCPCS,outpatient,3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0711-10 - lidocaine 2% jelly  5ml [YUMA],8618705,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0711-31 - lidocaine 2% jelly  5ml [YUMA],9580214,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0850-10 - esomeprazole sodium 40mg powder [YUMA],8618572,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0934-01 - hydrALAZINE hcl 20mg/ml  inj=1ml [YUMA],8746745,CDM,250,RC,J0360,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0953-02 - adenosine 3mg/ml  inj=2ml [YUMA],8618369,CDM,250,RC,J0153,HCPCS,outpatient,3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
17478-0955-10 - ePHEDrine sulfate 50mg/ml  inj=1ml [YUMA],8618558,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0166-41 - Tranexamic Acid (TXA) 100mg/1ml  inj=10ml [YUMA],9040929,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0194-01 - NIFEdipine 10mg capsule [YUMA],9181793,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0288-01 - acetaZOLAMIDE 250mg tablet [YUMA],8618362,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0290-41 - amikacin sulfate 250mg/1ml  inj=2ml [YUMA],8618382,CDM,250,RC,J0278,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0497-42 - prochlorperazine 5mg/1ml  inj=2ml [YUMA],8618844,CDM,250,RC,J0780,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0662-03 - calcitriol 0.25mcg gelcap [YUMA],8618450,CDM,250,RC,,HCPCS,outpatient,0.25,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
23155-0785-41 - amikacin sulfate 250mg/1ml  inj=2ml [YUMA],9699488,CDM,636,RC,J0278,HCPCS,both,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0446-05 - besifloxacin ophthalmic 0.6% Sus [YUMA],8631539,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0539-20 - acetylcholine ophthalmic 1% Pow [YUMA],8631541,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0631-10 - neomycin mix OTIC 1.75mg/10ml drops [YUMA],8618648,CDM,250,RC,,HCPCS,outpatient,1.75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0670-04 - sulfacetamide sodium 10% opth drops [YUMA],10165295,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0780-55 - neomycin mix OPTHALMIC 3.5gm ointment [YUMA],8618420,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0785-55 - bacitracin/HC/neomycin/polymyxin B ophthalmic Oint 3.5gm [YUMA],8802375,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0795-35 - neomycin/polymyxin/dexamethasone 0.1%  OPHTH 3.5gm oint [YUMA],9078922,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24208-0910-55 - erythromycin OPTHALMIC 3.5gm 0.5% ointment [YUMA],8618570,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
24338-0134-02 - erythromycin ethylsuccinate 200mg/5ml susp 100ml [YUMA],8618569,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0115-04 - clindamycin 600mg/4ml  inj=4ml [YUMA],8810824,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0115-06 - clindamycin 900 mg/6mL  inj=6ml [YUMA],8806318,CDM,250,RC,,HCPCS,outpatient,900,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0118-10 - cefuroxime 750mg vial [YUMA],8618474,CDM,250,RC,J0697,HCPCS,outpatient,750,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0174-15 - DAPTOmycin 500mg inj [YUMA],9591135,CDM,636,RC,J0878,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0184-66 - fluconazole PREMIX 200mg/100ml  inj=100ml [YUMA],9951187,CDM,636,RC,J1450,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0184-82 - fluconazole PREMIX 200mg/100ml  inj=100ml [YUMA],8618591,CDM,250,RC,J1450,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0234-10 - gemcitabine 200mg PWVL CHEMO [YUMA],8618614,CDM,250,RC,J9201,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0302-66 - amiodarone 50mg/1ml  inj=3ml [YUMA],9399655,CDM,636,RC,J0282,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0311-02 - furosemide 20mg/2ml  inj=2ml [YUMA],10655836,CDM,250,RC,J1940,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0314-10 - esmolol hcl inj 100mg/10ml  inj=10ml,9559742,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0601-03 - caffeine citrate 20 mg/mL soln Inj=3ml [YUMA],9708839,CDM,636,RC,J0706,HCPCS,both,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0783-05 - palonosetron hcl 0.05mg/ml  inj=5ml CHEMO [YUMA],8750335,CDM,250,RC,J2469,HCPCS,outpatient,0.05,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0790-02 - prochlorperazine 5mg/1ml  inj=2ml [YUMA],10115051,CDM,250,RC,J0780,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0812-30 - acetylcysteine 6GM/30ml  inj=30ml [YUMA],9176855,CDM,250,RC,J0132,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0814-30 - leucovorin calcium 100mg PWVL CHEMO [YUMA],8618681,CDM,250,RC,J0640,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0816-30 - leucovorin calcium 350mg PWVL CHEMO [YUMA],9526238,CDM,636,RC,J0640,HCPCS,both,350,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0825-82 - levofloxacin 500mg/100ml  inj=100ml [YUMA],8741014,CDM,250,RC,J1956,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0826-67 - zoledronic acid 4mg/100ml  inj=100ml CHEMO [YUMA],10102502,CDM,250,RC,J3489,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0826-82 - zoledronic acid 4mg/100ml  inj=100ml CHEMO [YUMA],10030782,CDM,636,RC,J3489,HCPCS,both,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
25021-0830-82 - zoledronic acid 5mg/100ml  inj=100ml [YUMA],9815071,CDM,636,RC,J3489,HCPCS,both,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
28595-0120-49 - nitroglycerin 0.4mg spray [YUMA],9252706,CDM,250,RC,,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
29300-0126-13 - bisoprolol 5mg tablet [YUMA],8618436,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
29300-0172-16 - memantine 10mg tablet [YUMA],8618727,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
29300-0188-13 - bisoprolol/hctz 5-6.25mg tablet [YUMA],8618437,CDM,250,RC,,HCPCS,outpatient,6.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
31604-0012-81 - thiamine 100 mg Tab [YUMA],9951227,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
31722-0777-01 - acyclovir 400mg tablet [YUMA],8618366,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
33342-0111-07 - montelukast sodium 5mg chew tablet [YUMA],8618757,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
36000-0033-10 - metorpolol TARTRATE 5mg/5ml  inj=5ml [YUMA],9908995,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
36000-0047-24 - levofloxacin 500mg/100ml  inj=100ml [YUMA],8618690,CDM,250,RC,J1956,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
36000-0283-25 - furosemide 40mg/4ml  inj=4ml [YUMA],10094037,CDM,636,RC,J1940,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
36000-0322-02 - labetalol hcl 5mg/ml  100mg/20ml inj [YUMA],9608433,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
37000-0024-04 - psyllium 3.4 g/5.8 g Pow [YUMA],8773094,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
37000-0741-08 - psyllium 3.4gm packet [YUMA],8618853,CDM,250,RC,,HCPCS,outpatient,3.4,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
37205-0295-65 - simethicone 125mg softgels [YUMA],8774238,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
37205-0557-72 - fish oil 1000mg softgels [YUMA],8774236,CDM,250,RC,,HCPCS,outpatient,1000,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
39822-1001-07 - Tranexamic Acid (TXA) 100mg/1ml  inj=10ml [YUMA],8618915,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
39822-1100-01 - folic acid 5mg/ml  inj=10ml [YUMA],10599075,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
39822-2000-01 - Clonidine 1000mcg/10mLfor epidural inj [YUMA],8802398,CDM,250,RC,J0735,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
40093-0106-03 - ascorbic acid 1000 mg tab [YUMA],10794837,CDM,250,RC,,HCPCS,outpatient,1000,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
41167-4131-04 - fexofenadine 60mg tablet [YUMA],8774205,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0104-01 - tuberculin PPD 5TU/0.1ml   inj=0.1ml [YUMA],8618921,CDM,250,RC,,HCPCS,outpatient,0.1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0116-25 - oxytocin 10units/1ml  inj=1ml [YUMA],8746698,CDM,250,RC,J2590,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0123-06 - dantrolene 20 mg Pow [YUMA],8631528,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0159-25 - EPINEPHrine 1mg/ml  inj=1 ml [YUMA],8618562,CDM,250,RC,J0171,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0164-10 - vasopressin 20units/1ml  inj=1ml [YUMA],9468076,CDM,250,RC,,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0164-25 - vasopressin 20units/1ml  inj=1ml [YUMA],8618928,CDM,250,RC,,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0168-01 - EPINEPHrine 1mg/ml  inj=30ml [YUMA],8618563,CDM,250,RC,J0171,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42023-0168-99 - EPINEPHrine 1mg/ml  inj=30ml [YUMA],9468255,CDM,636,RC,J0171,HCPCS,both,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42292-0039-20 - levothyroxine 112mcg tablet [YUMA],8618693,CDM,250,RC,,HCPCS,outpatient,112,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42571-0265-75 - nitroprusside 25mg/ml  inj=2ml [YUMA],8618778,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42658-0010-01 - cladribine 1mg/ml  inj=10ml CHEMO [YUMA],9380431,CDM,636,RC,J9065,HCPCS,both,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42806-0151-34 - azithromycin 200mg/5ml suspension  30ml [YUMA],8802642,CDM,250,RC,Q0144,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42858-0001-10 - oxyCODONE IR 5mg tablet [YUMA],10600451,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
42858-0301-25 - hydromorphone hcl 2mg tablet [YUMA],8618652,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43066-0007-10 - rocuronium 50 mg/5 mL Sol [YUMA],8863531,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43066-0018-01 - oxaliplatin 100mg/20ml  inj=20ml CHEMO [YUMA],8750316,CDM,250,RC,J9263,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43066-0150-10 - amiodarone PREMIX 150mg/100ml IVPB [YUMA],8618387,CDM,250,RC,J0282,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43066-0360-20 - amiodarone PREMIX 360mg/200ml IVPB [YUMA],8618385,CDM,250,RC,J0282,HCPCS,outpatient,360,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43386-0160-06 - misoprostol 100mcg tablet [YUMA],8618755,CDM,250,RC,,HCPCS,outpatient,100,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43386-0440-24 - NIFEdipine 10mg capsule [YUMA],8618771,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43547-0269-10 - roPINIRole hcl 0.5mg tablet [YUMA],8618867,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43547-0275-03 - donepezil 5mg tablet [YUMA],8618543,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43547-0336-10 - benazepril 10mg tablet [YUMA],8618423,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43547-0406-10 - clonazePAM 0.5 mg Tab [YUMA],8805831,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43547-0543-25 - glycopyrrolate 0.2mg/ml  inj=1ml [YUMA],10674405,CDM,250,RC,,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0331-11 - zoledronic acid 5mg/100ml  inj=100ml [YUMA],8853589,CDM,250,RC,J3489,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0405-16 - vitamin K-ADULT 10mg/1ml  inj=1ml [YUMA],8812453,CDM,250,RC,J3430,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0413-11 - DAPTOmycin 500mg inj [YUMA],10190011,CDM,250,RC,J0878,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0436-11 - nitroglycerin 0.4mg tablet [YUMA],8743074,CDM,250,RC,,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0698-58 - carboprost 250mcg/ml inj soln [YUMA],8773110,CDM,250,RC,,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0721-01 - hydroxychloroquine sulfate 200 mg tab [YUMA],8862637,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43598-0752-60 - buPROPion ER 150mg tablet [YUMA],10600452,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
43825-0102-01 - acetaminophen 10mg/ml 100ml inj [YUMA],8618123,CDM,250,RC,J0131,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0221-10 - nafcillin sodium 1gm vial [YUMA],9007799,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0240-10 - cefepime 1gm vial [YUMA],9007800,CDM,250,RC,J0692,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0436-24 - levofloxacin 500mg/100ml  inj=100ml [YUMA],8802641,CDM,250,RC,J1956,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0437-24 - levofloxacin 750mg/150ml  inj=150ml [YUMA],8741052,CDM,250,RC,J1956,HCPCS,outpatient,750,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0707-25 - ceFAZolin 1 g Pow [YUMA],8741056,CDM,250,RC,J0690,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
44567-0802-10 - piperacillin tazobactam 3.375gm vial [YUMA],10491142,CDM,250,RC,J2543,HCPCS,outpatient,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45802-0059-35 - nystatin 100MU/GM cream  15gm [YUMA],8618783,CDM,250,RC,,HCPCS,outpatient,15,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45802-0060-70 - bacitracin 500u/gm packets [YUMA],8618419,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45802-0395-04 - vitamin A & D topical - Oint 120 g [YUMA],8802643,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45802-0730-30 - acetaminophen 650mg suppository [YUMA],8618128,CDM,250,RC,,HCPCS,outpatient,650,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
45802-0732-30 - acetaminophen 120mg suppository [YUMA],8618124,CDM,250,RC,,HCPCS,outpatient,120,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
46287-0006-60 - sodium polystyrene sulfonate 15g/60ml suspension [YUMA],8618887,CDM,250,RC,,HCPCS,outpatient,60,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47335-0703-52 - albuterol 2.5mg unit dose  inh=3ml [YUMA],9867071,CDM,636,RC,J7613,HCPCS,both,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47426-0301-02 - bupivacaine-meloxicam 400 mg-12 mg/14 mL ER soln [YUMA],10925154,CDM,250,RC,C9088,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0303-01 - nitrofurantoin mono MACROcrystals  100mg capsule [YUMA],8618773,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0384-26 - oseltamivir phosphate 6mg/ml  60ml suspension [YUMA],8618800,CDM,250,RC,,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0586-29 - labetalol hcl 5mg/ml  100mg/20ml inj [YUMA],8764710,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0587-17 - metorpolol TARTRATE 5mg/5ml  inj=5ml [YUMA],8764434,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0588-68 - midazolam 2mg/2ml inj=2ml [YUMA],9001020,CDM,250,RC,J2250,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0593-07 - paclitaxel inj 6mg/ml 30mg/5ml vial (CHEMO) [YUMA],8776410,CDM,250,RC,J9267,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0597-91 - vancomycin 1gm vial [YUMA],8618924,CDM,250,RC,J3370,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
47781-0598-91 - vancomycin 500mg vial [YUMA],8618926,CDM,250,RC,J3370,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
48582-0512-01 - biotene 1.5 oz jelly [YUMA],8618869,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0120-65 - influenza virus vaccine,9089566,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0121-65 - influenza virus vaccine,9663757,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0122-65 - influenza virus vaccine,10318501,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0215-15 - tetanus-diphtheria toxoids adult/adol (Td) inj 0.5ml [YUMA],8805849,CDM,636,RC,90714,HCPCS,both,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0286-10 - diphtheria/tetanus/pertussis (DTaP) ped [YUMA],8849111,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0400-20 - tetanus diptheria pertussis (Tdap) inj=0.5ml [YUMA],8618906,CDM,250,RC,90715,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0405-65 - influenza virus vaccine,8858903,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0420-10 - influenza virus vaccine,9087419,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0420-50 - influenza virus vaccine,9087617,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0421-50 - influenza virus vaccine,9662810,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0422-50 - influenza virus vaccine,10301191,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0510-05 - diphth/haemophilus/pertussis/tetanus/polio - Kit [YUMA],8850208,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0519-25 - influenza virus vaccine,8858900,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0545-03 - haemophilus b conjugate (ActHIB) inj=0.5ml [YUMA],8849097,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0589-05 - meningococcal conjugate vaccine-MCV4 0.5ml [YUYMA],8810016,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0590-05 - meningococcal conjugate vaccine group ACYW soln [YUMA],10257983,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0631-15 - YUMA90658,8858898,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0633-15 - influenza virus vaccine 20-21 QIV MDV [YUMA],9087618,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0635-15 - influenza virus vaccine,9662813,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0637-15 - influenza virus vaccine,10302967,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0752-21 - tuberculin PPD 5TU/0.1ml   inj=0.1ml [YUMA],8764455,CDM,250,RC,,HCPCS,outpatient,0.1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49281-0860-10 - poliovirus vaccine,8849167,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49483-0222-06 - nitroglycerin ER 6.5mg capsule [YUMA],8753440,CDM,250,RC,,HCPCS,outpatient,6.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49483-0481-12 - aspirin 81mg Enteric Coated [YUMA],9458273,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49502-0101-02 - epinephrine injector-PED   inj=0.15mg [YUMA],9075880,CDM,250,RC,J0171,HCPCS,outpatient,0.15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49502-0102-02 - epinephrine injector-ADULT   inj=0.3mg [YUMA],9172910,CDM,250,RC,J0171,HCPCS,outpatient,0.3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49502-0500-02 - epinephrine injector-ADULT   inj=0.3mg [YUMA],8618560,CDM,250,RC,J0171,HCPCS,outpatient,0.3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49502-0501-02 - epinephrine injector-PED   inj=0.15mg [YUMA],8618559,CDM,250,RC,J0171,HCPCS,outpatient,0.15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49580-0329-01 - magnesium citrate oral soln 10oz bottle [YUMA],8773112,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49884-0161-11 - calcitonin 200 IU/dose intranasal [YUMA],8618448,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
49884-0465-65 - cholestyramine 4gm packet [YUMA],8618485,CDM,250,RC,,HCPCS,outpatient,4,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0041-64 - alteplase 2mg  [YUMA],8618380,CDM,250,RC,J2997,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0051-21 - rituximab 10mg/ml   inj=10ml CHEMO [YUMA],8618863,CDM,250,RC,J9312,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0053-06 - rituximab 10mg/ml   inj=50ml CHEMO [YUMA],8618864,CDM,250,RC,J9312,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0060-01 - bevacizumab 25mg/ml  inj=4ml CHEMO [YUMA],8618431,CDM,250,RC,J9035,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0061-01 - bevacizumab 25mg/ml  inj=16ml CHEMO [YUMA],8618432,CDM,250,RC,J9035,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0085-27 - alteplase 100mg  inj=100ml [YUMA],8618379,CDM,250,RC,J2997,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0120-47 - tenecteplase 50 mg inj [YUMA],8805845,CDM,250,RC,J3101,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0132-01 - trastuzumab 150mg PWVL CHEMO [YUMA],8618916,CDM,250,RC,J9355,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0136-01 - tocilizumab 200mg/10ml soln [YUMA],11004144,CDM,250,RC,J3262,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0137-01 - tocilizumab 400mg/20ml soln [YUMA],11006875,CDM,250,RC,J3262,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0150-01 - ocrelizumab 300 mg/10 mL Soln [YUMA],8918073,CDM,250,RC,J2350,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0215-01 - Xolair (omalizumab) 150mg prefilled syringe [YUMA],8618790,CDM,250,RC,J2357,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50242-0917-01 - atezolizumab 1200 mg/20 mL soln [YUMA],10004194,CDM,636,RC,J9022,HCPCS,both,1200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0098-15 - azithromycin 250mg tablet [YUMA],8618416,CDM,250,RC,Q0144,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0130-15 - bumetanide 0.5mg tablet [YUMA],8618441,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0350-15 - gemfibrozil 600mg tablet [YUMA],8618615,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0522-15 - meclizine 12.5mg tablet [YUMA],8743073,CDM,250,RC,,HCPCS,outpatient,12.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0525-15 - meloxicam 7.5mg tablet [YUMA],8618726,CDM,250,RC,,HCPCS,outpatient,7.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0574-15 - montelukast sodium 5mg chew tablet [YUMA],8756230,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0695-15 - risperiDONE 0.5mg tablet [YUMA],8741587,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0730-15 - sulfaSALAzine 500mg tablet [YUMA],8618899,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50268-0765-15 - terazosin hcl 2mg capsule [YUMA],9304273,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50383-0363-17 - lidocaine 2% VISCOUS SOLUTION 20mg/ml  15ml solution [YUMA],11182794,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50383-0775-17 - lidocaine 2% VISCOUS SOLUTION 20mg/ml  15ml solution [YUMA],8618704,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50383-0779-17 - lactulose 10gm/15ml syrup [YUMA],8618680,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50383-0824-16 - sulfamethoxazole/trimethoprim 200-40mg/5ml susp [YUMA],9572230,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50419-0424-01 - levonorgestrel 19.5 mg IUD kit [YUMA],9916545,CDM,636,RC,J7296,HCPCS,both,19.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50458-0564-01 - paliperidone ER inj susp 234 mg/1.5 mL [YUMA],9526239,CDM,636,RC,J2426,HCPCS,both,234,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50458-0578-30 - rivaroxaban 15mg tablet [YUMA],8618866,CDM,250,RC,,HCPCS,outpatient,15,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50458-0580-30 - rivaroxaban 10mg tablet [YUMA],8618865,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50632-0010-01 - rabies vaccine 2.5IU/1ml  inj=1ml [YUMA],10101341,CDM,250,RC,90675,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50633-0120-11 - digoxin immune fab 40mg vial [YUMA],8618528,CDM,250,RC,J1162,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50742-0484-01 - bortezomib 3.5mg PWVL CHEMO [YUMA],10103456,CDM,636,RC,J9041,HCPCS,both,3.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50742-0505-04 - scopolamine 1.5 mg Fil [YUMA],10067688,CDM,250,RC,,HCPCS,outpatient,1.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
50742-0620-01 - NIFEdipine ER 30mg tablet [YUMA],8618772,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0023-20 - metolazone 2.5mg tablet [YUMA],8618743,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0072-20 - furosemide 20mg tablet [YUMA],8618609,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0073-20 - furosemide 40mg tablet [YUMA],8618611,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0103-20 - spironolactone 25mg tablet [YUMA],8744184,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0141-20 - chlordiazePOXIDE 25mg capsule [YUMA],8618480,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0170-20 - metoprolol SUCCINATE 50mg tablet [YUMA],8743004,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0205-20 - allopurinol 100mg tablet [YUMA],9603098,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0208-20 - atorvaSTATIN 10mg tablet [YUMA],8618409,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0255-20 - metoprolol TARTRATE 25mg tablet [YUMA],8829995,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0285-20 - diazepam 5mg tablet [YUMA],10198951,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0299-20 - cloNIDine 0.1mg tablet [YUMA],8618496,CDM,250,RC,,HCPCS,outpatient,0.1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0306-30 - polyethylene UD 17gm powder [YUMA],8744218,CDM,250,RC,,HCPCS,outpatient,17,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0425-20 - glimepiride 2mg tablet [YUMA],8743056,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0440-20 - levothyroxine 50mcg tablet  [YUMA],8618694,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0597-20 - cetirizine 10mg tablet [YUMA],8742994,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0733-20 - haloperidol 0.5mg tablet [YUMA],8618633,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0746-20 - diltiazem 60mg capsule [YUMA],8618534,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0759-20 - atenolol 25mg tablet [YUMA],8618408,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0788-20 - ALPRAZolam 0.25mg tablet [YUMA],8618378,CDM,250,RC,,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0935-20 - triamterene/HCTZ 37.5/25mg capsules [YUMA],8618644,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0937-20 - terazosin hcl 2mg capsule [YUMA],8618903,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0966-20 - famotidine 20mg tablet [YUMA],8618578,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0985-20 - busPIRone 5mg tablet [YUMA],8618447,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51079-0991-20 - traMADol 50mg tablet [YUMA],9182519,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51248-0150-01 - solifenacin succinate 5mg tablet [YUMA],8764417,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51645-0785-99 - magnesium oxide 400mg tablet [YUMA],8769783,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51645-0905-99 - thiamine 100 mg Tab [YUMA],8773097,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51672-1275-01 - clotrimazole 1% cream  15gm [YUMA],8618498,CDM,250,RC,,HCPCS,outpatient,15,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51672-1312-00 - mupirocin 2% ointment [YUMA],8618765,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51754-0203-02 - verapamil 2.5mg/ml  inj=2ml [YUMA],8618933,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51754-1000-04 - magnesium sulfate 50% 5gm/10ml  inj=10ml [YUMA],8618721,CDM,250,RC,J3475,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51754-5060-01 - BETAmethasone 6mg/ml   inj=5ml [YUMA],8812807,CDM,250,RC,J0702,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51991-0144-17 - methylergonovine maleate 0.2mg/ml  inj=1ml [YUMA],8618733,CDM,250,RC,J2210,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51991-0893-33 - solifenacin succinate 5mg tablet [YUMA],8618890,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
51991-0934-98 - labetalol hcl 5mg/ml  100mg/20ml inj [YUMA],8746788,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
52244-0100-10 - theophylline 100mg capsules [YUMA],8618908,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
52817-0270-30 - bisoprolol 5mg tablet [YUMA],8876697,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
53276-1010-02 - Avitene microfibrillar [YUMA],8631522,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
53746-0544-01 - primidone 50 mg tab [YUMA],9751389,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
53746-0643-01 - flecainide acetate 150mg tablet [YUMA],8618588,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
54288-0103-10 - EPINEPHrine Preservative Free 1mg/ml  inj=1ml [YUMA],8618564,CDM,250,RC,J0171,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
54643-5649-01 - multivitamins for infusion  inj=10ml [YUMA],8618762,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
54643-9007-01 - multivitamins for infusion  inj=10ml [YUMA],8764447,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
54838-0117-40 - guaiFENesin 100mg/5ml suspension  120ml [YUMA],8618630,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55111-0145-12 - fluconazole 150mg tablet [YUMA],10053265,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55111-0688-52 - zoledronic acid 5mg/100ml  inj=100ml [YUMA],8618940,CDM,250,RC,J3489,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0113-10 - ampicillin 1gm inj [YUMA],10588176,CDM,250,RC,J0290,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0117-20 - ampicillin-sulbactam 3 g powdr [YUMA],9691062,CDM,636,RC,J0295,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0120-30 - piperacillin tazobactam 3.375gm vial [YUMA],8618825,CDM,250,RC,J2543,HCPCS,outpatient,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0122-15 - nafcillin sodium 1gm vial [YUMA],9699482,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0154-10 - acyclovir 50mg/ml  inj=10ml [YUMA],8618367,CDM,250,RC,J0133,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0167-10 - bupivacaine 0.25%  inj=10ml [YUMA],8776490,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0169-10 - bupivacaine 0.5%  inj=10ml [YUMA],8618443,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0173-05 - SUMAtriptan succinate 6mg/0.5ml  inj=0.5ml [YUMA],8618900,CDM,250,RC,J3030,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0174-10 - azithromycin 500mg inj [YUMA],8618417,CDM,250,RC,J0456,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0177-05 - KEPPRA 500mg/5ml  inj=5ml [YUMA],8618686,CDM,250,RC,J1953,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0185-05 - esomeprazole sodium 40mg powder [YUMA],9401445,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0186-05 - palonosetron hcl 0.05mg/ml  inj=5ml CHEMO [YUMA],8618809,CDM,250,RC,J2469,HCPCS,outpatient,0.05,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0188-10 - Tranexamic Acid (TXA) 100mg/1ml  inj=10ml [YUMA],9827353,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0202-10 - pantoprazole 40mg inj [YUMA],9455444,CDM,636,RC,S0164,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0208-30 - meropenem 1 Gm powder vial  [YUMA],8773093,CDM,250,RC,J2185,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0221-10 - etomidate 2mg/ml  inj=10ml [YUMA],8749305,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0236-20 - vecuronium bromide 1mg/1ml  inj=20ml [YUMA],8618929,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0251-10 - lidocaine 1%  inj=10ml [YUMA],8618698,CDM,636,RC,J2001,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0254-10 - lidocaine 2%  inj=10ml [YUMA],8741729,CDM,250,RC,J2001,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0255-20 - lidocaine 2%  inj=20ml [YUMA],8618702,CDM,636,RC,J2001,HCPCS,both,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0259-30 - acetylcysteine 6GM/30ml  inj=30ml [YUMA],8742991,CDM,250,RC,J0132,HCPCS,outpatient,30,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0266-05 - zoledronic acid 4mg/5ml  inj=5ml [YUMA],8618939,CDM,250,RC,J3489,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0282-09 - ertapenem 1gm inj [YUMA],8725712,CDM,250,RC,J1335,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0282-20 - ertapenem 1gm inj [YUMA],8618568,CDM,250,RC,J1335,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0304-25 - DEXAmethasone 10mg/ml  inj=1ml PF  [YUMA],9630525,CDM,636,RC,J1100,HCPCS,both,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0322-25 - furosemide 20mg/2ml  inj=2ml [YUMA],9566164,CDM,636,RC,J1940,HCPCS,both,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0332-01 - oxaliplatin 100mg/20ml  inj=20ml CHEMO [YUMA],9893465,CDM,636,RC,J9263,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0344-01 - DAPTOmycin 500mg inj [YUMA],10715734,CDM,250,RC,J0878,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55150-0345-10 - naloxone hcl 1mg/ml  inj=2ml [YUMA],10767201,CDM,250,RC,J2310,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0023-04 - darbepoetin alfa 60mcg/0.3ml  inj=0.3ml [YUMA],8618509,CDM,250,RC,J0881,HCPCS,outpatient,0.3,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0192-01 - pegfilgrastim 6mg/0.6ml kit CHEMO [YUMA],8618813,CDM,250,RC,J2505,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0207-01 - bevacizumab awwb 400mg/16ml soln [YUMA],10004213,CDM,636,RC,Q5107,HCPCS,both,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0224-01 - riTUXimab arrx 10 mg/mL soln CHEMO [YUMA],10549090,CDM,250,RC,Q5123,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0326-01 - riTUXimab arrx 500 mg/50mL soln CHEMO [YUMA],10544110,CDM,250,RC,Q5123,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0710-01 - denosumab 60mg/ml  inj=1ml [YUMA],8618513,CDM,250,RC,J0897,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0730-01 - denosumab 70mg/ml  inj=1.7ml CHEMO [YUMA],8618512,CDM,250,RC,J0897,HCPCS,outpatient,70,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0924-91 - filgrastim 300mcg/0.5ml  inj=0.5ml CHEMO [YUMA],8618586,CDM,250,RC,J1442,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0954-01 - panitumumab 100mg/5ml soln [YUMA],10448963,CDM,250,RC,J9303,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
55513-0956-01 - panitumumab 400mg/20ml soln [YUMA],10446932,CDM,250,RC,J9303,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57237-0005-11 - fluconazole 150mg tablet [YUMA],8618590,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57237-0018-30 - DULoxetine 30mg capsule [YUMA],8618548,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57644-0648-88 - chlorthalidone 25mg tab [YUMA],8773114,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57644-0663-83 - carvedilol ER 10mg capsule [YUMA],8773115,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57894-0030-01 - infliximab 100mg PWVL CHEMO [YUMA],8618660,CDM,250,RC,J1745,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57894-0350-01 - golimumab 50 mg/4 mL soln [YUMA],10865127,CDM,250,RC,J1602,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0102-01 - acetaminophen 325mg tablet [YUMA],8856032,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0381-24 - loperamide 2mg tablet [YUMA],8618711,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0504-01 - multivitamin tablet [YUMA],8618763,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0663-15 - calcium carbonate 500mg tablet [YUMA],8764513,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0746-06 - calcium carbonate 600mg tablet [YUMA],9220123,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
57896-0921-01 - aspirin 325mg Enteric Coated [YUMA],8618404,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0810-52 - diphtheria/tetanus/pertussis (DTaP) ped inj=0.5ml [YUMA],8849154,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0811-52 - diphtheria/hepB/pertussis,8849151,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0812-52 - diphtheria/pertussis,8849155,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0818-11 - haemophilus b conjugate (PRP-OMP) vaccine - Pow [YUMA],8849165,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0819-12 - zoster vaccine,8850211,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0820-52 - hepatitis B vaccine-Ped&Adol 10mcg/0.5ml  inj=0.5ml [YUMA],8618640,CDM,250,RC,90744,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0823-11 - zoster vaccine,10218658,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0964-12 - rabies vaccine 2.5IU/1ml  inj=1ml [YUMA],8618857,CDM,250,RC,90675,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58160-0976-20 - meningococcal group B vaccine recombinant,8850188,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
58980-0409-12 - glycerin 1gm suppository [YUMA],10986130,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59011-0410-20 - oxyCODONE CR 10mg tablet [YUMA],8618803,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59148-0046-70 - decitabine 50mg PWVL CHEMO [YUMA],8618511,CDM,250,RC,J0894,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59267-0078-04 - SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine 3mcg/0.2ml [YUMA],10197236,CDM,250,RC,91308,HCPCS,outpatient,0.2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59267-1000-03 - SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine 30mcg/0.3ml [YUMA],9669852,CDM,250,RC,91305,HCPCS,outpatient,0.2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59267-1055-04 - SARS-CoV-2 (COVID-19) mRNA BNT-162b2 vaccine 3mcg/0.2ml [YUMA],10194826,CDM,250,RC,91307,HCPCS,outpatient,0.2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59310-0304-80 - beclomethasone dipropionate 80mcg inhaler  10.6gm [YUMA],8618422,CDM,250,RC,,HCPCS,outpatient,80,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59572-0102-01 - azacitidine 100mg PWVL CHEMO [YUMA],8618414,CDM,250,RC,J9025,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59651-0295-01 - NIFEdipine ER 30mg tablet [YUMA],10038627,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59676-0360-01 - hyaluronan 30 mg/2 mL soln [YUMA],9486760,CDM,636,RC,J7324,HCPCS,both,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59746-0324-30 - valacyclovir 500mg tablet [YUMA],8618922,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-0016-01 - clindamycin 75mg/5ml solution  100ml [YUMA],8618493,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-0117-01 - mesalamine 400mg capsules [YUMA],8618730,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-0800-02 - tolterodine tartrate 2mg tablet [YUMA],8746769,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-3304-03 - nitroglycerin 0.4mg tablet [YUMA],8618775,CDM,250,RC,,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-5000-05 - sulfaSALAzine 500mg tablet [YUMA],8961837,CDM,250,RC,,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
59762-5007-01 - misoprostol 100mcg tablet [YUMA],9699481,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60258-0006-01 - sodium & potassium phosphate 7.125mEq powder [YUMA],8618835,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60267-0311-10 - sodium nitrite 30mg/ml  inj=10ml [YUMA],8618886,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60267-0705-50 - sodium thiosulfate 250mg/ml   inj=50ml [YUMA],8618889,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0080-00 - sotalol hcl 80mg tablet [YUMA],8618891,CDM,250,RC,,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0363-01 - ofloxacin 0.3% solution  5ml [YUMA],8618788,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0791-00 - enoxaparin 30mg  inj=0.3ml [YUMA],8818048,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0795-04 - enoxaparin 100mg  inj=1ml [YUMA],9218031,CDM,250,RC,J1650,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0823-06 - calcitonin 200 IU/dose intranasal [YUMA],10074248,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0829-01 - fluticasone NASAL spray 50mcg spray [YUMA],8618599,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-0830-01 - mometasone furoate 50mcg spray [YUMA],8618756,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-2656-01 - triamterene/HCTZ 37.5/25mg tablet [YUMA],9951225,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6128-00 - irinotecan hcl 20mg/ml  inj=2ml CHEMO [YUMA],9819084,CDM,636,RC,J9206,HCPCS,both,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6130-05 - ondansetron 4mg/2ml  inj=2ml  [YUMA],8618793,CDM,250,RC,J2405,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6132-07 - oxaliplatin 100mg/20ml  inj=20ml CHEMO [YUMA],8618801,CDM,250,RC,J9263,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6142-05 - ceFAZolin 1 g Pow [YUMA],9227578,CDM,250,RC,J0690,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6144-04 - cefepime 1gm vial [YUMA],8618467,CDM,250,RC,J0692,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6145-04 - cefepime 2gm vial [YUMA],8618468,CDM,250,RC,J0692,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6147-04 - cefepime 2gm vial [YUMA],10613161,CDM,250,RC,J0692,HCPCS,outpatient,2,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6157-04 - piperacillin tazobactam 3.375gm vial [YUMA],9234701,CDM,250,RC,J2543,HCPCS,outpatient,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6196-04 - ertapenem 1gm inj [YUMA],10495018,CDM,250,RC,J1335,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-6230-04 - paclitaxel protein-bound 100mg PWVL CHEMO [YUMA],10446934,CDM,250,RC,J9264,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-7006-02 - fentaNYL patch 25 mcg/hr [YUMA],8618581,CDM,250,RC,,HCPCS,outpatient,25,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-7007-00 - fentaNYL patch 50 mcg/hr [YUMA],8764440,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60505-7082-02 - fentaNYL patch 50 mcg/hr [YUMA],8618582,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60574-4113-01 - palivizumab 100 mg/mL Sol [YUMA],8850212,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0113-01 - cloNIDine 0.1mg tablet [YUMA],9397771,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0145-01 - prednisone 20mg tablet [YUMA],8787113,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0152-01 - cephalexin 250mg capsule [YUMA],8618476,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0156-25 - phenytoin 50mg chewable tablet [YUMA],8618820,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0195-01 - diltiazem ER 120mg capsule [YUMA],8618530,CDM,250,RC,,HCPCS,outpatient,120,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0242-01 - sertraline hcl 50mg tablet [YUMA],8618871,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0341-71 - potassium chloride 10% UD 20mEq/15ml solution [YUMA],8746747,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0381-94 - mephyton 5mg tablet [YUMA],8618823,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0389-21 - colchicine 0.6mg tablet [YUMA],8618500,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0418-01 - HYDROcodone/acetamin 10/325mg tablet [YUMA],8618131,CDM,250,RC,,HCPCS,outpatient,325,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0429-76 - magnesium hydroxide 2400mg/30ml suspension [YUMA],9827352,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0443-01 - traZADone 50mg tablet [YUMA],8618917,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0446-01 - ibuprofen 400mg tablet [YUMA],10494914,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0457-01 - ibuprofen 600mg tablet [YUMA],10067702,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0464-01 - levothyroxine 50mcg tablet  [YUMA],8808663,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0466-01 - potassium chloride 10mEq tablet [YUMA],9161147,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0481-21 - buprenorphine 2 mg SL tab [YUMA],10059397,CDM,250,RC,J0571,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0507-01 - gabapentin 600mg tab [YUMA],10913326,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0508-01 - levothyroxine 112mcg tablet [YUMA],8876696,CDM,250,RC,,HCPCS,outpatient,112,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0558-01 - cyclobenzaprine 10mg tablet [YUMA],11093861,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0576-86 - midazolam 10mg/5ml syrup unit dose [YUMA],9951188,CDM,636,RC,J2250,HCPCS,both,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0595-01 - famotidine 20mg tablet [YUMA],9956094,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0618-21 - fenofibrate 48 mg Tab [YUMA],9768531,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0622-01 - senna/docusate 8.6-50mg tablet [YUMA],10302080,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60687-0631-01 - metoclopramide 10mg tablet [YUMA],10913328,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60758-0018-05 - sulfacetamide sodium 10% opth drops [YUMA],8618888,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60793-0701-10 - penicillin G benzathine 1200000 units/2ml  inj=2ml [YUMA],8618815,CDM,250,RC,J0561,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
60977-0141-01 - pralidoxime 1gm inj [YUMA],8618836,CDM,250,RC,J2730,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61269-0343-56 - hydrocortisone 1% cream  28gm [YUMA],10202809,CDM,250,RC,,HCPCS,outpatient,28,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0016-01 - proparacaine ophthalmic 0.5% Sol [YUMA],8631533,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0204-15 - pilocarpine ophthalmic 2% Sol 15ml [YUMA],8802344,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0326-01 - filgrastim  480 mcg/0.8 mL Sol  Inj=0.8ml [YUMA],8945647,CDM,250,RC,Q5101,HCPCS,outpatient,0.8,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0631-36 - neomycin/polymyxin/dexamethasone 0.1%  OPHTH 3.5gm oint [YUMA],9580216,CDM,250,RC,,HCPCS,outpatient,3.5,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0633-05 - gentamicin EYES 0.3% drops 5ml [YUMA],8618618,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0637-05 - prednisolone acetate OPTHAL 1%  5ml suspension [YUMA],8618839,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61314-0665-05 - apraclonidine ophthalmic 0.5% Sol [YUMA],8631540,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61442-0102-60 - diclofenac 50mg tablet [YUMA],8618523,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61442-0451-01 - carisoprodol 350mg tablet [YUMA],8618462,CDM,250,RC,,HCPCS,outpatient,350,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61570-0131-40 - silver sulfadiazine 1%  400gm cream [YUMA],8746529,CDM,250,RC,,HCPCS,outpatient,400,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61703-0305-38 - cytarabine 20mg/ml  inj=5ml CHEMO [YUMA],8618506,CDM,250,RC,J9100,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61703-0309-06 - vincristine sulfate 1mg/ml  inj=1ml CHEMO [YUMA],8618935,CDM,250,RC,J9370,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61703-0309-25 - vincristine sulfate 1mg/ml  inj=1ml CHEMO [YUMA],9231421,CDM,250,RC,J9370,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61703-0342-22 - paclitaxel 100mg/16.7ml CHEMO [YUMA],8618807,CDM,250,RC,J9267,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61703-0350-38 - methorexate 25mg/ml  inj=2ml CHEMO [YUMA],8618732,CDM,250,RC,J9250,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61755-0026-01 - casirivimab 300 mg/2.5 mL Sol,9590083,CDM,636,RC,Q0243,HCPCS,both,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61755-0027-01 - imdevimab 300 mg/2.5 mL Sol,9590084,CDM,636,RC,Q0243,HCPCS,both,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61755-0039-01 - casirivimab-imdevimab 600 mg-600 mg/10 mL soln [YUMA],9690270,CDM,250,RC,Q0243,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61958-2901-01 - remdesivir 100 mg pwdr inj [YUMA],9085717,CDM,636,RC,J3490,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61990-0411-01 - DHE-dihydroergotamine mesylate 1mg/1ml  inj=1ml [YUMA],9397770,CDM,636,RC,J1110,HCPCS,both,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
61990-0611-02 - Tranexamic Acid (TXA) 100mg/1ml  inj=10ml [YUMA],9630526,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62332-0415-10 - oseltamivir 75mg capsule [YUMA],10599521,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62332-0508-17 - bromfenac opth soln 0.09% [YUMA],8776416,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62584-0897-01 - folic acid 1mg tablet [YUMA],8618601,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62756-0129-44 - pantoprazole 40mg inj [YUMA],11148776,CDM,250,RC,S0164,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62756-0517-88 - carbidopa/levodopa 10-100mg tablet [YUMA],8618457,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
62935-0303-30 - leuprolide 30 mg/4 months powder-Inj ER [YUMA],10148687,CDM,250,RC,J9217,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63020-0049-01 - bortezomib 3.5mg PWVL CHEMO [YUMA],8618438,CDM,250,RC,J9041,HCPCS,outpatient,3.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0010-02 - gentamicin sulfate 80mg/2ml  inj=2ml [YUMA],8753436,CDM,250,RC,J1580,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0012-12 - oxytocin 10units/1ml  inj=1ml [YUMA],8618806,CDM,250,RC,J2590,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0013-02 - thiamine hydrochloride 100mg/ml  inj=2ml [YUMA],8618909,CDM,250,RC,J3411,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0013-09 - thiamine hydrochloride 100mg/ml  inj=2ml [YUMA],9576843,CDM,636,RC,J3411,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0044-01 - cyanocobalamin 1000mcg/1ml inj [YUMA],8823721,CDM,250,RC,J3420,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0064-11 - magnesium sulfate 50% 5gm/10ml  inj=10ml [YUMA],8961785,CDM,250,RC,J3475,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0064-23 - magnesium sulfate 50% 1gm/2ml  inj=2ml [YUMA],8618722,CDM,250,RC,J3475,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0117-10 - fluorouracil 50mg/ml  inj=10ml CHEMO [YUMA],8618595,CDM,636,RC,J9190,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0117-69 - fluorouracil inj 50mg/ml inj=100ml vial (CHEMO) [YUMA],9526237,CDM,636,RC,J9190,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0128-20 - dacarbazine 200 mg powder CHEMO [YUMA],9287754,CDM,250,RC,J9130,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0137-20 - bleomycin 30 units CHEMO [YUMA],8980910,CDM,250,RC,J9040,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0140-10 - cladribine 1mg/ml  inj=10ml CHEMO [YUMA],8618490,CDM,250,RC,J9065,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0162-12 - ketorolac (IV) 30mg/ml  inj=1ml [YUMA],8618674,CDM,250,RC,J1885,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0165-01 - DEXAmethasone INJECTABLE 4mg/1ml  inj=1ml [YUMA],8957815,CDM,250,RC,J1100,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0184-10 - folic acid 5mg/ml  inj=10ml [YUMA],8618602,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0201-10 - lidocaine 1%  inj=10ml [YUMA],9609979,CDM,636,RC,J2001,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0208-05 - lidocaine 2% PF  inj=5ml [YUMA],10446938,CDM,250,RC,J2001,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0229-30 - protamine sulfate 10mg/ml   inj=25ml [YUMA],9572224,CDM,636,RC,J2720,HCPCS,both,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0229-35 - protamine sulfate 10mg/ml   inj=25ml [YUMA],8618850,CDM,250,RC,J2720,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0258-03 - methylPREDNISolone SUCCINATE 125mg/2ml  inj=2ml [YUMA],8618737,CDM,250,RC,J2930,HCPCS,outpatient,125,mg,$83.88 ,$62.91 ,,$77.17 ,92,,,$46.13 ,$81.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.13 ,55,,,$46.13 ,$81.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.13 ,$81.36 ,other,,Not applicable. No negotiated rates per contract,$72.14 ,86,,,$46.13 ,$81.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$67.10 ,80,,,$46.13 ,$81.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.13 ,55,,,$46.13 ,$81.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.69 ,95,,,$46.13 ,$81.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.69 ,95,,,$46.13 ,$81.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.91 ,75,,,$46.13 ,$81.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$71.30 ,85,,,$46.13 ,$81.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.36 ,97,,,$46.13 ,$81.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.13 ,55,,,$46.13 ,$81.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.49 ,90,,,$46.13 ,$81.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.36 ,97,,,$46.13 ,$81.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.36 ,97,,,$46.13 ,$81.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.36 ,97,,,$46.13 ,$81.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.30 ,85,,,$46.13 ,$81.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.49 ,90,,,$46.13 ,$81.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.13 ,55,,,$46.13 ,$81.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.69 ,90,,,$46.13 ,$81.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.13 ,55,,,$46.13 ,$81.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.01 ,93,,,$46.13 ,$81.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
63323-0265-30 - methylPREDNISolone SUCCINATE 1000mg/16ml inj [YUMA],8618736,CDM,250,RC,J2930,HCPCS,outpatient,1000,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0269-10 - propofol 100 mg/10 mL emulsion inj=10ml [YUMA],8863533,CDM,250,RC,J2704,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0269-29 - propofol 200 mg/20 ml emulsion inj=20ml  [YUMA],9713758,CDM,636,RC,J2704,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0269-37 - propofol 200 mg/20 ml emulsion inj=20ml  [YUMA],8631529,CDM,250,RC,J2704,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0278-10 - vinBLAStine 1 mg/mL soln inj=10ml CHEMO [YUMA],8980951,CDM,250,RC,J9360,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0284-20 - vancomycin 1gm vial [YUMA],8875954,CDM,636,RC,J3370,HCPCS,both,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0286-05 - Ropivacaine (Naropin) 0.5% 100mg/20mL [YUMA],8802400,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0286-35 - ropivacaine (Naropin) 0.5% 150mg/30ml [YUMA],10496810,CDM,250,RC,J2795,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0286-95 - ropivacaine (Naropin) 0.5% 150mg/30ml [YUMA],9040950,CDM,250,RC,J2795,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0307-51 - tobramycin 40 mg/mL soln  inj=50ml [YUMA],9017685,CDM,250,RC,J3260,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0318-01 - granisetron hcl 1mg/ml  inj=1ml CHEMO [YUMA],8618629,CDM,250,RC,J1626,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0322-25 - imipenem 500mg inj [YUMA],9681707,CDM,636,RC,J0743,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0322-93 - imipenem 500mg inj [YUMA],8618658,CDM,250,RC,J0743,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0325-10 - acyclovir 50mg/ml  inj=10ml [YUMA],9572219,CDM,636,RC,J0133,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0360-19 - calcium gluconate 100mg/ml  inj=10ml [YUMA],8618454,CDM,250,RC,J0610,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0360-59 - calcium gluconate 100mg/ml  inj=50ml [YUMA],8618455,CDM,250,RC,J0610,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0371-19 - DAPTOmycin 500mg inj [YUMA],8803222,CDM,250,RC,J0878,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0379-05 - octreotide acetate 1000mcg/1ml  inj=5ml [YUMA],8618785,CDM,250,RC,J2354,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0385-10 - cefoTETAN 1gm vial [YUMA],8618469,CDM,250,RC,,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0398-10 - azithromycin 500mg inj [YUMA],8764686,CDM,250,RC,J0456,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0401-26 - aztreonam 1gm inj [YUMA],8618418,CDM,250,RC,S0073,HCPCS,outpatient,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0452-01 - morphine sulfate 2mg/ml  inj=1ml [YUMA],9885986,CDM,636,RC,J2274,HCPCS,both,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0461-57 - bupivacaine-epi 0.25%-1:200,8960977,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0463-57 - bupivacaine-epinephrine 0.5%-1:200,10965403,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0464-17 - bupivacaine 0.25%  inj=10ml [YUMA],8741054,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0466-17 - bupivacaine 0.5%  inj=10ml [YUMA],9908996,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0468-17 - bupivacaine-epinephrine 0.25%-1:200,8774210,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0474-01 - haloperidol-IMMEDIATE RELEASE 5mg/ml  inj=1ml [YUMA],8618634,CDM,250,RC,J1630,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0482-17 - lidocaine 1% with Epi  inj=10ml [YUMA],8618565,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0483-27 - lidocaine 2% with Epi  inj=20ml [YUMA],8618567,CDM,250,RC,,HCPCS,outpatient,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0485-27 - lidocaine 1%  inj=20ml [YUMA],8618699,CDM,636,RC,J2001,HCPCS,both,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0486-17 - lidocaine 2%  inj=10ml [YUMA],8618701,CDM,636,RC,J2001,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0486-27 - lidocaine 2%  inj=20ml [YUMA],8764708,CDM,250,RC,J2001,HCPCS,outpatient,20,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0492-27 - Lidocaine MPF 1%  inj=2ml [YUMA],8618700,CDM,250,RC,J2001,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0495-27 - Lidocaine MPF 2%  inj=2ml [YUMA],9478714,CDM,250,RC,,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0506-01 - DEXAmethasone 10mg/ml  inj=1ml PF  [YUMA],9200602,CDM,250,RC,J1100,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0522-77 - heparin PREMIX 50units/ml inj=500ml [YUMA],9181823,CDM,250,RC,J1644,HCPCS,outpatient,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0523-74 - heparin PREMIX 100units/ml  inj=250ml [YUMA],8741015,CDM,250,RC,J1644,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0530-75 - Sodium Chloride 3% IV Sol 500 mL [YUMA],9401838,CDM,636,RC,J7131,HCPCS,both,500,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0533-83 - enoxaparin 30mg  inj=0.3ml [YUMA],10186976,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0533-93 - enoxaparin 30mg  inj=0.3ml [YUMA],8938655,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0535-87 - enoxaparin 40mg  inj=0.4ml [YUMA],9362485,CDM,636,RC,J1650,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0535-98 - enoxaparin 40mg  inj=0.4ml [YUMA],8764633,CDM,636,RC,J1650,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0540-15 - heparin 1,9397767,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0540-57 - heparin 1,8741725,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0542-01 - heparin 10,8618636,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0559-65 - enoxaparin 30mg  inj=0.3ml [YUMA],10189994,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0559-93 - enoxaparin 30mg  inj=0.3ml [YUMA],10304651,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0564-65 - enoxaparin 40mg  inj=0.4ml [YUMA],10539868,CDM,250,RC,J1650,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0564-97 - enoxaparin 40mg  inj=0.4ml [YUMA],10354534,CDM,250,RC,J1650,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0568-94 - enoxaparin 30mg  inj=0.3ml [YUMA],8618555,CDM,250,RC,J1650,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0568-95 - enoxaparin 100mg  inj=1ml [YUMA],8618554,CDM,250,RC,J1650,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0568-96 - enoxaparin 40mg  inj=0.4ml [YUMA],8618556,CDM,250,RC,J1650,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0568-98 - enoxaparin 60mg  inj=0.6ml [YUMA],8618557,CDM,250,RC,J1650,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0593-03 - glucagon 1mg  inj=1ml [YUMA],8618622,CDM,250,RC,J1610,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0594-03 - glucagon 1mg  inj=1ml [YUMA],8755819,CDM,250,RC,J1610,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0604-01 - propranolol 1mg/ml  inj=1ml [YUMA],8618848,CDM,250,RC,J1800,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0605-84 - enoxaparin 100mg  inj=1ml [YUMA],8856030,CDM,250,RC,J1650,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0605-94 - enoxaparin 100mg  inj=1ml [YUMA],8975864,CDM,250,RC,J1650,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0607-98 - enoxaparin 60mg  inj=0.6ml [YUMA],9207891,CDM,250,RC,J1650,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0614-55 - hydrALAZINE hcl 20mg/ml  inj=1ml [YUMA],8618642,CDM,250,RC,J0360,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0664-01 - diphenhydramine 50mg/ml  inj=2ml CHEMO [YUMA],8741013,CDM,250,RC,J1200,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0690-30 - acetylcysteine 20%  200mg/ml  inh=30ml [YUMA],8848585,CDM,250,RC,J7608,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0710-50 - leucovorin calcium 200mg PWVL CHEMO [YUMA],9655298,CDM,636,RC,J0640,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0782-20 - vecuronium bromide 1mg/1ml  inj=20ml [YUMA],8741057,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0806-01 - fentaNYL 50 mcg/1mL  inj=1ml [YUMA],10369302,CDM,250,RC,J3010,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0877-15 - pentamidine isethionate 300mg PWVL CHEMO [YUMA],8618817,CDM,250,RC,J2545,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0965-10 - potassium chloride 20mEq/10ml  inj=10ml [YUMA],8618832,CDM,250,RC,J3480,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0966-00 - zoledronic acid 5mg/100ml  inj=100ml [YUMA],8808665,CDM,250,RC,J3489,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63323-0983-21 - piperacillin tazobactam 3.375gm vial [YUMA],8960929,CDM,250,RC,J2543,HCPCS,outpatient,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63402-0911-30 - arformoterol tartrate 15mcg/2ml   inh=2ml [YUMA],8618402,CDM,250,RC,J7605,HCPCS,outpatient,2,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63459-0390-08 - bendamustine hcl 25mg PWVL CHEMO [YUMA],8618425,CDM,250,RC,J9033,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63459-0391-20 - bendamustine hcl 100mg PWVL CHEMO [YUMA],8618424,CDM,250,RC,J9033,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0015-10 - diltiazem ER 180mg capsule [YUMA],8618531,CDM,250,RC,,HCPCS,outpatient,180,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0046-10 - carbidopa/levodopa 10-100mg tablet [YUMA],8742992,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0107-10 - carbidopa/levodopa 10-100mg tablet [YUMA],8810031,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0119-10 - glyBURIDE 5mg tablet [YUMA],8618624,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0128-10 - hydroCHLOROthiazide 25mg tablet [YUMA],8618643,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0212-10 - aspirin 81mg Enteric Coated [YUMA],9118777,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0293-10 - metoclopramide 10mg tablet [YUMA],8618742,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0446-10 - potassium chloride 10mEq tablet [YUMA],8618830,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0522-10 - aspirin 81mg Enteric Coated [YUMA],8618406,CDM,250,RC,,HCPCS,outpatient,81,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0544-10 - spironolactone 25mg tablet [YUMA],8618892,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0571-10 - simvaSTATIN 10mg tablet [YUMA],9862018,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0591-10 - gabapentin 100mg capsule [YUMA],8743051,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0645-10 - famotidine 20mg tablet [YUMA],8763605,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0672-10 - ibuprofen 400mg tablet [YUMA],8618656,CDM,250,RC,,HCPCS,outpatient,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0902-10 - gabapentin 100mg capsule [YUMA],10063472,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63739-0964-25 - heparin 10,8808664,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63824-0057-18 - guaiFENesin/pseudophedrine 600-60mg tablet [YUMA],8618632,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63824-0710-16 - benzocaine/menthol 15-3.6mg lozenge [YUMA],8618427,CDM,250,RC,,HCPCS,outpatient,3.6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63833-0386-02 - KCENTRA (Prothrombin CC) 500 units inj [YUMA],8618852,CDM,250,RC,J7168,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
63833-0387-02 - KCENTRA (Prothrombin CC) 1,8618851,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64253-0111-30 - sodium chloride FLUSH 0.9%  10ml syringe [YUMA],9929037,CDM,636,RC,A4216,HCPCS,both,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64253-0333-35 - heparin lock flush 100units/ml  inj=5ml [YUMA],8618638,CDM,250,RC,J1642,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64679-0034-01 - piperacillin tazobactam 2.25gm vial [YUMA],8618824,CDM,250,RC,J2543,HCPCS,outpatient,2.25,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64679-0056-01 - piperacillin tazobactam 3.375gm vial [YUMA],9699484,CDM,636,RC,J2543,HCPCS,both,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64679-0728-01 - SUMAtriptan succinate 6mg/0.5ml  inj=0.5ml [YUMA],9402040,CDM,636,RC,J3030,HCPCS,both,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64679-0759-02 - furosemide 40mg/4ml  inj=4ml [YUMA],9794215,CDM,636,RC,J1940,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64764-0175-30 - dexlansoprazole 60mg capsule [YUMA],8618519,CDM,250,RC,,HCPCS,outpatient,60,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64764-0240-60 - lubiprostone 24mcg capsule [YUMA],8618718,CDM,250,RC,,HCPCS,outpatient,24,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64764-0300-20 - vedolizumab 300mg PWVL CHEMO [YUMA],8618930,CDM,250,RC,J3380,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64980-0515-05 - ofloxacin OPTH soln 0.3% 5ml [YUMA],8805850,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65162-0253-06 - ranitidine 150mg tablet [YUMA],8618860,CDM,250,RC,,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65162-0891-29 - mometasone furoate 50mcg spray [YUMA],8756231,CDM,250,RC,,HCPCS,outpatient,50,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65219-0433-15 - pantoprazole 40mg inj [YUMA],10331062,CDM,250,RC,S0164,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65250-0133-04 - bupivacaine liposome 1.3% (13.3 mg/mL) Sus [YUMA],8631549,CDM,250,RC,C9290,HCPCS,outpatient,13.3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65628-0016-05 - vancomycin hcl powder 50mg/1ml solution  150ml [YUMA],9768532,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65628-0050-04 - magic mouthwash suspension kit 120ml [YUMA],8618377,CDM,250,RC,,HCPCS,outpatient,120,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65628-0206-05 - vancomycin hcl powder 50mg/1ml solution  150ml [YUMA],8618927,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65649-0551-02 - methylnaltrexone bromide 12mg/0.6ml  inj=0.6ml [YUMA],8618734,CDM,250,RC,J2212,HCPCS,outpatient,12,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0149-30 - finasteride 5mg tablet [YUMA],10845295,CDM,250,RC,S0138,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0177-60 - cefdinir 300mg capsule [YUMA],8618465,CDM,250,RC,,HCPCS,outpatient,300,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0293-90 - rosuvastatin calcium 5mg tablet [YUMA],8618868,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0390-10 - ondansetron ODT 4mg tablet [YUMA],10115047,CDM,250,RC,Q0162,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0476-01 - ramipril 5mg capsule [YUMA],8618859,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0496-47 - sulfamethoxazole/trimethoprim 200-40mg/5ml susp [YUMA],8618897,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0503-01 - amoxicillin/pot clavulanate 875-125mg tablet [YUMA],9486756,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0527-30 - venlafaxine hcl ER 37.5mg capsule [YUMA],8618931,CDM,250,RC,,HCPCS,outpatient,37.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0533-50 - amoxicillin/pot clavulanate 200-28.5mg/5ml suspension [YUMA],8618395,CDM,250,RC,,HCPCS,outpatient,28.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
65862-0699-20 - cefuroxime axetil 250mg tablet [YUMA],8618473,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66621-0790-02 - crotalidae equine antivenin [YUMA],8618400,CDM,250,RC,J0841,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66685-1001-00 - amoxicillin/pot clavulanate 875-125mg tablet [YUMA],8618396,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66689-0037-50 - nystatin 500000 units/5 mL Susp [YUMA],8805837,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66689-0047-30 - potassium chloride 10% UD 20mEq/15ml solution [YUMA],8618833,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66689-0063-10 - belladonna alkaloids phenobarb 16.2mg/5ml elixir [YUMA],8618413,CDM,250,RC,,HCPCS,outpatient,16.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66689-0201-08 - charcoal activated 50gm susp [YUMA],10399077,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66689-0203-08 - charcoal sorbitol 50gm susp [YUMA],10399075,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66758-0170-13 - potassium chloride 10mEq tablet [YUMA],8983264,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66794-0219-43 - linezolid 600mg/300ml IVPB [YUMA],10301195,CDM,250,RC,J2020,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
66993-0019-68 - albuterol 90mcg inhaler [YUMA],9220121,CDM,250,RC,,HCPCS,outpatient,90,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67253-0900-10 - ALPRAZolam 0.25mg tablet [YUMA],8764488,CDM,250,RC,,HCPCS,outpatient,0.25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0001-10 - ketamine 50mg/ml  500mg/10ml inj [YUMA],8764494,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0108-10 - ketamine 100mg/ml  1000mg/10ml inj [YUMA],8866620,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0153-03 - amiodarone 50mg/1ml  inj=3ml [YUMA],8740609,CDM,250,RC,J0282,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0181-20 - ketamine 10mg/ml  200mg/20ml inj [YUMA],8618672,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0218-10 - Clonidine 1000mcg/10mLfor epidural inj [YUMA],9227580,CDM,250,RC,J0735,HCPCS,outpatient,1000,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0317-25 - palonosetron hcl 0.05mg/ml  inj=5ml CHEMO [YUMA],9893466,CDM,636,RC,J2469,HCPCS,both,0.05,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0423-12 - DEXAmethasone INJECTABLE 4mg/1ml  inj=1ml [YUMA],8725707,CDM,250,RC,J1100,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0433-22 - famotidine 10 mg/mL Sol [YUMA],10094038,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0524-33 - ibandronate 3 mg/3 mL soln [YUMA],10453762,CDM,250,RC,J1740,HCPCS,outpatient,3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0528-10 - leucovorin calcium 100mg PWVL CHEMO [YUMA],9655299,CDM,636,RC,J0640,HCPCS,both,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0529-20 - leucovorin calcium 200mg PWVL CHEMO [YUMA],9395620,CDM,636,RC,J0640,HCPCS,both,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0602-99 - heparin 10,8764443,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0619-10 - zoledronic acid 5mg/100ml  inj=100ml [YUMA],9884080,CDM,636,RC,J3489,HCPCS,both,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0675-02 - calcitonin 200 IU/1ml  inj=2ml [YUMA],8618449,CDM,250,RC,J0630,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0852-04 - norepinephrine bitartrate 1mg/ml  inj=4ml [YUMA],8618782,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0853-50 - acetaZOLAMIDE 500 mg inj [YUMA],9362502,CDM,636,RC,J1120,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67457-0855-02 - adenosine 3mg/ml  inj=2ml [YUMA],9951185,CDM,636,RC,J0153,HCPCS,both,3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67618-0150-04 - povidone iodine topical 10% Sol 120ml [YUMA],8806311,CDM,250,RC,,HCPCS,outpatient,120,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0124-40 - silver sulfadiazine 1%  400gm cream [YUMA],8618873,CDM,250,RC,,HCPCS,outpatient,400,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0124-50 - silver sulfadiazine 1%  50gm cream [YUMA],8618874,CDM,250,RC,,HCPCS,outpatient,50,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0222-01 - gabapentin 100mg capsule [YUMA],9707763,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0251-15 - triamcinolone 0.1% cream  15gm [YUMA],8618920,CDM,250,RC,,HCPCS,outpatient,15,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0419-20 - linezolid 600mg tablet [YUMA],8618708,CDM,250,RC,,HCPCS,outpatient,600,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0490-30 - ezetimibe 10mg tablet [YUMA],8961786,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0545-88 - cephalexin 250mg/5ml suspension  100ml [YUMA],8853587,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67877-0548-98 - cefdinir 250mg/5ml suspension  60ml [YUMA],10769167,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
67979-0001-01 - valrubicin 40mg/ml  inj=5ml CHEMO [YUMA],8618923,CDM,250,RC,J9357,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0069-01 - ciprofloxacin 250mg tablet [YUMA],8618487,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0128-01 - omeprazole 20mg capsule [YUMA],8816064,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0196-01 - lisinopril 5mg tablet [YUMA],8618710,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0214-01 - benzonatate 100mg capsule [YUMA],9664833,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0326-01 - glimepiride 2mg tablet [YUMA],8618620,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0346-01 - losartan potassium 25mg tablet [YUMA],8618716,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0354-01 - oxyCODONE IR 5mg tablet [YUMA],8764503,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0355-01 - oxyCODONE 5 acetaminophen 325 tablet [YUMA],9220849,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0511-01 - simvaSTATIN 10mg tablet [YUMA],8618875,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0572-01 - guaiFENesin ER 600mg tablet [YUMA],9680366,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0635-21 - fenofibrate 48 mg Tab [YUMA],8805676,CDM,250,RC,,HCPCS,outpatient,48,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0676-01 - metoclopramide 10mg tablet [YUMA],8753439,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0750-25 - triamterene/HCTZ 37.5/25mg tablet [YUMA],9220149,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0776-01 - divalproex Na 250mg tablet [YUMA],8618538,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0783-01 - gabapentin 100mg capsule [YUMA],9013140,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68084-0808-01 - traMADol 50mg tablet [YUMA],9271640,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0022-62 - diphenhydraMINE 12.5mg/5ml unit dose [YUMA],9611530,CDM,636,RC,Q0163,HCPCS,both,12.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0171-62 - sucralfate 1gm/10ml liquid UD [YUMA],8618896,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0231-62 - acetaminophen 160mg/5ml suspension [YUMA],9220114,CDM,250,RC,,HCPCS,outpatient,160,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0494-61 - ibuprofen UD 100mg/5ml suspension [YUMA],9827348,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0587-62 - acetaminophen 160mg/5ml suspension [YUMA],8618125,CDM,250,RC,,HCPCS,outpatient,160,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0599-62 - nystatin 500000 units/5 mL Susp [YUMA],10399078,CDM,250,RC,,HCPCS,outpatient,5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68094-0764-62 - midazolam 10mg/5ml syrup unit dose [YUMA],8618750,CDM,250,RC,J2250,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0166-13 - vancomycin hydrochloride 125mg capsule [YUMA],8618925,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0302-20 - cefuroxime axetil 250mg tablet [YUMA],8961787,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0361-09 - fenofibrate 145mg tablet [YUMA],8618579,CDM,250,RC,,HCPCS,outpatient,145,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0441-01 - cephalexin 250mg/5ml suspension  100ml [YUMA],9699489,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0468-07 - lovastatin 20mg tablet [YUMA],8618717,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0652-08 - doxycycline monohydrate 100 mg Cap [YUMA],8810049,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0675-11 - oseltamivir 30mg capsule [YUMA],8618798,CDM,250,RC,,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0676-11 - oseltamivir 45mg capsule [YUMA],8618799,CDM,250,RC,,HCPCS,outpatient,45,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0677-11 - oseltamivir 75mg capsule [YUMA],8618797,CDM,250,RC,,HCPCS,outpatient,75,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0678-01 - oseltamivir phosphate 6mg/ml  60ml suspension [YUMA],9768535,CDM,250,RC,,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0723-04 - cefdinir 250mg/5ml suspension  60ml [YUMA],9304274,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0723-20 - cefdinir 250mg/5ml suspension  60ml [YUMA],8618466,CDM,250,RC,,HCPCS,outpatient,250,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0852-11 - levonorgestrel 1.5mg tablet [YUMA],8618692,CDM,250,RC,,HCPCS,outpatient,1.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0963-01 - albuterol 90mcg inhaler [YUMA],10655837,CDM,250,RC,,HCPCS,outpatient,90,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68180-0968-09 - levothyroxine 88mcg tablet [YUMA],9362482,CDM,250,RC,,HCPCS,outpatient,88,mcg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68382-0113-14 - risperiDONE 0.5mg tablet [YUMA],8618862,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68382-0140-14 - topiramate 100mg tablet [YUMA],8618912,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68382-0318-18 - MINOcycline 100mg capsule [YUMA],8618753,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0104-30 - fluconazole 200mg tablet [YUMA],8618592,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0157-13 - ondansetron ODT 4mg tablet [YUMA],8618794,CDM,250,RC,Q0162,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0260-01 - verapamil 240mg tablet [YUMA],8618932,CDM,250,RC,,HCPCS,outpatient,240,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0261-90 - rosuvastatin calcium 5mg tablet [YUMA],9304275,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0317-32 - fulvestrant 50mg/ml  inj=10ml CHEMO [YUMA],8960885,CDM,250,RC,J9395,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0405-60 - aspirin/dipyridamole 25-200mg tablet [YUMA],9397772,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68462-0406-01 - indomethacin 25mg capsule [YUMA],8618659,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68516-5216-01 - albumin 25% 12.5gm/50ml  inj=50ml [YUMA],8618371,CDM,250,RC,P9047,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68516-5216-02 - albumin 25% 25gm/100ml  inj=100ml [YUMA],10385373,CDM,250,RC,P9047,HCPCS,outpatient,100,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68682-0652-20 - diazepam rectal gel 10mg kit [YUMA],8618521,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68803-0612-10 - trypan blue ophthalmic 0.06% Sol PFS 0.5ml,8957478,CDM,250,RC,,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
68817-0134-50 - paclitaxel protein-bound 100mg PWVL CHEMO [YUMA],8618808,CDM,250,RC,J9264,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69097-0224-16 - alendronate 70mg tablet [YUMA],8618375,CDM,250,RC,,HCPCS,outpatient,70,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69097-0423-03 - celecoxib 50mg capsule [YUMA],8618475,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69097-0458-05 - fenofibrate 145mg tablet [YUMA],9397773,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69097-0846-07 - cyclobenzaprine 10mg tablet [YUMA],9007811,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69238-1489-01 - bumetanide 0.5mg tablet [YUMA],8774777,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69292-0722-25 - flurbiprofen ophthalmic 0.03% Sol [YUMA],8631530,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69315-0248-12 - guaiFENesin codeine 100-10mg/5ml suspension  120ml [YUMA],8859601,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69315-0904-01 - LORazepam 0.5mg tablet [YUMA],8764499,CDM,250,RC,,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69339-0148-17 - sucralfate 1gm/10ml liquid UD [YUMA],9573220,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69339-0153-17 - magnesium hydroxide 2400mg/30ml suspension [YUMA],11117325,CDM,250,RC,,HCPCS,outpatient,2400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69536-0025-15 - phenylephrine 0.25% nasal spray 15ml [YUMA],8774202,CDM,250,RC,,HCPCS,outpatient,15,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69918-0700-25 - succinylcholine 200mg/10ml  inj=10ml [YUMA],8618895,CDM,250,RC,J0330,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
69918-0899-10 - desmopressin 4mcg/1ml ampule [YUMA],8618514,CDM,250,RC,J2597,HCPCS,outpatient,1,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70000-0201-02 - naproxen 220mg tablets [YUMA],8774237,CDM,250,RC,,HCPCS,outpatient,220,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70000-0382-01 - simethicone 125mg softgels [YUMA],8810823,CDM,250,RC,,HCPCS,outpatient,125,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70000-0418-01 - loperamide oral soln 1mg/7.5ml [YUMA],8774240,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70000-0424-01 - magnesium citrate oral soln 10oz bottle [YUMA],9696918,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70000-0503-01 - famotidine 20mg tablet [YUMA],8939041,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70003-0300-65 - nitroglycerin 0.4mg spray [YUMA],8618774,CDM,250,RC,,HCPCS,outpatient,0.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70010-0063-01 - metFORMIN 500mg tablet [YUMA],9752287,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70069-0011-25 - glycopyrrolate 0.2mg/ml  inj=1ml [YUMA],8741723,CDM,250,RC,,HCPCS,outpatient,0.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70069-0021-25 - DEXAmethasone 10mg/ml  inj=1ml PF  [YUMA],8618515,CDM,250,RC,J1100,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70069-0261-01 - nitroprusside 25mg/ml  inj=2ml [YUMA],9768534,CDM,250,RC,,HCPCS,outpatient,25,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70069-0271-05 - verapamil 2.5mg/ml  inj=2ml [YUMA],9908997,CDM,250,RC,,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70114-0101-01 - pegfilgrastim -CBQV 6mg/0.6ml syringe CHEMO [YUMA],8618812,CDM,250,RC,Q5111,HCPCS,outpatient,6,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1049-05 - triamcinolone acetonide 40mg/1ml  inj=1ml [YUMA],9025673,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1168-01 - triamcinolone acetonide 40mg/1ml  inj=5ml [YUMA],8618918,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1463-02 - fulvestrant 50mg/ml  inj=10ml CHEMO [YUMA],9327595,CDM,636,RC,J9395,HCPCS,both,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1573-05 - methylPREDNISolone ACETATE 40mg/ml  inj=1ml [YUMA],9580215,CDM,636,RC,J1030,HCPCS,both,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1574-01 - methylPREDNISolone ACETATE 80mg/ml  inj=1ml [YUMA],9397776,CDM,250,RC,J1040,HCPCS,outpatient,80,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1576-07 - norepinephrine bitartrate 1mg/ml  inj=4ml [YUMA],10905484,CDM,250,RC,,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1637-07 - ePHEDrine sulfate 50mg/ml  inj=1ml [YUMA],9397769,CDM,250,RC,,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1651-01 - triamcinolone acetonide 40mg/1ml  inj=1ml [YUMA],8618919,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70121-1652-01 - triamcinolone acetonide 40mg/1ml  inj=5ml [YUMA],8774203,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0019-82 - azithromycin 500mg inj [YUMA],9236683,CDM,250,RC,J0456,HCPCS,outpatient,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0020-82 - vancomycin 500mg vial [YUMA],9381678,CDM,636,RC,J3370,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0021-82 - vancomycin 1gm vial [YUMA],9381677,CDM,636,RC,J3370,HCPCS,both,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0092-05 - aspirin/dipyridamole 25-200mg tablet [YUMA],8618407,CDM,250,RC,,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0147-81 - dicyclomine 20mg/2ml   inj=2ml [YUMA],10600457,CDM,250,RC,J0500,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70436-0190-82 - esomeprazole sodium 40mg powder [YUMA],10756778,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70594-0026-02 - bacitracin 50000 units pwdr [YUMA],9130048,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70594-0045-02 - vancomycin 500mg vial [YUMA],10039721,CDM,636,RC,J3370,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70655-0002-06 - fluconazole PREMIX 200mg/100ml  inj=100ml [YUMA],8740862,CDM,250,RC,J1450,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70700-0170-22 - irinotecan hcl 20mg/ml  inj=5ml CHEMO [YUMA],9650160,CDM,636,RC,J9206,HCPCS,both,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70700-0189-22 - fluorouracil inj 50mg/ml inj=100ml vial (CHEMO) [YUMA],9650237,CDM,636,RC,J9190,HCPCS,both,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70700-0268-94 - fosfomycin tromethamine 3gm packet [YUMA],9182334,CDM,250,RC,,HCPCS,outpatient,3,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70710-1460-02 - azithromycin 200mg/5ml suspension  30ml [YUMA],8618415,CDM,250,RC,Q0144,HCPCS,outpatient,200,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70720-0951-30 - goserelin acetate 10.8mg implant kit CHEMO [YUMA],8618628,CDM,250,RC,J9202,HCPCS,outpatient,10.8,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70801-0003-01 - triamcinolone 32 mg inj pwdr-er [YUMA],9091456,CDM,250,RC,,HCPCS,outpatient,32,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70842-0140-03 - oritavancin 400 mg powder [YUMA],9910378,CDM,636,RC,J2407,HCPCS,both,400,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70860-0121-30 - piperacillin tazobactam 3.375gm vial [YUMA],9669780,CDM,636,RC,J2543,HCPCS,both,3.375,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70860-0210-51 - zoledronic acid 4mg/100ml  inj=100ml CHEMO [YUMA],8618938,CDM,250,RC,J3489,HCPCS,outpatient,4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70860-0600-02 - midazolam 2mg/2ml inj=2ml [YUMA],9763732,CDM,636,RC,J2250,HCPCS,both,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70860-0701-03 - ketorolac (IV) 30mg/ml  inj=1ml [YUMA],9365260,CDM,636,RC,J1885,HCPCS,both,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
70860-0801-01 - terbutaline 1mg/ml  inj=1ml [YUMA],8618904,CDM,250,RC,J3105,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
71288-0807-02 - phenylephrine 10 mg/mL Sol [YUMA],9580217,CDM,636,RC,J2370,HCPCS,both,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
71839-0107-01 - DAPTOmycin 500mg inj [YUMA],10039719,CDM,636,RC,J0878,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
71839-0122-10 - pantoprazole 40mg inj [YUMA],10328486,CDM,250,RC,S0164,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
71914-0162-10 - belladonna alkaloids phenobarb 16.2mg/5ml elixir [YUMA],8741730,CDM,250,RC,,HCPCS,outpatient,16.2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72078-0033-02 - adenosine 3mg/ml  inj=2ml [YUMA],10913329,CDM,250,RC,J0153,HCPCS,outpatient,3,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72078-0040-08 - DOCEtaxel 10 mg/mL   inj=8ml [YUMA],10777630,CDM,250,RC,J9171,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72205-0054-01 - fosaprepitant 150mg PWVL CHEMO [YUMA],9337890,CDM,250,RC,J1453,HCPCS,outpatient,150,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72266-0103-01 - labetalol hcl 5 mg/mL  200mg/40ml inj [YUMA],10369298,CDM,250,RC,,HCPCS,outpatient,5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72266-0118-25 - ketorolac (IV) 30mg/ml  inj=1ml [YUMA],8851948,CDM,250,RC,J1885,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72266-0142-01 - bromfenac opth soln 0.09% [YUMA],9478713,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72266-0146-10 - etomidate 2mg/ml  inj=10ml [YUMA],9606404,CDM,250,RC,,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72485-0101-25 - diphenhydramine 50mg/ml  inj=2ml CHEMO [YUMA],10312321,CDM,250,RC,J1200,HCPCS,outpatient,50,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72611-0722-25 - ketorolac (IV) 30mg/ml  inj=1ml [YUMA],8876379,CDM,250,RC,J1885,HCPCS,outpatient,30,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72611-0761-10 - vancomycin 500mg vial [YUMA],9687065,CDM,636,RC,J3370,HCPCS,both,500,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
72611-0765-10 - vancomycin 1gm vial [YUMA],9692399,CDM,636,RC,J3370,HCPCS,both,1,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
74300-0003-00 - zinc oxide topical 13% Cream 57gm [YUMA],8805634,CDM,250,RC,,HCPCS,outpatient,57,gm,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
75826-0114-10 - phenazopyridine 100mg tablet [YUMA],8618818,CDM,250,RC,,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
75834-0020-12 - vitamin D3 50000 IU capsule [YUMA],8618484,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76014-0004-25 - phenylephrine 10 mg/mL Sol [YUMA],8631538,CDM,250,RC,J2370,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76014-0903-10 - neostigmine methylsulfate 1mg/ml  inj=10ml [YUMA],8618769,CDM,250,RC,J2710,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76045-0004-10 - morphine sulfate 2mg/ml  inj=1ml [YUMA],8618760,CDM,250,RC,J2274,HCPCS,outpatient,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76045-0004-11 - morphine sulfate 2mg/ml  inj=1ml [YUMA],9472236,CDM,636,RC,J2274,HCPCS,both,2,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76045-0009-06 - HYDROmorphone 0.5 mg/0.5 mL inj=0.5ml [YUMA],10367823,CDM,250,RC,J1170,HCPCS,outpatient,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76045-0009-10 - HYDROmorphone 1mg/ml  inj=1ml [YUMA],8764441,CDM,250,RC,J1170,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76045-0009-11 - HYDROmorphone 1mg/ml  inj=1ml [YUMA],8764442,CDM,250,RC,J1170,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76125-0790-25 - albumin 5% 12.5gm/250ml  inj=250ml [YUMA],9040967,CDM,250,RC,P9045,HCPCS,outpatient,250,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76204-0100-01 - ipratropium 0.5mg unit dose [YUMA],9684625,CDM,636,RC,J7644,HCPCS,both,0.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76204-0200-30 - albuterol 2.5mg unit dose  inh=3ml [YUMA],10102503,CDM,250,RC,J7613,HCPCS,outpatient,2.5,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76204-0300-03 - sodium chloride 0.9% inh solution  3ml [YUMA],10063031,CDM,250,RC,,HCPCS,outpatient,3,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3304-01 - calcium chloride 10%  inj=10ml [YUMA],9951186,CDM,250,RC,,HCPCS,outpatient,10,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3316-01 - EPINEPHrine 0.1mg/ml  inj=10ml [YUMA],8618561,CDM,250,RC,J0171,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3339-01 - atropine 0.1mg/ml  inj=10ml [YUMA],8740614,CDM,250,RC,J0461,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3352-01 - sodium bicarb 8.4% 1mEq/ml  inj=50ml [YUMA],8740619,CDM,250,RC,,HCPCS,outpatient,50,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3369-01 - naloxone hcl 1mg/ml  inj=2ml [YUMA],8618767,CDM,250,RC,J2310,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-3390-01 - lidocaine 2% Cardiac 20mg/ml  inj=5ml [YUMA],9182428,CDM,250,RC,J2001,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-6300-05 - lidocaine topical 4% Soln [YUMA],9265880,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76329-9060-00 - EPINEPHrine 1mg/ml  inj=30ml [YUMA],9078921,CDM,250,RC,J0171,HCPCS,outpatient,1,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
76385-0134-01 - nadolol 40 mg tab [YUMA],10257785,CDM,250,RC,,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
77333-0948-10 - vitamin D 400 IU tablet [YUMA],8848584,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
78112-0694-80 - phenol 1.4% spray [YUMA],8618819,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
78206-0162-01 - inFLIXimab-abda 100 mg pwdr CHEMO [YUMA],11120793,CDM,250,RC,Q5104,HCPCS,outpatient,100,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
78670-0003-67 - dantrolene sodium 20mg pwdr inj [YUMA],10091390,CDM,250,RC,,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
80681-0005-00 - calcium carbonate 600mg tablet [YUMA],9908993,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
80681-0050-00 - multivitamin tablet [YUMA],9670402,CDM,637,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
80777-0273-99 - SARS-CoV-2 (COVID-19) mRNA-1273 vaccine 100 mcg/0.5 mL [YUMA],9250235,CDM,250,RC,91301,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
80777-0275-99 - SARS-CoV-2 (COVID-19) mRNA-1273 vaccine 50mcg/0.5ml  [YUMA],10197122,CDM,250,RC,91309,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
80777-0279-99 - SARS-CoV-2 (COVID-19) m-RNA-1273 vaccine 25mcg/0.25ml [YUMA],10194755,CDM,250,RC,91311,HCPCS,outpatient,0.5,ml,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
81298-5781-05 - triamcinolone acetonide 40mg/1ml  inj=1ml [YUMA],10986131,CDM,250,RC,J3301,HCPCS,outpatient,40,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
81421-0021-02 - bisacodyl 10mg suppository [YUMA],8618433,CDM,250,RC,,HCPCS,outpatient,10,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
89122-0724-20 - sodium hyaluronate 20 mg/2mL Sol [YUMA],8806254,CDM,250,RC,J7321,HCPCS,outpatient,20,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
89130-3111-01 - sodium hyaluronate 8.4 mg/mL soln  inj=2ml  [YUMA],9366078,CDM,636,RC,J7328,HCPCS,both,8.4,mg,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-49 - Template Non Formulary Cap [YUMA],8960406,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-50 - Template Non Formulary Eye Drops [YUMA],8960405,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-51 - Template Non Formulary Inhaler [YUMA],8960404,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-52 - Template Non Formulary Patch [YUMA],8960403,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-53 - Template Non-Formulary Tablet [YUMA],8960402,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-54 - KCENTRA (Prothrombin CC) 500 units Additive [YUMA],8800057,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-76 - Cataract Bundle Charge [YUMA],8854555,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-83 - YAG Bundle Charge [YUMA],8854550,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-85 - Bupivacaine HCl 0.75% with Dextrose 8.25%  Spinal Needle [YUMA],8802402,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-86 - DO NOT USE alteplase IV Additive [YUMA],8739622,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-87 - DO NOT USE sterile water diluent [YUMA],8739621,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-88 - DO NOT USE propofol IV Additive [YUMA],8739492,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-89 - DO NOT USE niCARdipine IV Additive [YUMA],8739482,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-90 - DO NOT USE mannitol IV Additive [YUMA],8739478,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-91 - DO NOT USE magnesium sulfate IV additive [YUMA],8739472,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-92 - DO NOT USE Premix Diluent [YUMA],8739471,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-93 - DO NOT USE amiodarone IV Additive [YUMA],8739116,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-94 - DO NOT USE nitroglycerin IV Additive [YUMA],8738888,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-95 - DO NOT USE lidocaine IV Additive [YUMA],8736505,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-96 - DO NOT USE heparin IV Additive [YUMA],8736465,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-97 - Do not use Dextrose 5% Premix Diluent [YUMA],8736414,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-98 - DO NOT USE - DOPamine IV Additive [YUMA],8736410,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
99999-9999-99 - Template Non-Formulary [YUMA],8711897,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
TNF MED,3644345,CDM,250,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
denosumab,2790898,CDM,636,RC,J0897,HCPCS,both,,,"$4,608.00 ","$3,456.00 ",,"$4,239.36 ",92,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,534.40 ","$4,469.76 ",other,,Not applicable. No negotiated rates per contract,"$3,962.88 ",86,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,686.40 ",80,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,377.60 ",95,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,377.60 ",95,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,456.00 ",75,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,916.80 ",85,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,147.20 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,469.76 ",97,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,916.80 ",85,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,147.20 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,377.60 ",90,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,534.40 ",55,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,285.44 ",93,,,"$2,534.40 ","$4,469.76 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Acupuncture,2389154,CDM,374,RC,97811,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
97542 WHEELCHAIR MNGMNT EA 15 MIN CHARGES,9004245,CDM,430,RC,97542,HCPCS,outpatient,,,$102.00 ,$76.50 ,,$93.84 ,92,,,$56.10 ,$98.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.10 ,$98.94 ,other,,Not applicable. No negotiated rates per contract,$87.72 ,86,,,$56.10 ,$98.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$81.60 ,80,,,$56.10 ,$98.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.90 ,95,,,$56.10 ,$98.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.50 ,75,,,$56.10 ,$98.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$56.10 ,$98.94 ,case rate,,100% case rate for initial eval or therapy,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.94 ,97,,,$56.10 ,$98.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.70 ,85,,,$56.10 ,$98.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.80 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.90 ,90,,,$56.10 ,$98.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.10 ,55,,,$56.10 ,$98.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.86 ,93,,,$56.10 ,$98.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97750 KEY FUNC CAP TEST/15 MIN CHARGE,8246382,CDM,420,RC,97750,HCPCS,outpatient,,,$135.00 ,$101.25 ,,$124.20 ,92,,,$32.00 ,$130.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.25 ,55,,,$32.00 ,$130.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.00 ,100,,,$32.00 ,$130.95 ,case rate,100% of Functional case rate per unit,,$116.10 ,86,,,$32.00 ,$130.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$108.00 ,80,,,$32.00 ,$130.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.25 ,55,,,$32.00 ,$130.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.25 ,95,,,$32.00 ,$130.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,95,,,$32.00 ,$130.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.25 ,75,,,$32.00 ,$130.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$114.75 ,85,,,$32.00 ,$130.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$130.95 ,97,,,$32.00 ,$130.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.25 ,55,,,$32.00 ,$130.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$32.00 ,$130.95 ,case rate,,100% case rate for initial eval or therapy,$130.95 ,97,,,$32.00 ,$130.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.95 ,97,,,$32.00 ,$130.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.95 ,97,,,$32.00 ,$130.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.75 ,85,,,$32.00 ,$130.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.50 ,90,,,$32.00 ,$130.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.25 ,55,,,$32.00 ,$130.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.25 ,90,,,$32.00 ,$130.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.25 ,55,,,$32.00 ,$130.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.55 ,93,,,$32.00 ,$130.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0238 THERAPEUTIC PROC-1:1 PER 15 MIN CHARGE,8728245,CDM,420,RC,G0238,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.20 ,70,,,$52.80 ,$93.12 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$52.80 ,$93.12 ,case rate,,100% case rate for initial eval or therapy,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
G0239 THERAPEUTIC PROC-GROUP CHARGE,8728246,CDM,420,RC,G0239,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.20 ,70,,,$52.80 ,$93.12 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$52.80 ,$93.12 ,case rate,,100% case rate for initial eval or therapy,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Massage Charge Units,8111689,CDM,420,RC,97124,HCPCS,outpatient,,,$61.00 ,$45.75 ,,$56.12 ,92,,,$33.55 ,$65.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.70 ,70,,,$33.55 ,$65.00 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$52.46 ,86,,,$33.55 ,$65.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.80 ,80,,,$33.55 ,$65.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.95 ,95,,,$33.55 ,$65.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.75 ,75,,,$33.55 ,$65.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$33.55 ,$65.00 ,case rate,,100% case rate for initial eval or therapy,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.17 ,97,,,$33.55 ,$65.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.85 ,85,,,$33.55 ,$65.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.90 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.95 ,90,,,$33.55 ,$65.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.55 ,55,,,$33.55 ,$65.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.73 ,93,,,$33.55 ,$65.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Wheelchair Management Charges,8111696,CDM,420,RC,97542,HCPCS,outpatient,,,$104.00 ,$78.00 ,,$95.68 ,92,,,$57.20 ,$100.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.00 ,70,,,$57.20 ,$100.88 ,percent of total billed charges,,70% of total billed charges for therapy rate with NTE of $70,$89.44 ,86,,,$57.20 ,$100.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.20 ,80,,,$57.20 ,$100.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.80 ,95,,,$57.20 ,$100.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.00 ,75,,,$57.20 ,$100.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.00 ,100,,,$57.20 ,$100.88 ,case rate,,100% case rate for initial eval or therapy,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.88 ,97,,,$57.20 ,$100.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.40 ,85,,,$57.20 ,$100.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.60 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.80 ,90,,,$57.20 ,$100.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.20 ,55,,,$57.20 ,$100.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.72 ,93,,,$57.20 ,$100.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
10005 U/S guided FNA,8763706,CDM,975,RC,10005,HCPCS,outpatient,,,$238.00 ,$178.50 ,,,,,,$75.15 ,$226.10 ,other,,Not seperately reimbursible per contract terms,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$75.15 ,$226.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$160.20 ,100,,,$75.15 ,$226.10 ,fee schedule,,100% of the Blue Cross physician fee schedule,$144.90 ,100,physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$108.97 ,145,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,145% CMS Medicare physician fee schedule ,$226.10 ,95,,,$75.15 ,$226.10 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$75.15 ,$226.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$104.76 ,100,,,$75.15 ,$226.10 ,fee schedule,,100% Humana physician fee schedule,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$75.15 ,$226.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$150.62 ,100,,,$75.15 ,$226.10 ,fee schedule,,100% Midlands Choice physician fee schedule,$142.80 ,60,,,$75.15 ,$226.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$142.80 ,60,,,$75.15 ,$226.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$105.21 ,140,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$75.15 ,$226.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$226.10 ,95,,,$75.15 ,$226.10 ,percent of total billed charges,,95% of total billed charges,$75.15 ,100,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$93.75 ,124.753,CMS physician fee schedule,,$75.15 ,$226.10 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING GUIDANCE ProFee,8016360,CDM,981,RC,10021,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$93.95 ,135,cms physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$55.48 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$121.98 ,100,,,$55.48 ,$352.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$112.00 ,100,physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$80.45 ,145,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$352.45 ,95,,,$55.48 ,$352.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$55.48 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$80.95 ,100,,,$55.48 ,$352.45 ,fee schedule,,100% Humana physician fee schedule,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$55.48 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$55.48 ,$352.45 ,other,,Not separately reimbursable per contract terms,$222.60 ,60,,,$55.48 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.60 ,60,,,$55.48 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$77.67 ,140,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$55.48 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.45 ,95,,,$55.48 ,$352.45 ,percent of total billed charges,,95% of total billed charges,$55.48 ,100,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$69.21 ,124.753,CMS physician fee schedule,,$55.48 ,$352.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10060 INCISION AND DRAINAGE OF ABSCESS (EG,8016366,CDM,981,RC,10060,HCPCS,outpatient,,,,,,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursible per contract terms,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursible. Not contracted for physician rates,$150.33 ,100,,,$146.92 ,$199.67 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursable per contract terms,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$146.92 ,100,,,$146.92 ,$199.67 ,fee schedule,,100% Humana physician fee schedule,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursible. Not contracted for physician rates,$199.67 ,100,,,$146.92 ,$199.67 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursable per contract terms,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursable per contract terms,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursable per contract terms,,,,,$146.92 ,$199.67 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$146.92 ,$199.67 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
10061 INCISION AND DRAINAGE OF ABSCESS (EG,8016367,CDM,981,RC,10061,HCPCS,outpatient,,,,,,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursible per contract terms,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursible. Not contracted for physician rates,$259.85 ,100,,,$259.85 ,$365.29 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursable per contract terms,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$265.78 ,100,,,$259.85 ,$365.29 ,fee schedule,,100% Humana physician fee schedule,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursible. Not contracted for physician rates,$365.29 ,100,,,$259.85 ,$365.29 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursable per contract terms,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursable per contract terms,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursable per contract terms,,,,,$259.85 ,$365.29 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.85 ,$365.29 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
10080 INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE ProFee,8016368,CDM,981,RC,10080,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$134.01 ,135,cms physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$108.18 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$262.85 ,100,,,$108.18 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$206.50 ,100,physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$156.86 ,145,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$108.18 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$108.18 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$150.71 ,100,,,$108.18 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$108.18 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$108.18 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$108.18 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$108.18 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$151.45 ,140,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$108.18 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$108.18 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$108.18 ,100,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$134.96 ,124.753,CMS physician fee schedule,,$108.18 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10081 INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED ProFee,8016369,CDM,981,RC,10081,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$225.21 ,135,cms physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$175.85 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$378.82 ,100,,,$175.85 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$345.10 ,100,physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$254.98 ,145,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$175.85 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$175.85 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$250.61 ,100,,,$175.85 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$175.85 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$175.85 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$175.85 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$175.85 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$246.19 ,140,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$175.85 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$175.85 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$175.85 ,100,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$219.38 ,124.753,CMS physician fee schedule,,$175.85 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10120 INCISION AND REMOVAL OF FOREIGN BODY,8016370,CDM,981,RC,10120,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$122.80 ,135,cms physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$106.74 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$188.98 ,100,,,$106.74 ,$352.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$205.80 ,100,physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$154.77 ,145,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$352.45 ,95,,,$106.74 ,$352.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$106.74 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$150.57 ,100,,,$106.74 ,$352.45 ,fee schedule,,100% Humana physician fee schedule,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$106.74 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$209.74 ,100,,,$106.74 ,$352.45 ,fee schedule,,100% Midlands Choice physician fee schedule,$222.60 ,60,,,$106.74 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.60 ,60,,,$106.74 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.44 ,140,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$106.74 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.45 ,95,,,$106.74 ,$352.45 ,percent of total billed charges,,95% of total billed charges,$106.74 ,100,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.16 ,124.753,CMS physician fee schedule,,$106.74 ,$352.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
10121 INCISION AND REMOVAL OF FOREIGN BODY,8016371,CDM,981,RC,10121,HCPCS,outpatient,,,"$1,591.00 ","$1,193.25 ",,$245.54 ,135,cms physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$188.54 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$338.02 ,100,,,$188.54 ,"$1,511.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$373.10 ,100,physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$273.38 ,145,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$188.54 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$188.54 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$270.97 ,100,,,$188.54 ,"$1,511.45 ",fee schedule,,100% Humana physician fee schedule,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$188.54 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$188.54 ,"$1,511.45 ",other,,Not separately reimbursable per contract terms,$954.60 ,60,,,$188.54 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$954.60 ,60,,,$188.54 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$263.96 ,140,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$188.54 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$188.54 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges,$188.54 ,100,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$235.21 ,124.753,CMS physician fee schedule,,$188.54 ,"$1,511.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
10140 INCISION AND DRAINAGE OF HEMATOMA,8016372,CDM,981,RC,10140,HCPCS,outpatient,,,"$1,591.00 ","$1,193.25 ",,$155.55 ,135,cms physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$121.31 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$211.74 ,100,,,$121.31 ,"$1,511.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$238.70 ,100,physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$175.90 ,145,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$121.31 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$121.31 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$173.92 ,100,,,$121.31 ,"$1,511.45 ",fee schedule,,100% Humana physician fee schedule,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$121.31 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$121.31 ,"$1,511.45 ",other,,Not separately reimbursable per contract terms,$954.60 ,60,,,$121.31 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$954.60 ,60,,,$121.31 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$169.83 ,140,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$121.31 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$121.31 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges,$121.31 ,100,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$151.34 ,124.753,CMS physician fee schedule,,$121.31 ,"$1,511.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
10160 PUNCTURE ASPIRATION OF ABSCESS,8016373,CDM,981,RC,10160,HCPCS,outpatient,,,,,,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursible per contract terms,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursible. Not contracted for physician rates,$161.92 ,100,,,$138.39 ,$161.92 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursable per contract terms,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$138.39 ,100,,,$138.39 ,$161.92 ,fee schedule,,100% Humana physician fee schedule,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursable per contract terms,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursable per contract terms,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursable per contract terms,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursable per contract terms,,,,,$138.39 ,$161.92 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$138.39 ,$161.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO 10% OF BODY SURFACE ProFee,8016375,CDM,981,RC,11000,HCPCS,outpatient,,,$576.00 ,$432.00 ,,$38.58 ,135,cms physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$28.04 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$70.44 ,100,,,$28.04 ,$547.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$57.40 ,100,physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$40.66 ,145,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$547.20 ,95,,,$28.04 ,$547.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$28.04 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$41.41 ,100,,,$28.04 ,$547.20 ,fee schedule,,100% Humana physician fee schedule,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$28.04 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$28.04 ,$547.20 ,other,,Not separately reimbursable per contract terms,$345.60 ,60,,,$28.04 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$345.60 ,60,,,$28.04 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$39.26 ,140,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$28.04 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$547.20 ,95,,,$28.04 ,$547.20 ,percent of total billed charges,,95% of total billed charges,$28.04 ,100,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$34.98 ,124.753,CMS physician fee schedule,,$28.04 ,$547.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11001 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; EACH ADDITIONAL 10% OF THE BODY ProFee,8016376,CDM,981,RC,11001,HCPCS,outpatient,,,$17.00 ,$12.75 ,,$19.21 ,135,cms physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,135% of 2011 CMS physician fee schedule,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$10.20 ,$29.21 ,other,,Not separately reimbursible. Not contracted for physician rates,$29.21 ,100,,,$10.20 ,$29.21 ,fee schedule,,100% of the Blue Cross physician fee schedule,$17.00 ,100,physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,$21.01 ,145,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,145% CMS Medicare physician fee schedule ,$16.15 ,95,,,$10.20 ,$29.21 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$10.20 ,$29.21 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,$20.71 ,100,,,$10.20 ,$29.21 ,fee schedule,,100% Humana physician fee schedule,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$10.20 ,$29.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$10.20 ,$29.21 ,other,,Not separately reimbursable per contract terms,$10.20 ,60,,,$10.20 ,$29.21 ,percent of total billed charges,,60% of total billed charges for physician settings,$10.20 ,60,,,$10.20 ,$29.21 ,percent of total billed charges,,60% of total billed charges for physician settings,$20.29 ,140,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$10.20 ,$29.21 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.15 ,95,,,$10.20 ,$29.21 ,percent of total billed charges,,95% of total billed charges,$14.49 ,100,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,100% CMS Medicare physician fee schedule ,$18.08 ,124.753,CMS physician fee schedule,,$10.20 ,$29.21 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11010 DEBRIDEMENT INCLUDING REMOVAL OF FOREIGN MATERIAL AT THE SITE OF AN OPEN FRACTURE AND/ ProFee,8016381,CDM,981,RC,11010,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$373.50 ,135,cms physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$282.48 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$591.85 ,100,,,$282.48 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$557.20 ,100,physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$409.60 ,145,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$282.48 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$282.48 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$403.82 ,100,,,$282.48 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$282.48 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$282.48 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$282.48 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$282.48 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$395.47 ,140,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$282.48 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$282.48 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$282.48 ,100,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.40 ,124.753,CMS physician fee schedule,,$282.48 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11042 DEBRIDEMENT,8016386,CDM,981,RC,11042,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$67.50 ,135,cms physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$61.23 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$156.34 ,100,,,$61.23 ,$352.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$122.50 ,100,physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$88.78 ,145,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$352.45 ,95,,,$61.23 ,$352.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$61.23 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$88.87 ,100,,,$61.23 ,$352.45 ,fee schedule,,100% Humana physician fee schedule,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$61.23 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$125.01 ,100,,,$61.23 ,$352.45 ,fee schedule,,100% Midlands Choice physician fee schedule,$222.60 ,60,,,$61.23 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.60 ,60,,,$61.23 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$85.72 ,140,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$61.23 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.45 ,95,,,$61.23 ,$352.45 ,percent of total billed charges,,95% of total billed charges,$61.23 ,100,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$76.39 ,124.753,CMS physician fee schedule,,$61.23 ,$352.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11043 DEBRIDEMENT,8016387,CDM,981,RC,11043,HCPCS,outpatient,,,,,,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursible per contract terms,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$288.62 ,100,,,$226.09 ,$288.62 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursable per contract terms,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$226.09 ,100,,,$226.09 ,$288.62 ,fee schedule,,100% Humana physician fee schedule,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursable per contract terms,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursable per contract terms,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursable per contract terms,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursable per contract terms,,,,,$226.09 ,$288.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$226.09 ,$288.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11055 PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG,8016392,CDM,981,RC,11055,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$26.54 ,135,cms physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.22 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$78.17 ,100,,,$16.22 ,$192.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$32.20 ,100,physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$23.52 ,145,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$16.22 ,$192.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$16.22 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$23.23 ,100,,,$16.22 ,$192.85 ,fee schedule,,100% Humana physician fee schedule,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.22 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$16.22 ,$192.85 ,other,,Not separately reimbursable per contract terms,$121.80 ,60,,,$16.22 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$16.22 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$22.71 ,140,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$16.22 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$16.22 ,$192.85 ,percent of total billed charges,,95% of total billed charges,$16.22 ,100,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$20.23 ,124.753,CMS physician fee schedule,,$16.22 ,$192.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11200 REMOVAL OF SKIN TAGS,8016397,CDM,981,RC,11200,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$96.12 ,135,cms physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$78.02 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$109.95 ,100,,,$78.02 ,$192.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$147.00 ,100,physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$113.13 ,145,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$78.02 ,$192.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$78.02 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$107.66 ,100,,,$78.02 ,$192.85 ,fee schedule,,100% Humana physician fee schedule,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$78.02 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$148.46 ,100,,,$78.02 ,$192.85 ,fee schedule,,100% Midlands Choice physician fee schedule,$121.80 ,60,,,$78.02 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$78.02 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$109.23 ,140,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$78.02 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$78.02 ,$192.85 ,percent of total billed charges,,95% of total billed charges,$78.02 ,100,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$97.33 ,124.753,CMS physician fee schedule,,$78.02 ,$192.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11400 EXCISION,8016411,CDM,981,RC,11400,HCPCS,outpatient,,,,,,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursible per contract terms,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursible. Not contracted for physician rates,$156.34 ,100,,,$119.39 ,$163.77 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursable per contract terms,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$119.39 ,100,,,$119.39 ,$163.77 ,fee schedule,,100% Humana physician fee schedule,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursible. Not contracted for physician rates,$163.77 ,100,,,$119.39 ,$163.77 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursable per contract terms,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursable per contract terms,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursable per contract terms,,,,,$119.39 ,$163.77 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.39 ,$163.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11402 EXCISION,8016413,CDM,521,RC,11402,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
11406 EXCISION,8016416,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11420 EXCISION,8016417,CDM,981,RC,11420,HCPCS,outpatient,,,,,,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursible per contract terms,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursible. Not contracted for physician rates,$157.63 ,100,,,$119.70 ,$157.63 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursable per contract terms,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$119.70 ,100,,,$119.70 ,$157.63 ,fee schedule,,100% Humana physician fee schedule,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursable per contract terms,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursable per contract terms,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursable per contract terms,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursable per contract terms,,,,,$119.70 ,$157.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$119.70 ,$157.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11440 EXCISION,8016423,CDM,981,RC,11440,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$135.55 ,135,cms physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$108.77 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$173.95 ,100,,,$108.77 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$205.80 ,100,physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$157.72 ,145,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$108.77 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$108.77 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$150.99 ,100,,,$108.77 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$108.77 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$108.77 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$108.77 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$108.77 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$152.28 ,140,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$108.77 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$108.77 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$108.77 ,100,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$135.69 ,124.753,CMS physician fee schedule,,$108.77 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11442 EXCISION,8016425,CDM,975,RC,11442,HCPCS,outpatient,,,,,,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursible per contract terms,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursible. Not contracted for physician rates,$237.08 ,100,,,$211.57 ,$291.79 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursable per contract terms,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$211.57 ,100,,,$211.57 ,$291.79 ,fee schedule,,100% Humana physician fee schedule,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursible. Not contracted for physician rates,$291.79 ,100,,,$211.57 ,$291.79 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursable per contract terms,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursable per contract terms,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursable per contract terms,,,,,$211.57 ,$291.79 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$211.57 ,$291.79 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11719 TRIMMING OF NONDYSTROPHIC NAILS,8016453,CDM,981,RC,11719,HCPCS,outpatient,,,$64.00 ,$48.00 ,,$10.37 ,135,cms physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$7.62 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$17.61 ,100,,,$7.62 ,$60.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$15.40 ,100,physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$11.05 ,145,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$60.80 ,95,,,$7.62 ,$60.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$7.62 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$11.13 ,100,,,$7.62 ,$60.80 ,fee schedule,,100% Humana physician fee schedule,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$7.62 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$7.62 ,$60.80 ,other,,Not separately reimbursable per contract terms,$38.40 ,60,,,$7.62 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.40 ,60,,,$7.62 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$10.67 ,140,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$7.62 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.80 ,95,,,$7.62 ,$60.80 ,percent of total billed charges,,95% of total billed charges,$7.62 ,100,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$9.51 ,124.753,CMS physician fee schedule,,$7.62 ,$60.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11720 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 1 TO 5 ProFee,8016454,CDM,981,RC,11720,HCPCS,outpatient,,,$64.00 ,$48.00 ,,$20.12 ,135,cms physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$14.82 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$40.80 ,100,,,$14.82 ,$60.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$29.40 ,100,physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$21.49 ,145,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$60.80 ,95,,,$14.82 ,$60.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$14.82 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$21.20 ,100,,,$14.82 ,$60.80 ,fee schedule,,100% Humana physician fee schedule,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$14.82 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$14.82 ,$60.80 ,other,,Not separately reimbursable per contract terms,$38.40 ,60,,,$14.82 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.40 ,60,,,$14.82 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$20.75 ,140,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$14.82 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.80 ,95,,,$14.82 ,$60.80 ,percent of total billed charges,,95% of total billed charges,$14.82 ,100,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$18.49 ,124.753,CMS physician fee schedule,,$14.82 ,$60.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11721 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); 6 OR MORE ProFee,8016455,CDM,981,RC,11721,HCPCS,outpatient,,,$64.00 ,$48.00 ,,$33.25 ,135,cms physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$24.22 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$56.26 ,100,,,$24.22 ,$60.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$50.40 ,100,physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$35.12 ,145,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$60.80 ,95,,,$24.22 ,$60.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$24.22 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.36 ,100,,,$24.22 ,$60.80 ,fee schedule,,100% Humana physician fee schedule,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$24.22 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$24.22 ,$60.80 ,other,,Not separately reimbursable per contract terms,$38.40 ,60,,,$24.22 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.40 ,60,,,$24.22 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$33.91 ,140,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$24.22 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.80 ,95,,,$24.22 ,$60.80 ,percent of total billed charges,,95% of total billed charges,$24.22 ,100,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$30.22 ,124.753,CMS physician fee schedule,,$24.22 ,$60.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11730 AVULSION OF NAIL PLATE,8016456,CDM,981,RC,11730,HCPCS,outpatient,,,,,,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursible per contract terms,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,$137.44 ,100,,,$79.60 ,$137.44 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$79.60 ,100,,,$79.60 ,$137.44 ,fee schedule,,100% Humana physician fee schedule,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.48 ,100,,,$79.60 ,$137.44 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$79.60 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$79.60 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11732 AVULSION OF NAIL PLATE,8016457,CDM,981,RC,11732,HCPCS,outpatient,,,,,,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursible per contract terms,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.23 ,100,,,$25.27 ,$41.23 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursable per contract terms,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$25.27 ,100,,,$25.27 ,$41.23 ,fee schedule,,100% Humana physician fee schedule,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursable per contract terms,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursable per contract terms,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursable per contract terms,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursable per contract terms,,,,,$25.27 ,$41.23 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$25.27 ,$41.23 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11740 EVACUATION OF SUBUNGUAL HEMATOMA ProFee,8016458,CDM,981,RC,11740,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$42.51 ,135,cms physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$32.28 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$66.57 ,100,,,$32.28 ,$119.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$63.00 ,100,physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$46.81 ,145,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$119.70 ,95,,,$32.28 ,$119.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$32.28 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$46.16 ,100,,,$32.28 ,$119.70 ,fee schedule,,100% Humana physician fee schedule,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$32.28 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$32.28 ,$119.70 ,other,,Not separately reimbursable per contract terms,$75.60 ,60,,,$32.28 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$75.60 ,60,,,$32.28 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$45.19 ,140,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$32.28 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.70 ,95,,,$32.28 ,$119.70 ,percent of total billed charges,,95% of total billed charges,$32.28 ,100,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$40.27 ,124.753,CMS physician fee schedule,,$32.28 ,$119.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11750 EXCISION OF NAIL AND NAIL MATRIX,8016459,CDM,981,RC,11750,HCPCS,outpatient,,,,,,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursible per contract terms,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursible. Not contracted for physician rates,$194.56 ,100,,,$148.47 ,$210.34 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursable per contract terms,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$148.47 ,100,,,$148.47 ,$210.34 ,fee schedule,,100% Humana physician fee schedule,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursible. Not contracted for physician rates,$210.34 ,100,,,$148.47 ,$210.34 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursable per contract terms,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursable per contract terms,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursable per contract terms,,,,,$148.47 ,$210.34 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$148.47 ,$210.34 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11760 REPAIR OF NAIL BED ProFee,8016462,CDM,981,RC,11760,HCPCS,outpatient,,,$576.00 ,$432.00 ,,$175.15 ,135,cms physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$114.14 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.67 ,100,,,$114.14 ,$547.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$230.30 ,100,physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$165.50 ,145,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$547.20 ,95,,,$114.14 ,$547.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$114.14 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$167.64 ,100,,,$114.14 ,$547.20 ,fee schedule,,100% Humana physician fee schedule,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$114.14 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$114.14 ,$547.20 ,other,,Not separately reimbursable per contract terms,$345.60 ,60,,,$114.14 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$345.60 ,60,,,$114.14 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$159.80 ,140,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$114.14 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$547.20 ,95,,,$114.14 ,$547.20 ,percent of total billed charges,,95% of total billed charges,$114.14 ,100,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.39 ,124.753,CMS physician fee schedule,,$114.14 ,$547.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11765 WEDGE EXCISION OF SKIN OF NAIL FOLD (EG,8016464,CDM,981,RC,11765,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$93.42 ,135,cms physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$93.42 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$210.88 ,100,,,$93.42 ,$352.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$184.80 ,100,physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$136.76 ,145,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$352.45 ,95,,,$93.42 ,$352.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$93.42 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$135.17 ,100,,,$93.42 ,$352.45 ,fee schedule,,100% Humana physician fee schedule,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$93.42 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$93.42 ,$352.45 ,other,,Not separately reimbursable per contract terms,$222.60 ,60,,,$93.42 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.60 ,60,,,$93.42 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$132.05 ,140,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$93.42 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.45 ,95,,,$93.42 ,$352.45 ,percent of total billed charges,,95% of total billed charges,$94.32 ,100,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$117.67 ,124.753,CMS physician fee schedule,,$93.42 ,$352.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
11770 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE ProFee,8016465,CDM,975,RC,11770,HCPCS,outpatient,,,,,,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursible per contract terms,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$388.70 ,100,,,$270.65 ,$388.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursable per contract terms,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$270.65 ,100,,,$270.65 ,$388.70 ,fee schedule,,100% Humana physician fee schedule,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursable per contract terms,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursable per contract terms,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursable per contract terms,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursable per contract terms,,,,,$270.65 ,$388.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$270.65 ,$388.70 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
11976 REMOVAL,8016481,CDM,981,RC,11976,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$128.37 ,135,cms physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$94.67 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$179.96 ,100,,,$94.67 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$191.10 ,100,physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$137.27 ,145,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$94.67 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$94.67 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$137.70 ,100,,,$94.67 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$94.67 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$94.67 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$94.67 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$94.67 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$132.54 ,140,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$94.67 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$94.67 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$94.67 ,100,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$118.10 ,124.753,CMS physician fee schedule,,$94.67 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
12002 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,8016488,CDM,981,RC,12002,HCPCS,outpatient,,,,,,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursible per contract terms,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,$137.44 ,100,,,$86.97 ,$137.44 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$86.97 ,100,,,$86.97 ,$137.44 ,fee schedule,,100% Humana physician fee schedule,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,$118.23 ,100,,,$86.97 ,$137.44 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursable per contract terms,,,,,$86.97 ,$137.44 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.97 ,$137.44 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12004 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,8016489,CDM,981,RC,12004,HCPCS,outpatient,,,,,,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursible per contract terms,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$160.20 ,100,,,$108.07 ,$160.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursable per contract terms,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$108.07 ,100,,,$108.07 ,$160.20 ,fee schedule,,100% Humana physician fee schedule,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursable per contract terms,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursable per contract terms,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursable per contract terms,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursable per contract terms,,,,,$108.07 ,$160.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$108.07 ,$160.20 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12005 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,8016490,CDM,981,RC,12005,HCPCS,outpatient,,,,,,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursible per contract terms,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursible. Not contracted for physician rates,$211.74 ,100,,,$140.39 ,$211.74 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursable per contract terms,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$140.39 ,100,,,$140.39 ,$211.74 ,fee schedule,,100% Humana physician fee schedule,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursable per contract terms,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursable per contract terms,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursable per contract terms,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursable per contract terms,,,,,$140.39 ,$211.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$140.39 ,$211.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12006 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,8016491,CDM,981,RC,12006,HCPCS,outpatient,,,,,,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursible per contract terms,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.54 ,100,,,$172.06 ,$249.54 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursable per contract terms,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$172.06 ,100,,,$172.06 ,$249.54 ,fee schedule,,100% Humana physician fee schedule,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursable per contract terms,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursable per contract terms,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursable per contract terms,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursable per contract terms,,,,,$172.06 ,$249.54 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.06 ,$249.54 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12007 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,8016492,CDM,981,RC,12007,HCPCS,outpatient,,,,,,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursible per contract terms,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,$284.76 ,100,,,$212.45 ,$284.76 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$212.45 ,100,,,$212.45 ,$284.76 ,fee schedule,,100% Humana physician fee schedule,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursable per contract terms,,,,,$212.45 ,$284.76 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$212.45 ,$284.76 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12011 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016493,CDM,521,RC,12011,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
12013 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016494,CDM,981,RC,12013,HCPCS,outpatient,,,,,,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursible per contract terms,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursible. Not contracted for physician rates,$143.02 ,100,,,$86.18 ,$143.02 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursable per contract terms,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$86.18 ,100,,,$86.18 ,$143.02 ,fee schedule,,100% Humana physician fee schedule,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursable per contract terms,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursable per contract terms,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursable per contract terms,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursable per contract terms,,,,,$86.18 ,$143.02 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$86.18 ,$143.02 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12014 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016495,CDM,981,RC,12014,HCPCS,outpatient,,,,,,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursible per contract terms,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,$173.52 ,100,,,$110.26 ,$173.52 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$110.26 ,100,,,$110.26 ,$173.52 ,fee schedule,,100% Humana physician fee schedule,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$110.26 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$110.26 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12015 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016496,CDM,981,RC,12015,HCPCS,outpatient,,,,,,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursible per contract terms,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$210.03 ,100,,,$139.34 ,$210.03 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursable per contract terms,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$139.34 ,100,,,$139.34 ,$210.03 ,fee schedule,,100% Humana physician fee schedule,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursable per contract terms,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursable per contract terms,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursable per contract terms,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursable per contract terms,,,,,$139.34 ,$210.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$139.34 ,$210.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12016 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016497,CDM,981,RC,12016,HCPCS,outpatient,,,,,,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursible per contract terms,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursible. Not contracted for physician rates,$266.72 ,100,,,$188.93 ,$266.72 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursable per contract terms,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$188.93 ,100,,,$188.93 ,$266.72 ,fee schedule,,100% Humana physician fee schedule,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursable per contract terms,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursable per contract terms,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursable per contract terms,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursable per contract terms,,,,,$188.93 ,$266.72 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$188.93 ,$266.72 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12017 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016498,CDM,981,RC,12017,HCPCS,outpatient,,,,,,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursible per contract terms,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$190.70 ,100,,,$190.70 ,$224.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursable per contract terms,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$224.45 ,100,,,$190.70 ,$224.45 ,fee schedule,,100% Humana physician fee schedule,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursable per contract terms,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursable per contract terms,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursable per contract terms,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursable per contract terms,,,,,$190.70 ,$224.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.70 ,$224.45 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12018 SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,8016499,CDM,981,RC,12018,HCPCS,outpatient,,,,,,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursible per contract terms,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursible. Not contracted for physician rates,$216.47 ,100,,,$216.47 ,$254.39 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursable per contract terms,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$254.39 ,100,,,$216.47 ,$254.39 ,fee schedule,,100% Humana physician fee schedule,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursable per contract terms,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursable per contract terms,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursable per contract terms,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursable per contract terms,,,,,$216.47 ,$254.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$216.47 ,$254.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
12020 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE ProFee,8016500,CDM,981,RC,12020,HCPCS,outpatient,,,$576.00 ,$432.00 ,,$247.20 ,135,cms physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$192.46 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$366.79 ,100,,,$192.46 ,$547.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$380.10 ,100,physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$279.07 ,145,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$547.20 ,95,,,$192.46 ,$547.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$192.46 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$276.18 ,100,,,$192.46 ,$547.20 ,fee schedule,,100% Humana physician fee schedule,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$192.46 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$192.46 ,$547.20 ,other,,Not separately reimbursable per contract terms,$345.60 ,60,,,$192.46 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$345.60 ,60,,,$192.46 ,$547.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$269.44 ,140,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$192.46 ,$547.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$547.20 ,95,,,$192.46 ,$547.20 ,percent of total billed charges,,95% of total billed charges,$192.46 ,100,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$240.10 ,124.753,CMS physician fee schedule,,$192.46 ,$547.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
13100 REPAIR,8016521,CDM,981,RC,13100,HCPCS,outpatient,,,,,,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursible per contract terms,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursible. Not contracted for physician rates,$425.21 ,100,,,$295.97 ,$425.21 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursable per contract terms,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$295.97 ,100,,,$295.97 ,$425.21 ,fee schedule,,100% Humana physician fee schedule,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursable per contract terms,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursable per contract terms,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursable per contract terms,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursable per contract terms,,,,,$295.97 ,$425.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.97 ,$425.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
13101 REPAIR,8016522,CDM,981,RC,13101,HCPCS,outpatient,,,,,,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursible per contract terms,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursible. Not contracted for physician rates,$499.08 ,100,,,$364.29 ,$510.56 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursable per contract terms,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$364.29 ,100,,,$364.29 ,$510.56 ,fee schedule,,100% Humana physician fee schedule,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursible. Not contracted for physician rates,$510.56 ,100,,,$364.29 ,$510.56 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursable per contract terms,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursable per contract terms,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursable per contract terms,,,,,$364.29 ,$510.56 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$364.29 ,$510.56 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
13102 REPAIR,8016523,CDM,981,RC,13102,HCPCS,outpatient,,,,,,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursible per contract terms,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursible. Not contracted for physician rates,$149.47 ,100,,,$106.37 ,$149.47 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursable per contract terms,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$106.37 ,100,,,$106.37 ,$149.47 ,fee schedule,,100% Humana physician fee schedule,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursable per contract terms,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursable per contract terms,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursable per contract terms,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursable per contract terms,,,,,$106.37 ,$149.47 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$106.37 ,$149.47 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
16000 INITIAL TREATMENT,8016674,CDM,981,RC,16000,HCPCS,outpatient,,,,,,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursible per contract terms,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$90.62 ,100,,,$67.16 ,$90.62 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursable per contract terms,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$67.16 ,100,,,$67.16 ,$90.62 ,fee schedule,,100% Humana physician fee schedule,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursable per contract terms,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursable per contract terms,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursable per contract terms,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursable per contract terms,,,,,$67.16 ,$90.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$67.16 ,$90.62 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
16020 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS,8016676,CDM,981,RC,16020,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$77.38 ,135,cms physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$55.89 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$102.65 ,100,,,$55.89 ,$192.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$109.20 ,100,physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$81.04 ,145,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$55.89 ,$192.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$55.89 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$79.52 ,100,,,$55.89 ,$192.85 ,fee schedule,,100% Humana physician fee schedule,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$55.89 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$55.89 ,$192.85 ,other,,Not separately reimbursable per contract terms,$121.80 ,60,,,$55.89 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$55.89 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$78.25 ,140,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$55.89 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$55.89 ,$192.85 ,percent of total billed charges,,95% of total billed charges,$55.89 ,100,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$69.72 ,124.753,CMS physician fee schedule,,$55.89 ,$192.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
16025 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS,8016677,CDM,981,RC,16025,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$154.72 ,135,cms physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$113.71 ,$203.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$190.70 ,100,,,$113.71 ,$203.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$203.00 ,100,physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$164.88 ,145,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$113.71 ,$203.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$113.71 ,$203.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$161.27 ,100,,,$113.71 ,$203.00 ,fee schedule,,100% Humana physician fee schedule,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$113.71 ,$203.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$113.71 ,$203.00 ,other,,Not separately reimbursable per contract terms,$121.80 ,60,,,$113.71 ,$203.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$113.71 ,$203.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$159.19 ,140,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$113.71 ,$203.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$113.71 ,$203.00 ,percent of total billed charges,,95% of total billed charges,$113.71 ,100,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$141.86 ,124.753,CMS physician fee schedule,,$113.71 ,$203.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
16030 DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS,8016678,CDM,981,RC,16030,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$175.72 ,135,cms physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$134.24 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$240.95 ,100,,,$134.24 ,$352.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$268.80 ,100,physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$194.65 ,145,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$352.45 ,95,,,$134.24 ,$352.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$134.24 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$194.56 ,100,,,$134.24 ,$352.45 ,fee schedule,,100% Humana physician fee schedule,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$134.24 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$134.24 ,$352.45 ,other,,Not separately reimbursable per contract terms,$222.60 ,60,,,$134.24 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$222.60 ,60,,,$134.24 ,$352.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$187.94 ,140,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$134.24 ,$352.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.45 ,95,,,$134.24 ,$352.45 ,percent of total billed charges,,95% of total billed charges,$134.24 ,100,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$167.47 ,124.753,CMS physician fee schedule,,$134.24 ,$352.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
17250 CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH,8016689,CDM,981,RC,17250,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$48.29 ,135,cms physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.35 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$106.09 ,100,,,$38.35 ,$192.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$74.90 ,100,physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$55.61 ,145,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$38.35 ,$192.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$38.35 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$54.43 ,100,,,$38.35 ,$192.85 ,fee schedule,,100% Humana physician fee schedule,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.35 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$38.35 ,$192.85 ,other,,Not separately reimbursable per contract terms,$121.80 ,60,,,$38.35 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$38.35 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$53.69 ,140,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$38.35 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$38.35 ,$192.85 ,percent of total billed charges,,95% of total billed charges,$38.35 ,100,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$47.84 ,124.753,CMS physician fee schedule,,$38.35 ,$192.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS,8016719,CDM,981,RC,19020,HCPCS,outpatient,,,"$1,592.00 ","$1,194.00 ",,$395.05 ,135,cms physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$324.49 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$590.56 ,100,,,$324.49 ,"$1,512.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,$625.10 ,100,physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$470.51 ,145,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$324.49 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$324.49 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$454.13 ,100,,,$324.49 ,"$1,512.40 ",fee schedule,,100% Humana physician fee schedule,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$324.49 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$324.49 ,"$1,512.40 ",other,,Not separately reimbursable per contract terms,$955.20 ,60,,,$324.49 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$955.20 ,60,,,$324.49 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$454.29 ,140,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$324.49 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$324.49 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges,$324.49 ,100,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$404.81 ,124.753,CMS physician fee schedule,,$324.49 ,"$1,512.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
19125 EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVE PLACEMENT OF RADIOLOGICAL MARKER,8016734,CDM,975,RC,19125,HCPCS,outpatient,,,"$1,484.00 ","$1,113.00 ",,$594.84 ,135,cms physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,135% of 2011 CMS physician fee schedule,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$477.97 ,"$1,409.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$693.64 ,100,,,$477.97 ,"$1,409.80 ",fee schedule,,100% of the Blue Cross physician fee schedule,$933.10 ,100,physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$693.06 ,145,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,409.80 ",95,,,$477.97 ,"$1,409.80 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$477.97 ,"$1,409.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$674.16 ,100,,,$477.97 ,"$1,409.80 ",fee schedule,,100% Humana physician fee schedule,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$477.97 ,"$1,409.80 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$477.97 ,"$1,409.80 ",other,,Not separately reimbursable per contract terms,$890.40 ,60,,,$477.97 ,"$1,409.80 ",percent of total billed charges,,60% of total billed charges for physician settings,$890.40 ,60,,,$477.97 ,"$1,409.80 ",percent of total billed charges,,60% of total billed charges for physician settings,$669.16 ,140,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$477.97 ,"$1,409.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,409.80 ",95,,,$477.97 ,"$1,409.80 ",percent of total billed charges,,95% of total billed charges,$477.97 ,100,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$596.28 ,124.753,CMS physician fee schedule,,$477.97 ,"$1,409.80 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
20102 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); ABDOMEN/FLANK/BACK ProFee,8016788,CDM,981,RC,20102,HCPCS,outpatient,,,"$1,882.00 ","$1,411.50 ",,$333.07 ,135,cms physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$263.33 ,"$1,787.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$643.39 ,100,,,$263.33 ,"$1,787.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,$520.10 ,100,physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$381.83 ,145,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,787.90 ",95,,,$263.33 ,"$1,787.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$263.33 ,"$1,787.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$375.34 ,100,,,$263.33 ,"$1,787.90 ",fee schedule,,100% Humana physician fee schedule,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$263.33 ,"$1,787.90 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$263.33 ,"$1,787.90 ",other,,Not separately reimbursable per contract terms,"$1,129.20 ",60,,,$263.33 ,"$1,787.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,129.20 ",60,,,$263.33 ,"$1,787.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$368.66 ,140,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$263.33 ,"$1,787.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,787.90 ",95,,,$263.33 ,"$1,787.90 ",percent of total billed charges,,95% of total billed charges,$263.33 ,100,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$328.51 ,124.753,CMS physician fee schedule,,$263.33 ,"$1,787.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
20103 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); EXTREMITY ProFee,8016789,CDM,981,RC,20103,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$462.71 ,135,cms physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,135% of 2011 CMS physician fee schedule,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$354.14 ,$722.42 ,other,,Not separately reimbursible. Not contracted for physician rates,$722.42 ,100,,,$354.14 ,$722.42 ,fee schedule,,100% of the Blue Cross physician fee schedule,$700.70 ,100,physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,$513.50 ,145,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$354.14 ,$722.42 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$354.14 ,$722.42 ,other,,Not separately reimbursible. Not contracted for physician rates,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,$507.33 ,100,,,$354.14 ,$722.42 ,fee schedule,,100% Humana physician fee schedule,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$354.14 ,$722.42 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$354.14 ,$722.42 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$354.14 ,$722.42 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$354.14 ,$722.42 ,percent of total billed charges,,60% of total billed charges for physician settings,$495.80 ,140,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$354.14 ,$722.42 ,other,,Not separately reimbursible. Not contracted for physician rates,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$354.14 ,$722.42 ,percent of total billed charges,,95% of total billed charges,$354.14 ,100,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,100% CMS Medicare physician fee schedule ,$441.80 ,124.753,CMS physician fee schedule,,$354.14 ,$722.42 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S),8016808,CDM,981,RC,20552,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$50.60 ,135,cms physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$69.15 ,100,,,$38.52 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$77.70 ,100,physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$55.85 ,145,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$38.52 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$38.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$56.25 ,100,,,$38.52 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$38.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.84 ,100,,,$38.52 ,$288.80 ,fee schedule,,100% Midlands Choice physician fee schedule,$182.40 ,60,,,$38.52 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.40 ,60,,,$38.52 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$53.93 ,140,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$38.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$38.52 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$38.52 ,100,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$48.05 ,124.753,CMS physician fee schedule,,$38.52 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
20605 ARTHROCENTESIS,8016813,CDM,981,RC,20605,HCPCS,outpatient,,,,,,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursible per contract terms,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$64.85 ,100,,,$54.66 ,$76.13 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursable per contract terms,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$54.66 ,100,,,$54.66 ,$76.13 ,fee schedule,,100% Humana physician fee schedule,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$76.13 ,100,,,$54.66 ,$76.13 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursable per contract terms,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursable per contract terms,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursable per contract terms,,,,,$54.66 ,$76.13 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$54.66 ,$76.13 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
20612 ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION ProFee,8016817,CDM,981,RC,20612,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$55.47 ,135,cms physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$42.01 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$76.45 ,100,,,$42.01 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$83.30 ,100,physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.91 ,145,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$42.01 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$42.01 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.35 ,100,,,$42.01 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$42.01 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$42.01 ,$288.80 ,other,,Not separately reimbursable per contract terms,$182.40 ,60,,,$42.01 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.40 ,60,,,$42.01 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$58.81 ,140,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$42.01 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$42.01 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$42.01 ,100,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$52.41 ,124.753,CMS physician fee schedule,,$42.01 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
20900 BONE GRAFT,8016842,CDM,975,RC,20900,HCPCS,outpatient,,,,,,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursible per contract terms,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursible. Not contracted for physician rates,$509.39 ,100,,,$269.89 ,$509.39 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursable per contract terms,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$269.89 ,100,,,$269.89 ,$509.39 ,fee schedule,,100% Humana physician fee schedule,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursable per contract terms,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursable per contract terms,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursable per contract terms,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursable per contract terms,,,,,$269.89 ,$509.39 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$269.89 ,$509.39 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
21320 CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION ProFee,8016980,CDM,981,RC,21320,HCPCS,outpatient,,,$456.00 ,$342.00 ,,$185.07 ,135,cms physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$97.57 ,$433.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$316.54 ,100,,,$97.57 ,$433.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$267.39 ,100,physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$141.48 ,145,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$433.20 ,95,,,$97.57 ,$433.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$97.57 ,$433.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$194.50 ,100,,,$97.57 ,$433.20 ,fee schedule,,100% Humana physician fee schedule,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$97.57 ,$433.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$97.57 ,$433.20 ,other,,Not separately reimbursable per contract terms,$273.60 ,60,,,$97.57 ,$433.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$273.60 ,60,,,$97.57 ,$433.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$136.60 ,140,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$97.57 ,$433.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$433.20 ,95,,,$97.57 ,$433.20 ,percent of total billed charges,,95% of total billed charges,$97.57 ,100,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.72 ,124.753,CMS physician fee schedule,,$97.57 ,$433.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
21480 CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION; INITIAL OR SUBSEQUENT ProFee,8017029,CDM,981,RC,21480,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$42.80 ,135,cms physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$31.34 ,$236.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$146.89 ,100,,,$31.34 ,$236.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$64.40 ,100,physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$45.44 ,145,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$31.34 ,$236.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$31.34 ,$236.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$46.28 ,100,,,$31.34 ,$236.55 ,fee schedule,,100% Humana physician fee schedule,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$31.34 ,$236.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$31.34 ,$236.55 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$31.34 ,$236.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$31.34 ,$236.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$43.88 ,140,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$31.34 ,$236.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$31.34 ,$236.55 ,percent of total billed charges,,95% of total billed charges,$31.34 ,100,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$39.10 ,124.753,CMS physician fee schedule,,$31.34 ,$236.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
23412 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG,8017231,CDM,975,RC,23412,HCPCS,outpatient,,,"$3,382.00 ","$2,536.50 ",,"$1,124.05 ",135,cms physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$881.24 ,"$3,212.90 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,062.58 ",100,,,$881.24 ,"$3,212.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,723.40 ",100,physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,277.80 ",145,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,212.90 ",95,,,$881.24 ,"$3,212.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$881.24 ,"$3,212.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,249.96 ",100,,,$881.24 ,"$3,212.90 ",fee schedule,,100% Humana physician fee schedule,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$881.24 ,"$3,212.90 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,697.73 ",100,,,$881.24 ,"$3,212.90 ",fee schedule,,100% Midlands Choice physician fee schedule,"$2,029.20 ",60,,,$881.24 ,"$3,212.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,029.20 ",60,,,$881.24 ,"$3,212.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,233.74 ",140,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$881.24 ,"$3,212.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,212.90 ",95,,,$881.24 ,"$3,212.90 ",percent of total billed charges,,95% of total billed charges,$881.24 ,100,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,099.37 ",124.753,CMS physician fee schedule,,$881.24 ,"$3,212.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
23430 TENODESIS OF LONG TENDON OF BICEPS ProFee,8017234,CDM,975,RC,23430,HCPCS,outpatient,,,"$2,883.00 ","$2,162.25 ",,$982.61 ,135,cms physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$771.66 ,"$2,738.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$928.58 ,100,,,$771.66 ,"$2,738.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,504.30 ",100,physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,118.91 ",145,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,738.85 ",95,,,$771.66 ,"$2,738.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$771.66 ,"$2,738.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,092.13 ",100,,,$771.66 ,"$2,738.85 ",fee schedule,,100% Humana physician fee schedule,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$771.66 ,"$2,738.85 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,483.99 ",100,,,$771.66 ,"$2,738.85 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,729.80 ",60,,,$771.66 ,"$2,738.85 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,729.80 ",60,,,$771.66 ,"$2,738.85 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,080.32 ",140,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$771.66 ,"$2,738.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,738.85 ",95,,,$771.66 ,"$2,738.85 ",percent of total billed charges,,95% of total billed charges,$771.66 ,100,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$962.67 ,124.753,CMS physician fee schedule,,$771.66 ,"$2,738.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
23605 CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL NECK) FRACTURE; WITH MANI ProFee,8017265,CDM,981,RC,23605,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$556.94 ,135,cms physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$447.99 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$584.12 ,100,,,$447.99 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$858.20 ,100,physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$649.59 ,145,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$447.99 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$447.99 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$624.97 ,100,,,$447.99 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$447.99 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$447.99 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$447.99 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$447.99 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$627.19 ,140,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$447.99 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$447.99 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$447.99 ,100,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$558.88 ,124.753,CMS physician fee schedule,,$447.99 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
23650 CLOSED TREATMENT OF SHOULDER DISLOCATION,8017271,CDM,981,RC,23650,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$426.12 ,other,,Not separately reimbursible. Not contracted for physician rates,$398.58 ,100,,,$149.40 ,$426.12 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$426.12 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$426.12 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,$426.12 ,100,,,$149.40 ,$426.12 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$426.12 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$426.12 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$426.12 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$426.12 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$426.12 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$426.12 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$426.12 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
23655 CLOSED TREATMENT OF SHOULDER DISLOCATION,8017272,CDM,981,RC,23655,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$517.39 ,135,cms physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$428.98 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$504.66 ,100,,,$428.98 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$814.80 ,100,physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$622.02 ,145,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$428.98 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$428.98 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$593.70 ,100,,,$428.98 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$428.98 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$428.98 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$428.98 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$428.98 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$600.57 ,140,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$428.98 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$428.98 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$428.98 ,100,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$535.17 ,124.753,CMS physician fee schedule,,$428.98 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
23665 CLOSED TREATMENT OF SHOULDER DISLOCATION,8017274,CDM,981,RC,23665,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$514.63 ,135,cms physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$419.80 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$535.59 ,100,,,$419.80 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$798.70 ,100,physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$608.71 ,145,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$419.80 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$419.80 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$581.92 ,100,,,$419.80 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$419.80 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$419.80 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$419.80 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$419.80 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$587.72 ,140,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$419.80 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$419.80 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$419.80 ,100,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$523.71 ,124.753,CMS physician fee schedule,,$419.80 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
23931 INCISION AND DRAINAGE,8017286,CDM,981,RC,23931,HCPCS,outpatient,,,"$1,592.00 ","$1,194.00 ",,$209.06 ,135,cms physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$166.55 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$363.36 ,100,,,$166.55 ,"$1,512.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,$312.89 ,100,physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$241.50 ,145,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$166.55 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$166.55 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$228.16 ,100,,,$166.55 ,"$1,512.40 ",fee schedule,,100% Humana physician fee schedule,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$166.55 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$166.55 ,"$1,512.40 ",other,,Not separately reimbursable per contract terms,$955.20 ,60,,,$166.55 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$955.20 ,60,,,$166.55 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$233.17 ,140,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$166.55 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$166.55 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges,$166.55 ,100,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$207.78 ,124.753,CMS physician fee schedule,,$166.55 ,"$1,512.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24200 REMOVAL OF FOREIGN BODY,8017321,CDM,981,RC,24200,HCPCS,outpatient,,,"$1,591.00 ","$1,193.25 ",,$184.41 ,135,cms physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$146.65 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$271.01 ,100,,,$146.65 ,"$1,511.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$283.50 ,100,physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$212.64 ,145,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$146.65 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$146.65 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$206.36 ,100,,,$146.65 ,"$1,511.45 ",fee schedule,,100% Humana physician fee schedule,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$146.65 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$146.65 ,"$1,511.45 ",other,,Not separately reimbursable per contract terms,$954.60 ,60,,,$146.65 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$954.60 ,60,,,$146.65 ,"$1,511.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$205.31 ,140,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$146.65 ,"$1,511.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,511.45 ",95,,,$146.65 ,"$1,511.45 ",percent of total billed charges,,95% of total billed charges,$146.65 ,100,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$182.95 ,124.753,CMS physician fee schedule,,$146.65 ,"$1,511.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24342 REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON,8017334,CDM,975,RC,24342,HCPCS,outpatient,,,"$3,079.00 ","$2,309.25 ",,"$1,026.80 ",135,cms physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,135% of 2011 CMS physician fee schedule,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$802.87 ,"$2,925.05 ",other,,Not separately reimbursible. Not contracted for physician rates,$966.80 ,100,,,$802.87 ,"$2,925.05 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,567.30 ",100,physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,164.16 ",145,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,925.05 ",95,,,$802.87 ,"$2,925.05 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$802.87 ,"$2,925.05 ",other,,Not separately reimbursible. Not contracted for physician rates,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,137.36 ",100,,,$802.87 ,"$2,925.05 ",fee schedule,,100% Humana physician fee schedule,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$802.87 ,"$2,925.05 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,548.09 ",100,,,$802.87 ,"$2,925.05 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,847.40 ",60,,,$802.87 ,"$2,925.05 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,847.40 ",60,,,$802.87 ,"$2,925.05 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,124.02 ",140,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$802.87 ,"$2,925.05 ",other,,Not separately reimbursible. Not contracted for physician rates,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,925.05 ",95,,,$802.87 ,"$2,925.05 ",percent of total billed charges,,95% of total billed charges,$802.87 ,100,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,001.60 ",124.753,CMS physician fee schedule,,$802.87 ,"$2,925.05 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24505 CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH MANIPULATION,8017359,CDM,981,RC,24505,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$591.03 ,135,cms physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$474.79 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$622.78 ,100,,,$474.79 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$905.80 ,100,physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$688.45 ,145,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$474.79 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$474.79 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$659.60 ,100,,,$474.79 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$474.79 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$474.79 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$474.79 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$474.79 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$664.71 ,140,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$474.79 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$474.79 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$474.79 ,100,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$592.31 ,124.753,CMS physician fee schedule,,$474.79 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24577 CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE,8017372,CDM,981,RC,24577,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$656.64 ,135,cms physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$532.44 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$689.78 ,100,,,$532.44 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,017.80 ",100,physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$772.04 ,145,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$532.44 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$532.44 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$741.16 ,100,,,$532.44 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$532.44 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$532.44 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$532.44 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$532.44 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$745.42 ,140,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$532.44 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$532.44 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$532.44 ,100,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$664.23 ,124.753,CMS physician fee schedule,,$532.44 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24600 TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA ProFee,8017377,CDM,981,RC,24600,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$494.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$462.14 ,100,,,$149.40 ,$494.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$494.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$494.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$494.00 ,100,,,$149.40 ,$494.00 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$494.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$494.00 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$494.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$494.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$494.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$494.00 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$494.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
24605 TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA ProFee,8017378,CDM,981,RC,24605,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$611.44 ,135,cms physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$500.86 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$590.99 ,100,,,$500.86 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$954.80 ,100,physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$726.25 ,145,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$500.86 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$500.86 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$695.45 ,100,,,$500.86 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$500.86 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$500.86 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$500.86 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$500.86 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$701.20 ,140,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$500.86 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$500.86 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$500.86 ,100,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$624.84 ,124.753,CMS physician fee schedule,,$500.86 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24620 CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATION AT ELBOW (FRACTURE PROXIMAL ProFee,8017380,CDM,981,RC,24620,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$725.67 ,135,cms physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$588.31 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$691.50 ,100,,,$588.31 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,119.30 ",100,physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$853.05 ,145,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$588.31 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$588.31 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$813.54 ,100,,,$588.31 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$588.31 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$588.31 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$588.31 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$588.31 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$823.63 ,140,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$588.31 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$588.31 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$588.31 ,100,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$733.93 ,124.753,CMS physician fee schedule,,$588.31 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24640 CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD,8017382,CDM,521,RC,24640,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$229.08 ,92,,,$186.75 ,$241.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$186.75 ,$241.53 ,case rate,,100% of clinic case rate per visit,,,,,$186.75 ,$241.53 ,other,,Not applicable. No negotiated rates per contract,$214.14 ,86,,,$186.75 ,$241.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$199.20 ,80,,,$186.75 ,$241.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,95,,,$186.75 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.55 ,95,,,$186.75 ,$241.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.75 ,75,,,$186.75 ,$241.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.65 ,85,,,$186.75 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$186.75 ,$241.53 ,case rate,,100% of clinic case rate per visit,$224.10 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.53 ,97,,,$186.75 ,$241.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.65 ,85,,,$186.75 ,$241.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$224.10 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.55 ,90,,,$186.75 ,$241.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$186.75 ,$241.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$186.75 ,$241.53 ,other,,Not separately reimbursable per table 3 referenced in contract
24675 CLOSED TREATMENT OF ULNAR FRACTURE,8017388,CDM,981,RC,24675,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$544.02 ,135,cms physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$442.17 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$572.95 ,100,,,$442.17 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$839.30 ,100,physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$641.15 ,145,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$442.17 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$442.17 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$611.39 ,100,,,$442.17 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$442.17 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$442.17 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$442.17 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$442.17 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$619.04 ,140,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$442.17 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$442.17 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$442.17 ,100,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$551.62 ,124.753,CMS physician fee schedule,,$442.17 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
24685 OPEN TREATMENT OF ULNAR FRACTURE,8017389,CDM,975,RC,24685,HCPCS,outpatient,,,,,,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursible per contract terms,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursible. Not contracted for physician rates,$815.19 ,100,,,$815.19 ,$958.94 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursable per contract terms,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$958.94 ,100,,,$815.19 ,$958.94 ,fee schedule,,100% Humana physician fee schedule,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursable per contract terms,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursable per contract terms,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursable per contract terms,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursable per contract terms,,,,,$815.19 ,$958.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$815.19 ,$958.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
25500 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT MANIPULATION ProFee,8017503,CDM,981,RC,25500,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$321.17 ,135,cms physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$370.96 ,other,,Not separately reimbursible. Not contracted for physician rates,$347.90 ,100,,,$150.00 ,$370.96 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$370.96 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$370.96 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,$370.96 ,100,,,$150.00 ,$370.96 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$370.96 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$370.96 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$370.96 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$370.96 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$370.96 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$370.96 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$370.96 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
25505 CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION ProFee,8017504,CDM,981,RC,25505,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$599.14 ,135,cms physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$481.20 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$629.22 ,100,,,$481.20 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$924.70 ,100,physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$697.74 ,145,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$481.20 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$481.20 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$673.58 ,100,,,$481.20 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$481.20 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$481.20 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$481.20 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$481.20 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$673.68 ,140,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$481.20 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$481.20 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$481.20 ,100,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$600.31 ,124.753,CMS physician fee schedule,,$481.20 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
25535 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION ProFee,8017510,CDM,981,RC,25535,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$337.50 ,135,cms physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$665.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$612.04 ,100,,,$150.00 ,$665.13 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$665.13 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$665.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,$665.13 ,100,,,$150.00 ,$665.13 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$665.13 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$665.13 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$665.13 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$665.13 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$665.13 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$665.13 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$665.13 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
25560 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHOUT MANIPULATION ProFee,8017512,CDM,981,RC,25560,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$320.67 ,135,cms physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$374.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$355.20 ,100,,,$150.00 ,$374.11 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$374.11 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$374.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$374.11 ,100,,,$150.00 ,$374.11 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$374.11 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$374.11 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$374.11 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$374.11 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$374.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$374.11 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$374.11 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
25565 CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH MANIPULATION ProFee,8017513,CDM,981,RC,25565,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$617.72 ,135,cms physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$488.12 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$644.25 ,100,,,$488.12 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$936.60 ,100,physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$707.77 ,145,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$488.12 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$488.12 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$681.28 ,100,,,$488.12 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$488.12 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$488.12 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$488.12 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$488.12 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$683.37 ,140,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$488.12 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$488.12 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$488.12 ,100,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$608.94 ,124.753,CMS physician fee schedule,,$488.12 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
25600 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG,8017516,CDM,981,RC,25600,HCPCS,outpatient,,,"$1,083.00 ",$812.25 ,,$345.64 ,135,cms physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$342.93 ,"$1,028.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$415.33 ,100,,,$342.93 ,"$1,028.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,$634.20 ,100,physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$497.25 ,145,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,028.85 ",95,,,$342.93 ,"$1,028.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$342.93 ,"$1,028.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$464.87 ,100,,,$342.93 ,"$1,028.85 ",fee schedule,,100% Humana physician fee schedule,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$342.93 ,"$1,028.85 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$342.93 ,"$1,028.85 ",other,,Not separately reimbursable per contract terms,$649.80 ,60,,,$342.93 ,"$1,028.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$649.80 ,60,,,$342.93 ,"$1,028.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$480.10 ,140,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$342.93 ,"$1,028.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,028.85 ",95,,,$342.93 ,"$1,028.85 ",percent of total billed charges,,95% of total billed charges,$342.93 ,100,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$427.82 ,124.753,CMS physician fee schedule,,$342.93 ,"$1,028.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
25605 CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG,8017517,CDM,981,RC,25605,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$768.12 ,135,cms physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$535.61 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$675.60 ,100,,,$535.61 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,031.09 ",100,physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$776.63 ,145,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$535.61 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$535.61 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$750.36 ,100,,,$535.61 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$535.61 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$535.61 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$535.61 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$535.61 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$749.85 ,140,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$535.61 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$535.61 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$535.61 ,100,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$668.19 ,124.753,CMS physician fee schedule,,$535.61 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
25660 CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION,8017531,CDM,981,RC,25660,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$608.73 ,other,,Not separately reimbursible. Not contracted for physician rates,$517.55 ,100,,,$149.40 ,$608.73 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$608.73 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$608.73 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,$608.73 ,100,,,$149.40 ,$608.73 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$608.73 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$608.73 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$608.73 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$608.73 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$608.73 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$608.73 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$608.73 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
25690 CLOSED TREATMENT OF LUNATE DISLOCATION,8017538,CDM,981,RC,25690,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$628.01 ,135,cms physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$515.16 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$606.88 ,100,,,$515.16 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$980.00 ,100,physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$746.98 ,145,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$515.16 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$515.16 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$713.79 ,100,,,$515.16 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$515.16 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$515.16 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$515.16 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$515.16 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$721.22 ,140,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$515.16 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$515.16 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$515.16 ,100,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$642.68 ,124.753,CMS physician fee schedule,,$515.16 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26010 DRAINAGE OF FINGER ABSCESS; SIMPLE ProFee,8017558,CDM,981,RC,26010,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$179.08 ,135,cms physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,135% of 2011 CMS physician fee schedule,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$121.80 ,$378.82 ,other,,Not separately reimbursible. Not contracted for physician rates,$378.82 ,100,,,$121.80 ,$378.82 ,fee schedule,,100% of the Blue Cross physician fee schedule,$203.00 ,100,physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,$212.29 ,145,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$121.80 ,$378.82 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$121.80 ,$378.82 ,other,,Not separately reimbursible. Not contracted for physician rates,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,$202.80 ,100,,,$121.80 ,$378.82 ,fee schedule,,100% Humana physician fee schedule,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$121.80 ,$378.82 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$121.80 ,$378.82 ,other,,Not separately reimbursable per contract terms,$121.80 ,60,,,$121.80 ,$378.82 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$121.80 ,$378.82 ,percent of total billed charges,,60% of total billed charges for physician settings,$204.97 ,140,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$121.80 ,$378.82 ,other,,Not separately reimbursible. Not contracted for physician rates,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$121.80 ,$378.82 ,percent of total billed charges,,95% of total billed charges,$146.41 ,100,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,100% CMS Medicare physician fee schedule ,$182.65 ,124.753,CMS physician fee schedule,,$121.80 ,$378.82 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26011 DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG,8017559,CDM,981,RC,26011,HCPCS,outpatient,,,"$1,592.00 ","$1,194.00 ",,$243.49 ,135,cms physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$192.64 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$548.04 ,100,,,$192.64 ,"$1,512.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,$372.40 ,100,physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$279.33 ,145,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$192.64 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$192.64 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$271.28 ,100,,,$192.64 ,"$1,512.40 ",fee schedule,,100% Humana physician fee schedule,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$192.64 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$192.64 ,"$1,512.40 ",other,,Not separately reimbursable per contract terms,$955.20 ,60,,,$192.64 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$955.20 ,60,,,$192.64 ,"$1,512.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$269.70 ,140,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$192.64 ,"$1,512.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,512.40 ",95,,,$192.64 ,"$1,512.40 ",percent of total billed charges,,95% of total billed charges,$192.64 ,100,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$240.32 ,124.753,CMS physician fee schedule,,$192.64 ,"$1,512.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26055 Incise finger tendon sheath ProFee,9046414,CDM,975,RC,26055,HCPCS,outpatient,,,"$1,062.00 ",$796.50 ,,$405.35 ,135,cms physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$304.44 ,"$1,008.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$685.48 ,100,,,$304.44 ,"$1,008.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,$581.70 ,100,physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$441.44 ,145,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,008.90 ",95,,,$304.44 ,"$1,008.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$304.44 ,"$1,008.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$424.91 ,100,,,$304.44 ,"$1,008.90 ",fee schedule,,100% Humana physician fee schedule,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$304.44 ,"$1,008.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$620.17 ,100,,,$304.44 ,"$1,008.90 ",fee schedule,,100% Midlands Choice physician fee schedule,$637.20 ,60,,,$304.44 ,"$1,008.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$637.20 ,60,,,$304.44 ,"$1,008.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$426.22 ,140,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$304.44 ,"$1,008.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,008.90 ",95,,,$304.44 ,"$1,008.90 ",percent of total billed charges,,95% of total billed charges,$304.44 ,100,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$379.80 ,124.753,CMS physician fee schedule,,$304.44 ,"$1,008.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26320 Remove implant from hand/finger,9021550,CDM,975,RC,26320,HCPCS,outpatient,,,"$1,186.00 ",$889.50 ,,$457.91 ,135,cms physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,135% of 2011 CMS physician fee schedule,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$365.87 ,"$1,126.70 ",other,,Not separately reimbursible. Not contracted for physician rates,$434.22 ,100,,,$365.87 ,"$1,126.70 ",fee schedule,,100% of the Blue Cross physician fee schedule,$700.70 ,100,physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,$530.51 ,145,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,126.70 ",95,,,$365.87 ,"$1,126.70 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$365.87 ,"$1,126.70 ",other,,Not separately reimbursible. Not contracted for physician rates,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,$510.89 ,100,,,$365.87 ,"$1,126.70 ",fee schedule,,100% Humana physician fee schedule,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$365.87 ,"$1,126.70 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$365.87 ,"$1,126.70 ",other,,Not separately reimbursable per contract terms,$711.60 ,60,,,$365.87 ,"$1,126.70 ",percent of total billed charges,,60% of total billed charges for physician settings,$711.60 ,60,,,$365.87 ,"$1,126.70 ",percent of total billed charges,,60% of total billed charges for physician settings,$512.22 ,140,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$365.87 ,"$1,126.70 ",other,,Not separately reimbursible. Not contracted for physician rates,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,126.70 ",95,,,$365.87 ,"$1,126.70 ",percent of total billed charges,,95% of total billed charges,$365.87 ,100,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,$456.43 ,124.753,CMS physician fee schedule,,$365.87 ,"$1,126.70 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26600 Clsd trtmnt mtcrpl Fx sng w/o manip,9033707,CDM,981,RC,26600,HCPCS,outpatient,,,$915.00 ,$686.25 ,,$356.76 ,135,cms physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,135% of 2011 CMS physician fee schedule,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$302.96 ,$869.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$370.66 ,100,,,$302.96 ,$869.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$564.20 ,100,physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$439.29 ,145,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$869.25 ,95,,,$302.96 ,$869.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$302.96 ,$869.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$413.24 ,100,,,$302.96 ,$869.25 ,fee schedule,,100% Humana physician fee schedule,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$302.96 ,$869.25 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$302.96 ,$869.25 ,other,,Not separately reimbursable per contract terms,$549.00 ,60,,,$302.96 ,$869.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$549.00 ,60,,,$302.96 ,$869.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.14 ,140,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$302.96 ,$869.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$869.25 ,95,,,$302.96 ,$869.25 ,percent of total billed charges,,95% of total billed charges,$302.96 ,100,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$377.95 ,124.753,CMS physician fee schedule,,$302.96 ,$869.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26605 CLOSED TREATMENT OF METACARPAL FRACTURE,8017690,CDM,981,RC,26605,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$337.50 ,135,cms physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$432.36 ,other,,Not separately reimbursible. Not contracted for physician rates,$406.74 ,100,,,$150.00 ,$432.36 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$432.36 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$432.36 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,$432.36 ,100,,,$150.00 ,$432.36 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$432.36 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$432.36 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$432.36 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$432.36 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$432.36 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$432.36 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$432.36 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26641 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION,8017694,CDM,981,RC,26641,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$508.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$478.03 ,100,,,$149.40 ,$508.37 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$508.37 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$508.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$508.37 ,100,,,$149.40 ,$508.37 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$508.37 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$508.37 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$508.37 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$508.37 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$508.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$508.37 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$508.37 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26670 CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION,8017698,CDM,981,RC,26670,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$452.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$428.21 ,100,,,$149.40 ,$452.03 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$452.03 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$452.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,$452.03 ,100,,,$149.40 ,$452.03 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$452.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$452.03 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$452.03 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$452.03 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$452.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$452.03 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$452.03 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26700 CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION,8017703,CDM,981,RC,26700,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$336.15 ,135,cms physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$451.32 ,other,,Not separately reimbursible. Not contracted for physician rates,$414.47 ,100,,,$149.40 ,$451.32 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$451.32 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$451.32 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,$451.32 ,100,,,$149.40 ,$451.32 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$451.32 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$451.32 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$451.32 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$451.32 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$451.32 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$451.32 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$451.32 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26720 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE,8017707,CDM,981,RC,26720,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$236.16 ,135,cms physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,135% of 2011 CMS physician fee schedule,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$288.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$246.96 ,100,,,$150.00 ,$288.27 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.27 ,145,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$288.27 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$288.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$272.66 ,100,,,$150.00 ,$288.27 ,fee schedule,,100% Humana physician fee schedule,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$288.27 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$288.27 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$288.27 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$288.27 ,percent of total billed charges,,60% of total billed charges for physician settings,$278.33 ,140,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$288.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$288.27 ,percent of total billed charges,,95% of total billed charges,$198.81 ,100,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$248.02 ,124.753,CMS physician fee schedule,,$150.00 ,$288.27 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26725 CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE,8017708,CDM,981,RC,26725,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$337.50 ,135,cms physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$445.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$423.92 ,100,,,$150.00 ,$445.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$445.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$445.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$445.70 ,100,,,$150.00 ,$445.70 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$445.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$445.70 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$445.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$445.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$445.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$445.70 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$445.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26742 CLOSED TREATMENT OF ARTICULAR FRACTURE,8017712,CDM,981,RC,26742,HCPCS,outpatient,,,"$1,571.00 ","$1,178.25 ",,$431.69 ,135,cms physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$353.49 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$464.72 ,100,,,$353.49 ,"$1,492.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$674.80 ,100,physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$512.56 ,145,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$353.49 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$353.49 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$491.76 ,100,,,$353.49 ,"$1,492.45 ",fee schedule,,100% Humana physician fee schedule,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$353.49 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$353.49 ,"$1,492.45 ",other,,Not separately reimbursable per contract terms,$942.60 ,60,,,$353.49 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$942.60 ,60,,,$353.49 ,"$1,492.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$494.89 ,140,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$353.49 ,"$1,492.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,492.45 ",95,,,$353.49 ,"$1,492.45 ",percent of total billed charges,,95% of total billed charges,$353.49 ,100,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$440.99 ,124.753,CMS physician fee schedule,,$353.49 ,"$1,492.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26755 CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE,8017715,CDM,981,RC,26755,HCPCS,outpatient,,,$250.00 ,$187.50 ,,$337.50 ,135,cms physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,135% of 2011 CMS physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$401.49 ,other,,Not separately reimbursible. Not contracted for physician rates,$396.86 ,100,,,$150.00 ,$401.49 ,fee schedule,,100% of the Blue Cross physician fee schedule,$250.00 ,100,physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,$362.50 ,145,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,145% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$401.49 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$150.00 ,$401.49 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,$401.49 ,100,,,$150.00 ,$401.49 ,fee schedule,,100% Humana physician fee schedule,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$150.00 ,$401.49 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$150.00 ,$401.49 ,other,,Not separately reimbursable per contract terms,$150.00 ,60,,,$150.00 ,$401.49 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.00 ,60,,,$150.00 ,$401.49 ,percent of total billed charges,,60% of total billed charges for physician settings,$350.00 ,140,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$150.00 ,$401.49 ,other,,Not separately reimbursible. Not contracted for physician rates,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,$237.50 ,95,,,$150.00 ,$401.49 ,percent of total billed charges,,95% of total billed charges,$250.00 ,100,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.88 ,124.753,CMS physician fee schedule,,$150.00 ,$401.49 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26765 OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE,8017717,CDM,981,RC,26765,HCPCS,outpatient,,,"$3,174.00 ","$2,380.50 ",,$660.83 ,135,cms physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$523.98 ,"$3,015.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$625.78 ,100,,,$523.98 ,"$3,015.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,009.40 ",100,physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$759.77 ,145,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,015.30 ",95,,,$523.98 ,"$3,015.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$523.98 ,"$3,015.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$736.06 ,100,,,$523.98 ,"$3,015.30 ",fee schedule,,100% Humana physician fee schedule,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$523.98 ,"$3,015.30 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$523.98 ,"$3,015.30 ",other,,Not separately reimbursable per contract terms,"$1,904.40 ",60,,,$523.98 ,"$3,015.30 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,904.40 ",60,,,$523.98 ,"$3,015.30 ",percent of total billed charges,,60% of total billed charges for physician settings,$733.57 ,140,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$523.98 ,"$3,015.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,015.30 ",95,,,$523.98 ,"$3,015.30 ",percent of total billed charges,,95% of total billed charges,$523.98 ,100,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$653.68 ,124.753,CMS physician fee schedule,,$523.98 ,"$3,015.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
26770 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION,8017718,CDM,983,RC,26770,HCPCS,outpatient,,,$249.00 ,$186.75 ,,$323.91 ,135,cms physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,135% of 2011 CMS physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$377.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$350.90 ,100,,,$149.40 ,$377.62 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.00 ,100,physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,$361.05 ,145,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,145% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$377.62 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.40 ,$377.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,$377.62 ,100,,,$149.40 ,$377.62 ,fee schedule,,100% Humana physician fee schedule,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.40 ,$377.62 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.40 ,$377.62 ,other,,Not separately reimbursable per contract terms,$149.40 ,60,,,$149.40 ,$377.62 ,percent of total billed charges,,60% of total billed charges for physician settings,$149.40 ,60,,,$149.40 ,$377.62 ,percent of total billed charges,,60% of total billed charges for physician settings,$348.60 ,140,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.40 ,$377.62 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,$236.55 ,95,,,$149.40 ,$377.62 ,percent of total billed charges,,95% of total billed charges,$249.00 ,100,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,100% CMS Medicare physician fee schedule ,$310.63 ,124.753,CMS physician fee schedule,,$149.40 ,$377.62 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
26775 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION,8017719,CDM,981,RC,26775,HCPCS,outpatient,,,$267.00 ,$200.25 ,,$360.45 ,135,cms physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$160.20 ,$509.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$480.61 ,100,,,$160.20 ,$509.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$267.00 ,100,physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$387.15 ,145,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$253.65 ,95,,,$160.20 ,$509.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$160.20 ,$509.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$509.00 ,100,,,$160.20 ,$509.00 ,fee schedule,,100% Humana physician fee schedule,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$160.20 ,$509.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$160.20 ,$509.00 ,other,,Not separately reimbursable per contract terms,$160.20 ,60,,,$160.20 ,$509.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$160.20 ,60,,,$160.20 ,$509.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$373.80 ,140,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$160.20 ,$509.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$253.65 ,95,,,$160.20 ,$509.00 ,percent of total billed charges,,95% of total billed charges,$267.00 ,100,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$333.09 ,124.753,CMS physician fee schedule,,$160.20 ,$509.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27062 EXCISION; TROCHANTERIC BURSA OR CALCIFICATION ProFee,8017764,CDM,975,RC,27062,HCPCS,outpatient,,,"$1,533.00 ","$1,149.75 ",,$599.39 ,135,cms physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,135% of 2011 CMS physician fee schedule,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$474.11 ,"$1,456.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$566.51 ,100,,,$474.11 ,"$1,456.35 ",fee schedule,,100% of the Blue Cross physician fee schedule,$916.30 ,100,physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$687.46 ,145,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,456.35 ",95,,,$474.11 ,"$1,456.35 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$474.11 ,"$1,456.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$666.37 ,100,,,$474.11 ,"$1,456.35 ",fee schedule,,100% Humana physician fee schedule,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$474.11 ,"$1,456.35 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$474.11 ,"$1,456.35 ",other,,Not separately reimbursable per contract terms,$919.80 ,60,,,$474.11 ,"$1,456.35 ",percent of total billed charges,,60% of total billed charges for physician settings,$919.80 ,60,,,$474.11 ,"$1,456.35 ",percent of total billed charges,,60% of total billed charges for physician settings,$663.75 ,140,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$474.11 ,"$1,456.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,456.35 ",95,,,$474.11 ,"$1,456.35 ",percent of total billed charges,,95% of total billed charges,$474.11 ,100,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$591.47 ,124.753,CMS physician fee schedule,,$474.11 ,"$1,456.35 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27096 INJECTION PROCEDURE FOR SACROILIAC JOINT,8017781,CDM,975,RC,27096,HCPCS,outpatient,,,$286.00 ,$214.50 ,,$98.81 ,135,cms physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.93 ,$271.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$201.87 ,100,,,$83.93 ,$271.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$167.30 ,100,physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.70 ,145,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$271.70 ,95,,,$83.93 ,$271.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$83.93 ,$271.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$121.44 ,100,,,$83.93 ,$271.70 ,fee schedule,,100% Humana physician fee schedule,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$83.93 ,$271.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$171.74 ,100,,,$83.93 ,$271.70 ,fee schedule,,100% Midlands Choice physician fee schedule,$171.60 ,60,,,$83.93 ,$271.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$171.60 ,60,,,$83.93 ,$271.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$117.50 ,140,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$83.93 ,$271.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$271.70 ,95,,,$83.93 ,$271.70 ,percent of total billed charges,,95% of total billed charges,$83.93 ,100,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$104.71 ,124.753,CMS physician fee schedule,,$83.93 ,$271.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27130 Total Hip Replacement,9077873,CDM,975,RC,27130,HCPCS,outpatient,,,"$5,557.00 ","$4,167.75 ",,"$1,910.91 ",135,cms physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,319.00 ","$5,279.15 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,687.51 ",100,,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$2,744.70 ",100,physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,912.55 ",145,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$5,279.15 ",95,,,"$1,319.00 ","$5,279.15 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,319.00 ","$5,279.15 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,985.35 ",100,,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% Humana physician fee schedule,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,319.00 ","$5,279.15 ",other,,Not separately reimbursible. Not contracted for physician rates,"$2,702.10 ",100,,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% Midlands Choice physician fee schedule,"$3,334.20 ",60,,,"$1,319.00 ","$5,279.15 ",percent of total billed charges,,60% of total billed charges for physician settings,"$3,334.20 ",60,,,"$1,319.00 ","$5,279.15 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,846.60 ",140,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,319.00 ","$5,279.15 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$5,279.15 ",95,,,"$1,319.00 ","$5,279.15 ",percent of total billed charges,,95% of total billed charges,"$1,319.00 ",100,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,645.49 ",124.753,CMS physician fee schedule,,"$1,319.00 ","$5,279.15 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27132 CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY,8017792,CDM,975,RC,27132,HCPCS,outpatient,,,"$6,936.00 ","$5,202.00 ",,"$2,226.65 ",135,cms physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,714.30 ","$6,589.20 ",other,,Not separately reimbursible. Not contracted for physician rates,"$2,085.22 ",100,,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$3,391.50 ",100,physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,485.74 ",145,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$6,589.20 ",95,,,"$1,714.30 ","$6,589.20 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,714.30 ","$6,589.20 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,453.12 ",100,,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% Humana physician fee schedule,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,714.30 ","$6,589.20 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,714.30 ","$6,589.20 ",other,,Not separately reimbursable per contract terms,"$4,161.60 ",60,,,"$1,714.30 ","$6,589.20 ",percent of total billed charges,,60% of total billed charges for physician settings,"$4,161.60 ",60,,,"$1,714.30 ","$6,589.20 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,400.02 ",140,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,714.30 ","$6,589.20 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$6,589.20 ",95,,,"$1,714.30 ","$6,589.20 ",percent of total billed charges,,95% of total billed charges,"$1,714.30 ",100,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,138.64 ",124.753,CMS physician fee schedule,,"$1,714.30 ","$6,589.20 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27250 CLOSED TREATMENT OF HIP DISLOCATION,8017837,CDM,981,RC,27250,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$239.68 ,135,cms physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,135% of 2011 CMS physician fee schedule,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$266.84 ,other,,Not separately reimbursible. Not contracted for physician rates,$226.78 ,100,,,$145.20 ,$266.84 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.00 ,100,physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,$264.94 ,145,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$266.84 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.20 ,$266.84 ,other,,Not separately reimbursible. Not contracted for physician rates,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,$266.84 ,100,,,$145.20 ,$266.84 ,fee schedule,,100% Humana physician fee schedule,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$266.84 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.20 ,$266.84 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$145.20 ,$266.84 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$145.20 ,$266.84 ,percent of total billed charges,,60% of total billed charges for physician settings,$255.81 ,140,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.20 ,$266.84 ,other,,Not separately reimbursible. Not contracted for physician rates,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$266.84 ,percent of total billed charges,,95% of total billed charges,$182.72 ,100,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,100% CMS Medicare physician fee schedule ,$227.95 ,124.753,CMS physician fee schedule,,$145.20 ,$266.84 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27265 CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; WITHOUT ANESTHESIA ProFee,8017845,CDM,981,RC,27265,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$326.70 ,135,cms physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,135% of 2011 CMS physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$593.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$504.23 ,100,,,$145.20 ,$593.11 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.00 ,100,physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$350.90 ,145,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$593.11 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.20 ,$593.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$593.11 ,100,,,$145.20 ,$593.11 ,fee schedule,,100% Humana physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$593.11 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.20 ,$593.11 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$145.20 ,$593.11 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$145.20 ,$593.11 ,percent of total billed charges,,60% of total billed charges for physician settings,$338.80 ,140,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.20 ,$593.11 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$593.11 ,percent of total billed charges,,95% of total billed charges,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,100% CMS Medicare physician fee schedule ,$301.90 ,124.753,CMS physician fee schedule,,$145.20 ,$593.11 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27266 Treat Hip Disclocation,9090652,CDM,981,RC,27266,HCPCS,outpatient,,,"$1,934.00 ","$1,450.50 ",,$764.73 ,135,cms physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$725.86 ,100,,,$608.23 ,"$1,837.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,176.00 ",100,physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$881.93 ,145,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,837.30 ",95,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$854.10 ,100,,,$608.23 ,"$1,837.30 ",fee schedule,,100% Humana physician fee schedule,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursable per contract terms,"$1,160.40 ",60,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,160.40 ",60,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,60% of total billed charges for physician settings,$851.52 ,140,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,837.30 ",95,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,95% of total billed charges,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$758.79 ,124.753,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27266 Treat hip dislocation,9148192,CDM,981,RC,27266,HCPCS,outpatient,,,"$1,934.00 ","$1,450.50 ",,$764.73 ,135,cms physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$725.86 ,100,,,$608.23 ,"$1,837.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,176.00 ",100,physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$881.93 ,145,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,837.30 ",95,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$854.10 ,100,,,$608.23 ,"$1,837.30 ",fee schedule,,100% Humana physician fee schedule,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursable per contract terms,"$1,160.40 ",60,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,160.40 ",60,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,60% of total billed charges for physician settings,$851.52 ,140,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$608.23 ,"$1,837.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,837.30 ",95,,,$608.23 ,"$1,837.30 ",percent of total billed charges,,95% of total billed charges,$608.23 ,100,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$758.79 ,124.753,CMS physician fee schedule,,$608.23 ,"$1,837.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27340 EXCISION,8017880,CDM,975,RC,27340,HCPCS,outpatient,,,"$1,223.00 ",$917.25 ,,$485.99 ,135,cms physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$391.86 ,"$1,161.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$463.86 ,100,,,$391.86 ,"$1,161.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,$749.00 ,100,physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$568.20 ,145,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,161.85 ",95,,,$391.86 ,"$1,161.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$391.86 ,"$1,161.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$545.76 ,100,,,$391.86 ,"$1,161.85 ",fee schedule,,100% Humana physician fee schedule,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$391.86 ,"$1,161.85 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$391.86 ,"$1,161.85 ",other,,Not separately reimbursable per contract terms,$733.80 ,60,,,$391.86 ,"$1,161.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$733.80 ,60,,,$391.86 ,"$1,161.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$548.60 ,140,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$391.86 ,"$1,161.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,161.85 ",95,,,$391.86 ,"$1,161.85 ",percent of total billed charges,,95% of total billed charges,$391.86 ,100,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$488.86 ,124.753,CMS physician fee schedule,,$391.86 ,"$1,161.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27438 Arthroplasty,9131720,CDM,975,RC,27438,HCPCS,outpatient,,,"$3,371.00 ","$2,528.25 ",,"$1,108.63 ",135,cms physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$868.82 ,"$3,202.45 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,048.84 ",100,,,$868.82 ,"$3,202.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,701.70 ",100,physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,259.79 ",145,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,202.45 ",95,,,$868.82 ,"$3,202.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$868.82 ,"$3,202.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,233.85 ",100,,,$868.82 ,"$3,202.45 ",fee schedule,,100% Humana physician fee schedule,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$868.82 ,"$3,202.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$868.82 ,"$3,202.45 ",other,,Not separately reimbursable per contract terms,"$2,022.60 ",60,,,$868.82 ,"$3,202.45 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,022.60 ",60,,,$868.82 ,"$3,202.45 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,216.35 ",140,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$868.82 ,"$3,202.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,202.45 ",95,,,$868.82 ,"$3,202.45 ",percent of total billed charges,,95% of total billed charges,$868.82 ,100,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,083.88 ",124.753,CMS physician fee schedule,,$868.82 ,"$3,202.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27486 REVISION OF TOTAL KNEE ARTHROPLASTY,8017946,CDM,975,RC,27486,HCPCS,outpatient,,,"$5,987.00 ","$4,490.25 ",,"$1,866.47 ",135,cms physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,442.44 ","$5,687.65 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,751.93 ",100,,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$2,847.60 ",100,physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,091.54 ",145,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$5,687.65 ",95,,,"$1,442.44 ","$5,687.65 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,442.44 ","$5,687.65 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,061.08 ",100,,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% Humana physician fee schedule,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,442.44 ","$5,687.65 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,442.44 ","$5,687.65 ",other,,Not separately reimbursable per contract terms,"$3,592.20 ",60,,,"$1,442.44 ","$5,687.65 ",percent of total billed charges,,60% of total billed charges for physician settings,"$3,592.20 ",60,,,"$1,442.44 ","$5,687.65 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,019.42 ",140,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,442.44 ","$5,687.65 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$5,687.65 ",95,,,"$1,442.44 ","$5,687.65 ",percent of total billed charges,,95% of total billed charges,"$1,442.44 ",100,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,799.49 ",124.753,CMS physician fee schedule,,"$1,442.44 ","$5,687.65 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27487 REVISION OF TOTAL KNEE ARTHROPLASTY,8017947,CDM,975,RC,27487,HCPCS,outpatient,,,"$7,686.00 ","$5,764.50 ",,"$2,337.01 ",135,cms physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,797.95 ","$7,301.70 ",other,,Not separately reimbursible. Not contracted for physician rates,"$2,189.59 ",100,,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$3,561.60 ",100,physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,607.03 ",145,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$7,301.70 ",95,,,"$1,797.95 ","$7,301.70 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,797.95 ","$7,301.70 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,575.76 ",100,,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% Humana physician fee schedule,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,797.95 ","$7,301.70 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,797.95 ","$7,301.70 ",other,,Not separately reimbursable per contract terms,"$4,611.60 ",60,,,"$1,797.95 ","$7,301.70 ",percent of total billed charges,,60% of total billed charges for physician settings,"$4,611.60 ",60,,,"$1,797.95 ","$7,301.70 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,517.13 ",140,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,797.95 ","$7,301.70 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$7,301.70 ",95,,,"$1,797.95 ","$7,301.70 ",percent of total billed charges,,95% of total billed charges,"$1,797.95 ",100,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,243.00 ",124.753,CMS physician fee schedule,,"$1,797.95 ","$7,301.70 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27502 CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE,8017956,CDM,981,RC,27502,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,"$1,026.30 ",135,cms physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,135% of 2011 CMS physician fee schedule,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$784.61 ,"$1,525.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$944.90 ,100,,,$784.61 ,"$1,525.00 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,525.00 ",100,physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,137.68 ",145,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$784.61 ,"$1,525.00 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$784.61 ,"$1,525.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,111.74 ",100,,,$784.61 ,"$1,525.00 ",fee schedule,,100% Humana physician fee schedule,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$784.61 ,"$1,525.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$784.61 ,"$1,525.00 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$784.61 ,"$1,525.00 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$784.61 ,"$1,525.00 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,098.45 ",140,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$784.61 ,"$1,525.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$784.61 ,"$1,525.00 ",percent of total billed charges,,95% of total billed charges,$784.61 ,100,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,$978.82 ,124.753,CMS physician fee schedule,,$784.61 ,"$1,525.00 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27510 CLOSED TREATMENT OF FEMORAL FRACTURE,8017962,CDM,981,RC,27510,HCPCS,outpatient,,,,,,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursible per contract terms,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursible. Not contracted for physician rates,$846.97 ,100,,,$846.97 ,$996.38 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursable per contract terms,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$996.38 ,100,,,$846.97 ,$996.38 ,fee schedule,,100% Humana physician fee schedule,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursable per contract terms,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursable per contract terms,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursable per contract terms,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursable per contract terms,,,,,$846.97 ,$996.38 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$846.97 ,$996.38 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
27535 OPEN TREATMENT OF TIBIAL FRACTURE,8017973,CDM,975,RC,27535,HCPCS,outpatient,,,,,,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,118.42 ",100,,,"$1,118.42 ","$1,315.62 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursable per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,315.62 ",100,,,"$1,118.42 ","$1,315.62 ",fee schedule,,100% Humana physician fee schedule,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursable per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursable per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursable per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursable per contract terms,,,,,"$1,118.42 ","$1,315.62 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,118.42 ","$1,315.62 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
27550 CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA ProFee,8017977,CDM,981,RC,27550,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$326.70 ,135,cms physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$711.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$652.84 ,100,,,$145.20 ,$711.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.00 ,100,physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$350.90 ,145,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$711.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.20 ,$711.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$711.00 ,100,,,$145.20 ,$711.00 ,fee schedule,,100% Humana physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$711.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.20 ,$711.00 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$145.20 ,$711.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$145.20 ,$711.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$338.80 ,140,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.20 ,$711.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$711.00 ,percent of total billed charges,,95% of total billed charges,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$301.90 ,124.753,CMS physician fee schedule,,$145.20 ,$711.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27552 CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA ProFee,8017978,CDM,981,RC,27552,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$824.09 ,135,cms physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$660.01 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$784.27 ,100,,,$660.01 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,269.80 ",100,physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$957.01 ,145,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$660.01 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$660.01 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$922.73 ,100,,,$660.01 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$660.01 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$660.01 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$660.01 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$660.01 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$924.01 ,140,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$660.01 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$660.01 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$660.01 ,100,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$823.38 ,124.753,CMS physician fee schedule,,$660.01 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27560 CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA ProFee,8017982,CDM,981,RC,27560,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$326.70 ,135,cms physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$503.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$466.44 ,100,,,$145.20 ,$503.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.00 ,100,physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$350.90 ,145,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$503.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.20 ,$503.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$503.90 ,100,,,$145.20 ,$503.90 ,fee schedule,,100% Humana physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$503.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.20 ,$503.90 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$145.20 ,$503.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$145.20 ,$503.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$338.80 ,140,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.20 ,$503.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$503.90 ,percent of total billed charges,,95% of total billed charges,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$301.90 ,124.753,CMS physician fee schedule,,$145.20 ,$503.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION ProFee,8017985,CDM,975,RC,27570,HCPCS,outpatient,,,"$4,490.00 ","$3,367.50 ",,$197.17 ,135,cms physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$158.61 ,"$4,265.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$188.12 ,100,,,$158.61 ,"$4,265.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,$303.80 ,100,physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$229.98 ,145,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$4,265.50 ",95,,,$158.61 ,"$4,265.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$158.61 ,"$4,265.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$221.27 ,100,,,$158.61 ,"$4,265.50 ",fee schedule,,100% Humana physician fee schedule,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$158.61 ,"$4,265.50 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$158.61 ,"$4,265.50 ",other,,Not separately reimbursable per contract terms,"$2,694.00 ",60,,,$158.61 ,"$4,265.50 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,694.00 ",60,,,$158.61 ,"$4,265.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$222.05 ,140,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$158.61 ,"$4,265.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$4,265.50 ",95,,,$158.61 ,"$4,265.50 ",percent of total billed charges,,95% of total billed charges,$158.61 ,100,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$197.87 ,124.753,CMS physician fee schedule,,$158.61 ,"$4,265.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27635 Excision of curettage of bone cyst or benign tumor,8017890,CDM,975,RC,27635,HCPCS,outpatient,,,"$2,277.00 ","$1,707.75 ",,$783.84 ,135,cms physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,135% of 2011 CMS physician fee schedule,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$600.16 ,"$2,163.15 ",other,,Not separately reimbursible. Not contracted for physician rates,$725.00 ,100,,,$600.16 ,"$2,163.15 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,173.90 ",100,physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,$870.23 ,145,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,163.15 ",95,,,$600.16 ,"$2,163.15 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$600.16 ,"$2,163.15 ",other,,Not separately reimbursible. Not contracted for physician rates,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,$852.96 ,100,,,$600.16 ,"$2,163.15 ",fee schedule,,100% Humana physician fee schedule,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$600.16 ,"$2,163.15 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$600.16 ,"$2,163.15 ",other,,Not separately reimbursable per contract terms,"$1,366.20 ",60,,,$600.16 ,"$2,163.15 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,366.20 ",60,,,$600.16 ,"$2,163.15 ",percent of total billed charges,,60% of total billed charges for physician settings,$840.22 ,140,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$600.16 ,"$2,163.15 ",other,,Not separately reimbursible. Not contracted for physician rates,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,163.15 ",95,,,$600.16 ,"$2,163.15 ",percent of total billed charges,,95% of total billed charges,$600.16 ,100,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,100% CMS Medicare physician fee schedule ,$748.72 ,124.753,CMS physician fee schedule,,$600.16 ,"$2,163.15 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27752 CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT FIBULAR FRACTURE); WITH MAN ProFee,8018068,CDM,981,RC,27752,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$653.01 ,135,cms physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$512.66 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$668.30 ,100,,,$512.66 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$993.30 ,100,physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$743.36 ,145,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$512.66 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$512.66 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$722.15 ,100,,,$512.66 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$512.66 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$512.66 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$512.66 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$512.66 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$717.72 ,140,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$512.66 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$512.66 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$512.66 ,100,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$639.56 ,124.753,CMS physician fee schedule,,$512.66 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27762 CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH MANIPULATION,8018073,CDM,981,RC,27762,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$575.25 ,135,cms physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$457.94 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$597.01 ,100,,,$457.94 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$874.30 ,100,physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$664.01 ,145,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$457.94 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$457.94 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$636.05 ,100,,,$457.94 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$457.94 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$457.94 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$457.94 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$457.94 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$641.12 ,140,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$457.94 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$457.94 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$457.94 ,100,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$571.29 ,124.753,CMS physician fee schedule,,$457.94 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27766 OPEN TREATMENT OF MEDIAL MALLEOLUS FRACTURE,8018074,CDM,975,RC,27766,HCPCS,outpatient,,,,,,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursible per contract terms,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursible. Not contracted for physician rates,$753.34 ,100,,,$753.34 ,$886.21 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursable per contract terms,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$886.21 ,100,,,$753.34 ,$886.21 ,fee schedule,,100% Humana physician fee schedule,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursable per contract terms,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursable per contract terms,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursable per contract terms,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursable per contract terms,,,,,$753.34 ,$886.21 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$753.34 ,$886.21 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
27768 CLOSED TREATMENT OF POSTERIOR MALLEOLUS FRACTURE; WITH MANIPULATION ProFee,8018076,CDM,981,RC,27768,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$575.49 ,135,cms physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$468.50 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$553.20 ,100,,,$468.50 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$893.20 ,100,physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$679.33 ,145,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$468.50 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$468.50 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$650.82 ,100,,,$468.50 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$468.50 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$468.50 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$468.50 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$468.50 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$655.90 ,140,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$468.50 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$468.50 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$468.50 ,100,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$584.47 ,124.753,CMS physician fee schedule,,$468.50 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27786 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITHOUT MANIPULATION ProFee,8018081,CDM,981,RC,27786,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$328.05 ,135,cms physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,135% of 2011 CMS physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$422.06 ,other,,Not separately reimbursible. Not contracted for physician rates,$392.56 ,100,,,$145.80 ,$422.06 ,fee schedule,,100% of the Blue Cross physician fee schedule,$243.00 ,100,physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.35 ,145,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$422.06 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.80 ,$422.06 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,$422.06 ,100,,,$145.80 ,$422.06 ,fee schedule,,100% Humana physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$422.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.80 ,$422.06 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$145.80 ,$422.06 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$145.80 ,$422.06 ,percent of total billed charges,,60% of total billed charges for physician settings,$340.20 ,140,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.80 ,$422.06 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$422.06 ,percent of total billed charges,,95% of total billed charges,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,100% CMS Medicare physician fee schedule ,$303.15 ,124.753,CMS physician fee schedule,,$145.80 ,$422.06 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27788 CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS); WITH MANIPULATION ProFee,8018082,CDM,981,RC,27788,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$328.05 ,135,cms physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,135% of 2011 CMS physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$565.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$530.43 ,100,,,$145.80 ,$565.98 ,fee schedule,,100% of the Blue Cross physician fee schedule,$243.00 ,100,physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.35 ,145,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$565.98 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.80 ,$565.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$565.98 ,100,,,$145.80 ,$565.98 ,fee schedule,,100% Humana physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$565.98 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.80 ,$565.98 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$145.80 ,$565.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$145.80 ,$565.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$340.20 ,140,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.80 ,$565.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$565.98 ,percent of total billed charges,,95% of total billed charges,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$303.15 ,124.753,CMS physician fee schedule,,$145.80 ,$565.98 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27792 OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS),8018083,CDM,975,RC,27792,HCPCS,outpatient,,,"$1,995.00 ","$1,496.25 ",,$944.89 ,135,cms physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,135% of 2011 CMS physician fee schedule,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$669.51 ,"$1,895.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$806.60 ,100,,,$669.51 ,"$1,895.25 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,306.20 ",100,physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$970.79 ,145,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,895.25 ",95,,,$669.51 ,"$1,895.25 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$669.51 ,"$1,895.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$949.05 ,100,,,$669.51 ,"$1,895.25 ",fee schedule,,100% Humana physician fee schedule,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$669.51 ,"$1,895.25 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$669.51 ,"$1,895.25 ",other,,Not separately reimbursable per contract terms,"$1,197.00 ",60,,,$669.51 ,"$1,895.25 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,197.00 ",60,,,$669.51 ,"$1,895.25 ",percent of total billed charges,,60% of total billed charges for physician settings,$937.31 ,140,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$669.51 ,"$1,895.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,895.25 ",95,,,$669.51 ,"$1,895.25 ",percent of total billed charges,,95% of total billed charges,$669.51 ,100,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$835.23 ,124.753,CMS physician fee schedule,,$669.51 ,"$1,895.25 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27808 CLOSED TREATMENT OF BIMALLEOLAR ANKLE FRACTURE (EG,8018084,CDM,981,RC,27808,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$328.05 ,135,cms physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,135% of 2011 CMS physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$445.41 ,other,,Not separately reimbursible. Not contracted for physician rates,$417.04 ,100,,,$145.80 ,$445.41 ,fee schedule,,100% of the Blue Cross physician fee schedule,$243.00 ,100,physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,$352.35 ,145,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$445.41 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.80 ,$445.41 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,$445.41 ,100,,,$145.80 ,$445.41 ,fee schedule,,100% Humana physician fee schedule,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$445.41 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.80 ,$445.41 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$145.80 ,$445.41 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$145.80 ,$445.41 ,percent of total billed charges,,60% of total billed charges for physician settings,$340.20 ,140,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.80 ,$445.41 ,other,,Not separately reimbursible. Not contracted for physician rates,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$445.41 ,percent of total billed charges,,95% of total billed charges,$243.00 ,100,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,100% CMS Medicare physician fee schedule ,$303.15 ,124.753,CMS physician fee schedule,,$145.80 ,$445.41 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
27818 CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH MANIPULATION ProFee,8018088,CDM,981,RC,27818,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$565.96 ,135,cms physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$457.19 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$606.45 ,100,,,$457.19 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$877.80 ,100,physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$662.93 ,145,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$457.19 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$457.19 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$637.97 ,100,,,$457.19 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$457.19 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$457.19 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$457.19 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$457.19 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$640.07 ,140,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$457.19 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$457.19 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$457.19 ,100,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$570.36 ,124.753,CMS physician fee schedule,,$457.19 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27825 CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULAR PORTION OF DISTAL TIBIA (EG,8018092,CDM,981,RC,27825,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$652.86 ,135,cms physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$511.25 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$681.19 ,100,,,$511.25 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$997.50 ,100,physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$741.31 ,145,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$511.25 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$511.25 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$724.37 ,100,,,$511.25 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$511.25 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$511.25 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$511.25 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$511.25 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$715.75 ,140,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$511.25 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$511.25 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$511.25 ,100,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$637.80 ,124.753,CMS physician fee schedule,,$511.25 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
27840 CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA ProFee,8018100,CDM,981,RC,27840,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$326.70 ,135,cms physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,135% of 2011 CMS physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$551.94 ,other,,Not separately reimbursible. Not contracted for physician rates,$469.01 ,100,,,$145.20 ,$551.94 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.00 ,100,physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,$350.90 ,145,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$551.94 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.20 ,$551.94 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,$551.94 ,100,,,$145.20 ,$551.94 ,fee schedule,,100% Humana physician fee schedule,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.20 ,$551.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.20 ,$551.94 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$145.20 ,$551.94 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$145.20 ,$551.94 ,percent of total billed charges,,60% of total billed charges for physician settings,$338.80 ,140,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.20 ,$551.94 ,other,,Not separately reimbursible. Not contracted for physician rates,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$145.20 ,$551.94 ,percent of total billed charges,,95% of total billed charges,$242.00 ,100,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,100% CMS Medicare physician fee schedule ,$301.90 ,124.753,CMS physician fee schedule,,$145.20 ,$551.94 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
28060 FASCIECTOMY,8018139,CDM,975,RC,28060,HCPCS,outpatient,,,"$1,169.00 ",$876.75 ,,$472.80 ,135,cms physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,135% of 2011 CMS physician fee schedule,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$371.17 ,"$1,110.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$657.99 ,100,,,$371.17 ,"$1,110.55 ",fee schedule,,100% of the Blue Cross physician fee schedule,$725.20 ,100,physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$538.20 ,145,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,110.55 ",95,,,$371.17 ,"$1,110.55 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$371.17 ,"$1,110.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$528.02 ,100,,,$371.17 ,"$1,110.55 ",fee schedule,,100% Humana physician fee schedule,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$371.17 ,"$1,110.55 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$371.17 ,"$1,110.55 ",other,,Not separately reimbursable per contract terms,$701.40 ,60,,,$371.17 ,"$1,110.55 ",percent of total billed charges,,60% of total billed charges for physician settings,$701.40 ,60,,,$371.17 ,"$1,110.55 ",percent of total billed charges,,60% of total billed charges for physician settings,$519.64 ,140,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$371.17 ,"$1,110.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,110.55 ",95,,,$371.17 ,"$1,110.55 ",percent of total billed charges,,95% of total billed charges,$371.17 ,100,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$463.05 ,124.753,CMS physician fee schedule,,$371.17 ,"$1,110.55 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
28291 Corrj Halux Tigdis w/Implt,9567487,CDM,975,RC,28291,HCPCS,outpatient,,,"$1,560.00 ","$1,170.00 ",,,,,,$502.48 ,"$1,482.00 ",other,,Not seperately reimbursible per contract terms,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$502.48 ,"$1,482.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$918.70 ,100,,,$502.48 ,"$1,482.00 ",fee schedule,,100% of the Blue Cross physician fee schedule,$987.70 ,100,physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,$728.60 ,145,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,482.00 ",95,,,$502.48 ,"$1,482.00 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$502.48 ,"$1,482.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,$718.17 ,100,,,$502.48 ,"$1,482.00 ",fee schedule,,100% Humana physician fee schedule,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$502.48 ,"$1,482.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$502.48 ,"$1,482.00 ",other,,Not separately reimbursable per contract terms,$936.00 ,60,,,$502.48 ,"$1,482.00 ",percent of total billed charges,,60% of total billed charges for physician settings,$936.00 ,60,,,$502.48 ,"$1,482.00 ",percent of total billed charges,,60% of total billed charges for physician settings,$703.47 ,140,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$502.48 ,"$1,482.00 ",other,,Not separately reimbursible. Not contracted for physician rates,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,482.00 ",95,,,$502.48 ,"$1,482.00 ",percent of total billed charges,,95% of total billed charges,$502.48 ,100,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,100% CMS Medicare physician fee schedule ,$626.86 ,124.753,CMS physician fee schedule,,$502.48 ,"$1,482.00 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
28299 Correction hallux Valgus.,9567490,CDM,360,RC,28299,HCPCS,outpatient,,,"$1,904.00 ","$1,428.00 ",,"$1,751.68 ",92,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,047.20 ",55,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,047.20 ","$1,846.88 ",other,,Not applicable. No negotiated rates per contract,"$1,637.44 ",86,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,523.20 ",80,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,047.20 ",55,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,808.80 ",95,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,808.80 ",95,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,428.00 ",75,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,618.40 ",85,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,846.88 ",97,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,047.20 ",55,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,713.60 ",90,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,846.88 ",97,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,846.88 ",97,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,846.88 ",97,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,618.40 ",85,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,713.60 ",90,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,047.20 ",55,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,808.80 ",90,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,047.20 ",55,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,770.72 ",93,,,"$1,047.20 ","$1,846.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
28435 CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION ProFee,8018237,CDM,981,RC,28435,HCPCS,outpatient,,,"$1,525.00 ","$1,143.75 ",,$420.67 ,135,cms physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$343.77 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$455.27 ,100,,,$343.77 ,"$1,448.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$651.70 ,100,physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$498.47 ,145,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$343.77 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$343.77 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$475.61 ,100,,,$343.77 ,"$1,448.75 ",fee schedule,,100% Humana physician fee schedule,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$343.77 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$343.77 ,"$1,448.75 ",other,,Not separately reimbursable per contract terms,$915.00 ,60,,,$343.77 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$915.00 ,60,,,$343.77 ,"$1,448.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$481.28 ,140,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$343.77 ,"$1,448.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,448.75 ",95,,,$343.77 ,"$1,448.75 ",percent of total billed charges,,95% of total billed charges,$343.77 ,100,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$428.86 ,124.753,CMS physician fee schedule,,$343.77 ,"$1,448.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
28495 CLOSED TREATMENT OF FRACTURE GREAT TOE,8018250,CDM,981,RC,28495,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$197.60 ,135,cms physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$222.91 ,100,,,$145.80 ,$243.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$243.00 ,100,physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$224.52 ,145,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$243.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.78 ,100,,,$145.80 ,$243.00 ,fee schedule,,100% Humana physician fee schedule,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$145.80 ,$243.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$145.80 ,$243.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$216.78 ,140,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$243.00 ,percent of total billed charges,,95% of total billed charges,$154.84 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$193.17 ,124.753,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
28510 CLOSED TREATMENT OF FRACTURE,8018253,CDM,981,RC,28510,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$155.99 ,135,cms physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$123.96 ,$238.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$151.61 ,100,,,$123.96 ,$238.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$238.70 ,100,physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$179.74 ,145,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$123.96 ,$238.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$123.96 ,$238.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$175.18 ,100,,,$123.96 ,$238.70 ,fee schedule,,100% Humana physician fee schedule,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$123.96 ,$238.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$123.96 ,$238.70 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$123.96 ,$238.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$123.96 ,$238.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$173.54 ,140,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$123.96 ,$238.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$123.96 ,$238.70 ,percent of total billed charges,,95% of total billed charges,$123.96 ,100,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$154.64 ,124.753,CMS physician fee schedule,,$123.96 ,$238.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
28515 CLOSED TREATMENT OF FRACTURE,8018254,CDM,981,RC,28515,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$186.03 ,135,cms physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$204.01 ,100,,,$145.80 ,$243.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$243.00 ,100,physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$214.99 ,145,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$243.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$209.19 ,100,,,$145.80 ,$243.00 ,fee schedule,,100% Humana physician fee schedule,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursable per contract terms,$145.80 ,60,,,$145.80 ,$243.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.80 ,60,,,$145.80 ,$243.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$207.58 ,140,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$145.80 ,$243.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$230.85 ,95,,,$145.80 ,$243.00 ,percent of total billed charges,,95% of total billed charges,$148.27 ,100,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$184.97 ,124.753,CMS physician fee schedule,,$145.80 ,$243.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
28630 CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA ProFee,8018270,CDM,981,RC,28630,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$144.59 ,135,cms physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$113.43 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$195.42 ,100,,,$113.43 ,$229.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$224.00 ,100,physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$164.47 ,145,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$113.43 ,$229.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$113.43 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$162.36 ,100,,,$113.43 ,$229.90 ,fee schedule,,100% Humana physician fee schedule,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$113.43 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$113.43 ,$229.90 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$113.43 ,$229.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$113.43 ,$229.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$158.80 ,140,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$113.43 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$113.43 ,$229.90 ,percent of total billed charges,,95% of total billed charges,$113.43 ,100,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$141.51 ,124.753,CMS physician fee schedule,,$113.43 ,$229.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
28660 CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION,8018274,CDM,981,RC,28660,HCPCS,outpatient,,,$242.00 ,$181.50 ,,$115.29 ,135,cms physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$95.82 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$148.61 ,100,,,$95.82 ,$229.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$183.40 ,100,physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$138.94 ,145,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$229.90 ,95,,,$95.82 ,$229.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$95.82 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.13 ,100,,,$95.82 ,$229.90 ,fee schedule,,100% Humana physician fee schedule,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$95.82 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$95.82 ,$229.90 ,other,,Not separately reimbursable per contract terms,$145.20 ,60,,,$95.82 ,$229.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$145.20 ,60,,,$95.82 ,$229.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$134.15 ,140,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$95.82 ,$229.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$229.90 ,95,,,$95.82 ,$229.90 ,percent of total billed charges,,95% of total billed charges,$95.82 ,100,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.54 ,124.753,CMS physician fee schedule,,$95.82 ,$229.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29105 APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) ProFee,8018309,CDM,981,RC,29105,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$78.27 ,135,cms physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$42.07 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$100.50 ,100,,,$42.07 ,$142.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$84.70 ,100,physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$61.00 ,145,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$142.50 ,95,,,$42.07 ,$142.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$42.07 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.98 ,100,,,$42.07 ,$142.50 ,fee schedule,,100% Humana physician fee schedule,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$42.07 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$42.07 ,$142.50 ,other,,Not separately reimbursable per contract terms,$90.00 ,60,,,$42.07 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.00 ,60,,,$42.07 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$58.90 ,140,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$42.07 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.50 ,95,,,$42.07 ,$142.50 ,percent of total billed charges,,95% of total billed charges,$42.07 ,100,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$52.48 ,124.753,CMS physician fee schedule,,$42.07 ,$142.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29125 APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC ProFee,8018310,CDM,981,RC,29125,HCPCS,outpatient,,,$122.00 ,$91.50 ,,$57.40 ,135,cms physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$40.85 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.46 ,100,,,$40.85 ,$115.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$79.09 ,100,physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$59.23 ,145,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$115.90 ,95,,,$40.85 ,$115.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$40.85 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$57.57 ,100,,,$40.85 ,$115.90 ,fee schedule,,100% Humana physician fee schedule,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$40.85 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$40.85 ,$115.90 ,other,,Not separately reimbursable per contract terms,$73.20 ,60,,,$40.85 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.20 ,60,,,$40.85 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$57.19 ,140,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$40.85 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.90 ,95,,,$40.85 ,$115.90 ,percent of total billed charges,,95% of total billed charges,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$50.96 ,124.753,CMS physician fee schedule,,$40.85 ,$115.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29130 APPLICATION OF FINGER SPLINT; STATIC ProFee,8018312,CDM,981,RC,29130,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$37.77 ,135,cms physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$29.77 ,$59.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$51.11 ,100,,,$29.77 ,$59.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$59.50 ,100,physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$43.17 ,145,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$58.90 ,95,,,$29.77 ,$59.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$29.77 ,$59.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$42.95 ,100,,,$29.77 ,$59.50 ,fee schedule,,100% Humana physician fee schedule,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$29.77 ,$59.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$29.77 ,$59.50 ,other,,Not separately reimbursable per contract terms,$37.20 ,60,,,$29.77 ,$59.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$37.20 ,60,,,$29.77 ,$59.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$41.68 ,140,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$29.77 ,$59.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$58.90 ,95,,,$29.77 ,$59.50 ,percent of total billed charges,,95% of total billed charges,$29.77 ,100,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$37.14 ,124.753,CMS physician fee schedule,,$29.77 ,$59.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29505 APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES) ProFee,8018330,CDM,981,RC,29505,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$63.65 ,135,cms physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$52.34 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$105.23 ,100,,,$52.34 ,$142.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$101.50 ,100,physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$75.89 ,145,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$142.50 ,95,,,$52.34 ,$142.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$52.34 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$73.82 ,100,,,$52.34 ,$142.50 ,fee schedule,,100% Humana physician fee schedule,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$52.34 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$52.34 ,$142.50 ,other,,Not separately reimbursable per contract terms,$90.00 ,60,,,$52.34 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.00 ,60,,,$52.34 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.28 ,140,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$52.34 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.50 ,95,,,$52.34 ,$142.50 ,percent of total billed charges,,95% of total billed charges,$52.34 ,100,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$65.30 ,124.753,CMS physician fee schedule,,$52.34 ,$142.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) ProFee,8018331,CDM,981,RC,29515,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$65.21 ,135,cms physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$50.15 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$87.62 ,100,,,$50.15 ,$142.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$99.40 ,100,physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$72.72 ,145,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$142.50 ,95,,,$50.15 ,$142.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$50.15 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$72.18 ,100,,,$50.15 ,$142.50 ,fee schedule,,100% Humana physician fee schedule,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$50.15 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$50.15 ,$142.50 ,other,,Not separately reimbursable per contract terms,$90.00 ,60,,,$50.15 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.00 ,60,,,$50.15 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$70.21 ,140,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$50.15 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.50 ,95,,,$50.15 ,$142.50 ,percent of total billed charges,,95% of total billed charges,$50.15 ,100,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$62.56 ,124.753,CMS physician fee schedule,,$50.15 ,$142.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29550 STRAPPING; TOES ProFee,8018335,CDM,981,RC,29550,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$19.51 ,135,cms physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.42 ,$58.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$23.62 ,100,,,$11.42 ,$58.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$23.10 ,100,physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.56 ,145,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$58.90 ,95,,,$11.42 ,$58.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$11.42 ,$58.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.67 ,100,,,$11.42 ,$58.90 ,fee schedule,,100% Humana physician fee schedule,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.42 ,$58.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$11.42 ,$58.90 ,other,,Not separately reimbursable per contract terms,$37.20 ,60,,,$11.42 ,$58.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$37.20 ,60,,,$11.42 ,$58.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$15.99 ,140,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$11.42 ,$58.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$58.90 ,95,,,$11.42 ,$58.90 ,percent of total billed charges,,95% of total billed charges,$11.42 ,100,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$14.25 ,124.753,CMS physician fee schedule,,$11.42 ,$58.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29580 STRAPPING; UNNA BOOT ProFee,8018336,CDM,981,RC,29580,HCPCS,outpatient,,,$150.00 ,$112.50 ,,$47.39 ,135,cms physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,135% of 2011 CMS physician fee schedule,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$27.25 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$78.60 ,100,,,$27.25 ,$142.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,$55.30 ,100,physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$39.51 ,145,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,145% CMS Medicare physician fee schedule ,$142.50 ,95,,,$27.25 ,$142.50 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$27.25 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$39.80 ,100,,,$27.25 ,$142.50 ,fee schedule,,100% Humana physician fee schedule,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$27.25 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$27.25 ,$142.50 ,other,,Not separately reimbursable per contract terms,$90.00 ,60,,,$27.25 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.00 ,60,,,$27.25 ,$142.50 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.15 ,140,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$27.25 ,$142.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.50 ,95,,,$27.25 ,$142.50 ,percent of total billed charges,,95% of total billed charges,$27.25 ,100,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,100% CMS Medicare physician fee schedule ,$34.00 ,124.753,CMS physician fee schedule,,$27.25 ,$142.50 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29705 REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST ProFee,8018343,CDM,981,RC,29705,HCPCS,outpatient,,,$258.00 ,$193.50 ,,$62.60 ,135,cms physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,135% of 2011 CMS physician fee schedule,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$45.47 ,$245.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.03 ,100,,,$45.47 ,$245.10 ,fee schedule,,100% of the Blue Cross physician fee schedule,$91.70 ,100,physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$65.93 ,145,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,145% CMS Medicare physician fee schedule ,$245.10 ,95,,,$45.47 ,$245.10 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$45.47 ,$245.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$66.39 ,100,,,$45.47 ,$245.10 ,fee schedule,,100% Humana physician fee schedule,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$45.47 ,$245.10 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$45.47 ,$245.10 ,other,,Not separately reimbursable per contract terms,$154.80 ,60,,,$45.47 ,$245.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$154.80 ,60,,,$45.47 ,$245.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$63.66 ,140,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$45.47 ,$245.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$245.10 ,95,,,$45.47 ,$245.10 ,percent of total billed charges,,95% of total billed charges,$45.47 ,100,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$56.73 ,124.753,CMS physician fee schedule,,$45.47 ,$245.10 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
29828 Arthroscopy Biceps Tenodesis.,9567513,CDM,975,RC,29828,HCPCS,outpatient,,,"$3,731.00 ","$2,798.25 ",,"$1,219.31 ",135,cms physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$946.47 ,"$3,544.45 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,144.19 ",100,,,$946.47 ,"$3,544.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,856.40 ",100,physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,372.38 ",145,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,544.45 ",95,,,$946.47 ,"$3,544.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$946.47 ,"$3,544.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,345.92 ",100,,,$946.47 ,"$3,544.45 ",fee schedule,,100% Humana physician fee schedule,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$946.47 ,"$3,544.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$946.47 ,"$3,544.45 ",other,,Not separately reimbursable per contract terms,"$2,238.60 ",60,,,$946.47 ,"$3,544.45 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,238.60 ",60,,,$946.47 ,"$3,544.45 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,325.06 ",140,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$946.47 ,"$3,544.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,544.45 ",95,,,$946.47 ,"$3,544.45 ",percent of total billed charges,,95% of total billed charges,$946.47 ,100,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,180.75 ",124.753,CMS physician fee schedule,,$946.47 ,"$3,544.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
29855 ARTHROSCOPICALLY AIDED TREATMENT OF TIBIAL FRACTURE,8018380,CDM,975,RC,29855,HCPCS,outpatient,,,"$3,050.00 ","$2,287.50 ",,"$1,037.38 ",135,cms physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$808.17 ,"$2,897.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$974.54 ,100,,,$808.17 ,"$2,897.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,579.90 ",100,physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,171.85 ",145,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,897.50 ",95,,,$808.17 ,"$2,897.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$808.17 ,"$2,897.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,146.67 ",100,,,$808.17 ,"$2,897.50 ",fee schedule,,100% Humana physician fee schedule,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$808.17 ,"$2,897.50 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$808.17 ,"$2,897.50 ",other,,Not separately reimbursable per contract terms,"$1,830.00 ",60,,,$808.17 ,"$2,897.50 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,830.00 ",60,,,$808.17 ,"$2,897.50 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,131.44 ",140,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$808.17 ,"$2,897.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,897.50 ",95,,,$808.17 ,"$2,897.50 ",percent of total billed charges,,95% of total billed charges,$808.17 ,100,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,008.22 ",124.753,CMS physician fee schedule,,$808.17 ,"$2,897.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
29880 ARTHROSCOPY,8018397,CDM,975,RC,29880,HCPCS,outpatient,,,,,,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursible per contract terms,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursible. Not contracted for physician rates,$700.09 ,100,,,$700.09 ,"$1,120.13 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursable per contract terms,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$823.49 ,100,,,$700.09 ,"$1,120.13 ",fee schedule,,100% Humana physician fee schedule,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,120.13 ",100,,,$700.09 ,"$1,120.13 ",fee schedule,,100% Midlands Choice physician fee schedule,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursable per contract terms,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursable per contract terms,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursable per contract terms,,,,,$700.09 ,"$1,120.13 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$700.09 ,"$1,120.13 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
29893 ENDOSCOPIC PLANTAR FASCIOTOMY ProFee,8018409,CDM,981,RC,29893,HCPCS,outpatient,,,"$2,202.00 ","$1,651.50 ",,$568.17 ,135,cms physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$446.13 ,"$2,091.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$800.59 ,100,,,$446.13 ,"$2,091.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,$866.60 ,100,physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$646.89 ,145,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,091.90 ",95,,,$446.13 ,"$2,091.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$446.13 ,"$2,091.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$632.24 ,100,,,$446.13 ,"$2,091.90 ",fee schedule,,100% Humana physician fee schedule,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$446.13 ,"$2,091.90 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$446.13 ,"$2,091.90 ",other,,Not separately reimbursable per contract terms,"$1,321.20 ",60,,,$446.13 ,"$2,091.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,321.20 ",60,,,$446.13 ,"$2,091.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$624.58 ,140,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$446.13 ,"$2,091.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,091.90 ",95,,,$446.13 ,"$2,091.90 ",percent of total billed charges,,95% of total billed charges,$446.13 ,100,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$556.56 ,124.753,CMS physician fee schedule,,$446.13 ,"$2,091.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
30000 DRAINAGE ABSCESS OR HEMATOMA,8018426,CDM,981,RC,30000,HCPCS,outpatient,,,,,,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursible per contract terms,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$315.25 ,100,,,$172.52 ,$315.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursable per contract terms,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$172.52 ,100,,,$172.52 ,$315.25 ,fee schedule,,100% Humana physician fee schedule,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursable per contract terms,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursable per contract terms,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursable per contract terms,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursable per contract terms,,,,,$172.52 ,$315.25 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$172.52 ,$315.25 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30020 DRAINAGE ABSCESS OR HEMATOMA,8018427,CDM,981,RC,30020,HCPCS,outpatient,,,$497.00 ,$372.75 ,,$162.39 ,135,cms physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,135% of 2011 CMS physician fee schedule,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$126.02 ,$472.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$318.26 ,100,,,$126.02 ,$472.15 ,fee schedule,,100% of the Blue Cross physician fee schedule,$238.00 ,100,physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$182.73 ,145,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,145% CMS Medicare physician fee schedule ,$472.15 ,95,,,$126.02 ,$472.15 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$126.02 ,$472.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$173.56 ,100,,,$126.02 ,$472.15 ,fee schedule,,100% Humana physician fee schedule,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$126.02 ,$472.15 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$126.02 ,$472.15 ,other,,Not separately reimbursable per contract terms,$298.20 ,60,,,$126.02 ,$472.15 ,percent of total billed charges,,60% of total billed charges for physician settings,$298.20 ,60,,,$126.02 ,$472.15 ,percent of total billed charges,,60% of total billed charges for physician settings,$176.43 ,140,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$126.02 ,$472.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$472.15 ,95,,,$126.02 ,$472.15 ,percent of total billed charges,,95% of total billed charges,$126.02 ,100,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$157.21 ,124.753,CMS physician fee schedule,,$126.02 ,$472.15 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
30300 REMOVAL FOREIGN BODY,8018443,CDM,981,RC,30300,HCPCS,outpatient,,,$122.00 ,$91.50 ,,$164.70 ,135,cms physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,135% of 2011 CMS physician fee schedule,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.20 ,$237.51 ,other,,Not separately reimbursible. Not contracted for physician rates,$237.51 ,100,,,$73.20 ,$237.51 ,fee schedule,,100% of the Blue Cross physician fee schedule,$122.00 ,100,physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,$176.90 ,145,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,145% CMS Medicare physician fee schedule ,$115.90 ,95,,,$73.20 ,$237.51 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$73.20 ,$237.51 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,$165.93 ,100,,,$73.20 ,$237.51 ,fee schedule,,100% Humana physician fee schedule,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.20 ,$237.51 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.20 ,$237.51 ,other,,Not separately reimbursable per contract terms,$73.20 ,60,,,$73.20 ,$237.51 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.20 ,60,,,$73.20 ,$237.51 ,percent of total billed charges,,60% of total billed charges for physician settings,$170.80 ,140,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$73.20 ,$237.51 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.90 ,95,,,$73.20 ,$237.51 ,percent of total billed charges,,95% of total billed charges,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,100% CMS Medicare physician fee schedule ,$152.20 ,124.753,CMS physician fee schedule,,$73.20 ,$237.51 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
30901 CONTROL NASAL HEMORRHAGE,8018465,CDM,981,RC,30901,HCPCS,outpatient,,,,,,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursible per contract terms,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$179.10 ,100,,,$82.60 ,$179.10 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursable per contract terms,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$82.60 ,100,,,$82.60 ,$179.10 ,fee schedule,,100% Humana physician fee schedule,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursable per contract terms,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursable per contract terms,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursable per contract terms,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursable per contract terms,,,,,$82.60 ,$179.10 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$82.60 ,$179.10 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30903 CONTROL NASAL HEMORRHAGE,8018466,CDM,981,RC,30903,HCPCS,outpatient,,,,,,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursible per contract terms,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursible. Not contracted for physician rates,$284.33 ,100,,,$114.69 ,$284.33 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursable per contract terms,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$114.69 ,100,,,$114.69 ,$284.33 ,fee schedule,,100% Humana physician fee schedule,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursable per contract terms,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursable per contract terms,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursable per contract terms,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursable per contract terms,,,,,$114.69 ,$284.33 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$114.69 ,$284.33 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30905 CONTROL NASAL HEMORRHAGE,8018467,CDM,981,RC,30905,HCPCS,outpatient,,,,,,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursible per contract terms,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursible. Not contracted for physician rates,$423.06 ,100,,,$154.74 ,$423.06 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursable per contract terms,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$154.74 ,100,,,$154.74 ,$423.06 ,fee schedule,,100% Humana physician fee schedule,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursable per contract terms,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursable per contract terms,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursable per contract terms,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursable per contract terms,,,,,$154.74 ,$423.06 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.74 ,$423.06 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30906 CONTROL NASAL HEMORRHAGE,8018468,CDM,981,RC,30906,HCPCS,outpatient,,,,,,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursible per contract terms,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursible. Not contracted for physician rates,$439.81 ,100,,,$198.11 ,$439.81 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursable per contract terms,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$198.11 ,100,,,$198.11 ,$439.81 ,fee schedule,,100% Humana physician fee schedule,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursable per contract terms,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursable per contract terms,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursable per contract terms,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursable per contract terms,,,,,$198.11 ,$439.81 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$198.11 ,$439.81 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
30930 FRACTURE NASAL INFERIOR TURBINATE(S),8018471,CDM,360,RC,30930,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
31500 INTUBATION,8018532,CDM,981,RC,31500,HCPCS,outpatient,,,,,,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursible per contract terms,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursible. Not contracted for physician rates,$176.95 ,100,,,$176.95 ,$289.92 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursable per contract terms,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$208.29 ,100,,,$176.95 ,$289.92 ,fee schedule,,100% Humana physician fee schedule,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursible. Not contracted for physician rates,$289.92 ,100,,,$176.95 ,$289.92 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursable per contract terms,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursable per contract terms,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursable per contract terms,,,,,$176.95 ,$289.92 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$176.95 ,$289.92 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
31502 TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULA TRACT ProFee,8018533,CDM,981,RC,31502,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$47.40 ,135,cms physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$35.67 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.38 ,100,,,$35.67 ,$217.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$70.70 ,100,physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$51.72 ,145,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$35.67 ,$217.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$35.67 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$51.04 ,100,,,$35.67 ,$217.55 ,fee schedule,,100% Humana physician fee schedule,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$35.67 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$35.67 ,$217.55 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$35.67 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$35.67 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$49.94 ,140,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$35.67 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$35.67 ,$217.55 ,percent of total billed charges,,95% of total billed charges,$35.67 ,100,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$44.50 ,124.753,CMS physician fee schedule,,$35.67 ,$217.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
31505 LARYNGOSCOPY,8018534,CDM,981,RC,31505,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$66.58 ,135,cms physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,135% of 2011 CMS physician fee schedule,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$50.38 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$108.66 ,100,,,$50.38 ,$166.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$97.30 ,100,physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$73.05 ,145,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$166.25 ,95,,,$50.38 ,$166.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$50.38 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$70.95 ,100,,,$50.38 ,$166.25 ,fee schedule,,100% Humana physician fee schedule,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$50.38 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$50.38 ,$166.25 ,other,,Not separately reimbursable per contract terms,$105.00 ,60,,,$50.38 ,$166.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$105.00 ,60,,,$50.38 ,$166.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$70.53 ,140,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$50.38 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$166.25 ,95,,,$50.38 ,$166.25 ,percent of total billed charges,,95% of total billed charges,$50.38 ,100,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$62.85 ,124.753,CMS physician fee schedule,,$50.38 ,$166.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
31525 LARYNGOSCOPY DIRECT,8018541,CDM,981,RC,31525,HCPCS,outpatient,,,"$1,610.00 ","$1,207.50 ",,$219.25 ,135,cms physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$162.92 ,"$1,529.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$311.39 ,100,,,$162.92 ,"$1,529.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,$319.20 ,100,physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$236.23 ,145,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,529.50 ",95,,,$162.92 ,"$1,529.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$162.92 ,"$1,529.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$231.22 ,100,,,$162.92 ,"$1,529.50 ",fee schedule,,100% Humana physician fee schedule,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$162.92 ,"$1,529.50 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$162.92 ,"$1,529.50 ",other,,Not separately reimbursable per contract terms,$966.00 ,60,,,$162.92 ,"$1,529.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$966.00 ,60,,,$162.92 ,"$1,529.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$228.09 ,140,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$162.92 ,"$1,529.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,529.50 ",95,,,$162.92 ,"$1,529.50 ",percent of total billed charges,,95% of total billed charges,$162.92 ,100,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$203.25 ,124.753,CMS physician fee schedule,,$162.92 ,"$1,529.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
31575 LARYNGOSCOPY FLEXIBLE DIAGNOSTIC ProFee,8018565,CDM,981,RC,31575,HCPCS,outpatient,,,$175.00 ,$131.25 ,,$104.69 ,135,cms physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,135% of 2011 CMS physician fee schedule,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$68.81 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$152.90 ,100,,,$68.81 ,$166.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$133.00 ,100,physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$99.77 ,145,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$166.25 ,95,,,$68.81 ,$166.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$68.81 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$96.82 ,100,,,$68.81 ,$166.25 ,fee schedule,,100% Humana physician fee schedule,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$68.81 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$134.58 ,100,,,$68.81 ,$166.25 ,fee schedule,,100% Midlands Choice physician fee schedule,$105.00 ,60,,,$68.81 ,$166.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$105.00 ,60,,,$68.81 ,$166.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$96.33 ,140,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$68.81 ,$166.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$166.25 ,95,,,$68.81 ,$166.25 ,percent of total billed charges,,95% of total billed charges,$68.81 ,100,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$85.84 ,124.753,CMS physician fee schedule,,$68.81 ,$166.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
31603 TRACHEOSTOMY,8018581,CDM,981,RC,31603,HCPCS,outpatient,,,"$1,518.00 ","$1,138.50 ",,$302.00 ,135,cms physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,135% of 2011 CMS physician fee schedule,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$302.00 ,"$1,442.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$398.58 ,100,,,$302.00 ,"$1,442.10 ",fee schedule,,100% of the Blue Cross physician fee schedule,$651.00 ,100,physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$473.41 ,145,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,442.10 ",95,,,$302.00 ,"$1,442.10 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$302.00 ,"$1,442.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$468.86 ,100,,,$302.00 ,"$1,442.10 ",fee schedule,,100% Humana physician fee schedule,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$302.00 ,"$1,442.10 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$302.00 ,"$1,442.10 ",other,,Not separately reimbursable per contract terms,$910.80 ,60,,,$302.00 ,"$1,442.10 ",percent of total billed charges,,60% of total billed charges for physician settings,$910.80 ,60,,,$302.00 ,"$1,442.10 ",percent of total billed charges,,60% of total billed charges for physician settings,$457.09 ,140,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$302.00 ,"$1,442.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,442.10 ",95,,,$302.00 ,"$1,442.10 ",percent of total billed charges,,95% of total billed charges,$326.49 ,100,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$407.31 ,124.753,CMS physician fee schedule,,$302.00 ,"$1,442.10 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
31605 TRACHEOSTOMY,8018582,CDM,981,RC,31605,HCPCS,outpatient,,,"$1,049.00 ",$786.75 ,,$243.49 ,135,cms physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$243.49 ,$996.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$414.47 ,100,,,$243.49 ,$996.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$679.00 ,100,physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$489.98 ,145,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$996.55 ,95,,,$243.49 ,$996.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$243.49 ,$996.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$487.49 ,100,,,$243.49 ,$996.55 ,fee schedule,,100% Humana physician fee schedule,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$243.49 ,$996.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$243.49 ,$996.55 ,other,,Not separately reimbursable per contract terms,$629.40 ,60,,,$243.49 ,$996.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$629.40 ,60,,,$243.49 ,$996.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$473.09 ,140,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$243.49 ,$996.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$996.55 ,95,,,$243.49 ,$996.55 ,percent of total billed charges,,95% of total billed charges,$337.92 ,100,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$421.57 ,124.753,CMS physician fee schedule,,$243.49 ,$996.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
32550 INSERTION OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF ProFee,8018680,CDM,981,RC,32550,HCPCS,outpatient,,,"$2,333.00 ","$1,749.75 ",,$296.07 ,135,cms physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,135% of 2011 CMS physician fee schedule,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$2.72 ,"$2,216.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$987.42 ,100,,,$2.72 ,"$2,216.35 ",fee schedule,,100% of the Blue Cross physician fee schedule,$417.90 ,100,physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$300.53 ,145,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,216.35 ",95,,,$2.72 ,"$2,216.35 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$2.72 ,"$2,216.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$301.63 ,100,,,$2.72 ,"$2,216.35 ",fee schedule,,100% Humana physician fee schedule,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$2.72 ,"$2,216.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$2.72 ,100,,,$2.72 ,"$2,216.35 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,399.80 ",60,,,$2.72 ,"$2,216.35 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,399.80 ",60,,,$2.72 ,"$2,216.35 ",percent of total billed charges,,60% of total billed charges for physician settings,$290.16 ,140,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$2.72 ,"$2,216.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,216.35 ",95,,,$2.72 ,"$2,216.35 ",percent of total billed charges,,95% of total billed charges,$207.26 ,100,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$258.56 ,124.753,CMS physician fee schedule,,$2.72 ,"$2,216.35 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
32551 TUBE THORACOSTOMY,8018681,CDM,981,RC,32551,HCPCS,outpatient,,,,,,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursible per contract terms,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursible. Not contracted for physician rates,$194.99 ,100,,,$194.99 ,$229.50 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursable per contract terms,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$229.50 ,100,,,$194.99 ,$229.50 ,fee schedule,,100% Humana physician fee schedule,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursable per contract terms,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursable per contract terms,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursable per contract terms,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursable per contract terms,,,,,$194.99 ,$229.50 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$194.99 ,$229.50 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
32554 THORACENTESIS,8018684,CDM,982,RC,32554,HCPCS,outpatient,,,,,,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursible per contract terms,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$277.03 ,100,,,$130.91 ,$277.03 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursable per contract terms,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$130.91 ,100,,,$130.91 ,$277.03 ,fee schedule,,100% Humana physician fee schedule,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursable per contract terms,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursable per contract terms,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursable per contract terms,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursable per contract terms,,,,,$130.91 ,$277.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$130.91 ,$277.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
32555 THORACENTESIS,8018685,CDM,981,RC,32555,HCPCS,outpatient,,,,,,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursible per contract terms,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$388.27 ,100,,,$163.04 ,$388.27 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursable per contract terms,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$163.04 ,100,,,$163.04 ,$388.27 ,fee schedule,,100% Humana physician fee schedule,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$232.98 ,100,,,$163.04 ,$388.27 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursable per contract terms,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursable per contract terms,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursable per contract terms,,,,,$163.04 ,$388.27 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$163.04 ,$388.27 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
33010 PERICARDIOCENTESIS; INITIAL ProFee,8018740,CDM,981,RC,33010,HCPCS,outpatient,,,"$1,231.00 ",$923.25 ,,$154.35 ,135,cms physician fee schedule,,$154.35 ,"$1,231.00 ",fee schedule,,135% of 2011 CMS physician fee schedule,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursible per contract terms,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursable per contract terms,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,169.45 ",95,,,$154.35 ,"$1,231.00 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,231.00 ",100,,,$154.35 ,"$1,231.00 ",fee schedule,,100% Humana physician fee schedule,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursable per contract terms,$738.60 ,60,,,$154.35 ,"$1,231.00 ",percent of total billed charges,,60% of total billed charges for physician settings,$738.60 ,60,,,$154.35 ,"$1,231.00 ",percent of total billed charges,,60% of total billed charges for physician settings,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursable per contract terms,,,,,$154.35 ,"$1,231.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,169.45 ",95,,,$154.35 ,"$1,231.00 ",percent of total billed charges,,95% of total billed charges,,,,,$154.35 ,"$1,231.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$492.40 ,40,,,$154.35 ,"$1,231.00 ",percent of total billed charges,,40% of total billed charges for physician setting
36000 INTRODUCTION OF NEEDLE OR INTRACATHETER,8019245,CDM,981,RC,36000,HCPCS,outpatient,,,$11.00 ,$8.25 ,,$12.78 ,135,cms physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,135% of 2011 CMS physician fee schedule,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursible. Not contracted for physician rates,$34.79 ,100,,,$6.60 ,$34.79 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursable per contract terms,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,$13.11 ,145,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,145% CMS Medicare physician fee schedule ,$10.45 ,95,,,$6.60 ,$34.79 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursible. Not contracted for physician rates,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,$13.20 ,100,,,$6.60 ,$34.79 ,fee schedule,,100% Humana physician fee schedule,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursable per contract terms,$6.60 ,60,,,$6.60 ,$34.79 ,percent of total billed charges,,60% of total billed charges for physician settings,$6.60 ,60,,,$6.60 ,$34.79 ,percent of total billed charges,,60% of total billed charges for physician settings,$12.66 ,140,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$6.60 ,$34.79 ,other,,Not separately reimbursible. Not contracted for physician rates,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,$10.45 ,95,,,$6.60 ,$34.79 ,percent of total billed charges,,95% of total billed charges,$9.04 ,100,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,100% CMS Medicare physician fee schedule ,$11.28 ,124.753,CMS physician fee schedule,,$6.60 ,$34.79 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36410 VENIPUNCTURE,8019286,CDM,981,RC,36410,HCPCS,outpatient,,,,,,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursible per contract terms,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.48 ,100,,,$13.66 ,$21.48 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursable per contract terms,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$13.66 ,100,,,$13.66 ,$21.48 ,fee schedule,,100% Humana physician fee schedule,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursable per contract terms,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursable per contract terms,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursable per contract terms,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursable per contract terms,,,,,$13.66 ,$21.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$13.66 ,$21.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
36556 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR O ProFee,8019317,CDM,981,RC,36556,HCPCS,outpatient,,,"$1,445.00 ","$1,083.75 ",,$162.15 ,135,cms physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$85.32 ,"$1,372.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$265.86 ,100,,,$85.32 ,"$1,372.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$172.20 ,100,physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$123.71 ,145,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,372.75 ",95,,,$85.32 ,"$1,372.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$85.32 ,"$1,372.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$124.05 ,100,,,$85.32 ,"$1,372.75 ",fee schedule,,100% Humana physician fee schedule,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$85.32 ,"$1,372.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$174.89 ,100,,,$85.32 ,"$1,372.75 ",fee schedule,,100% Midlands Choice physician fee schedule,$867.00 ,60,,,$85.32 ,"$1,372.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$867.00 ,60,,,$85.32 ,"$1,372.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$119.45 ,140,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$85.32 ,"$1,372.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,372.75 ",95,,,$85.32 ,"$1,372.75 ",percent of total billed charges,,95% of total billed charges,$85.32 ,100,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$106.44 ,124.753,CMS physician fee schedule,,$85.32 ,"$1,372.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
36561 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,8019321,CDM,975,RC,36561,HCPCS,outpatient,,,"$2,589.00 ","$1,941.75 ",,$473.39 ,135,cms physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,135% of 2011 CMS physician fee schedule,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$339.86 ,"$2,459.55 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,344.76 ",100,,,$339.86 ,"$2,459.55 ",fee schedule,,100% of the Blue Cross physician fee schedule,$681.80 ,100,physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$492.80 ,145,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,459.55 ",95,,,$339.86 ,"$2,459.55 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$339.86 ,"$2,459.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$492.69 ,100,,,$339.86 ,"$2,459.55 ",fee schedule,,100% Humana physician fee schedule,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$339.86 ,"$2,459.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$680.55 ,100,,,$339.86 ,"$2,459.55 ",fee schedule,,100% Midlands Choice physician fee schedule,$386.30 ,100,,,$339.86 ,"$2,459.55 ",fee schedule,,100% Multiplan physician fee schedule,$386.30 ,100,,,$339.86 ,"$2,459.55 ",fee schedule,,100% Multiplan physician fee schedule,$475.80 ,140,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$339.86 ,"$2,459.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,459.55 ",95,,,$339.86 ,"$2,459.55 ",percent of total billed charges,,95% of total billed charges,$339.86 ,100,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,$423.99 ,124.753,CMS physician fee schedule,,$339.86 ,"$2,459.55 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
36569 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC),8019326,CDM,981,RC,36569,HCPCS,outpatient,,,"$1,836.00 ","$1,377.00 ",,$122.12 ,135,cms physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,135% of 2011 CMS physician fee schedule,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$94.71 ,"$1,744.20 ",other,,Not separately reimbursible. Not contracted for physician rates,$117.25 ,100,,,$94.71 ,"$1,744.20 ",fee schedule,,100% of the Blue Cross physician fee schedule,$191.10 ,100,physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,$137.33 ,145,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,744.20 ",95,,,$94.71 ,"$1,744.20 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$94.71 ,"$1,744.20 ",other,,Not separately reimbursible. Not contracted for physician rates,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,$138.15 ,100,,,$94.71 ,"$1,744.20 ",fee schedule,,100% Humana physician fee schedule,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$94.71 ,"$1,744.20 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$94.71 ,"$1,744.20 ",other,,Not separately reimbursable per contract terms,"$1,101.60 ",60,,,$94.71 ,"$1,744.20 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,101.60 ",60,,,$94.71 ,"$1,744.20 ",percent of total billed charges,,60% of total billed charges for physician settings,$132.59 ,140,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$94.71 ,"$1,744.20 ",other,,Not separately reimbursible. Not contracted for physician rates,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,744.20 ",95,,,$94.71 ,"$1,744.20 ",percent of total billed charges,,95% of total billed charges,$94.71 ,100,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,100% CMS Medicare physician fee schedule ,$118.15 ,124.753,CMS physician fee schedule,,$94.71 ,"$1,744.20 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
36571 INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE,8019328,CDM,975,RC,36571,HCPCS,outpatient,,,"$1,002.00 ",$751.50 ,,$427.50 ,135,cms physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,135% of 2011 CMS physician fee schedule,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$320.74 ,"$1,631.24 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,631.24 ",100,,,$320.74 ,"$1,631.24 ",fee schedule,,100% of the Blue Cross physician fee schedule,$632.10 ,100,physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,$465.07 ,145,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,145% CMS Medicare physician fee schedule ,$951.90 ,95,,,$320.74 ,"$1,631.24 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$320.74 ,"$1,631.24 ",other,,Not separately reimbursible. Not contracted for physician rates,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,$456.54 ,100,,,$320.74 ,"$1,631.24 ",fee schedule,,100% Humana physician fee schedule,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$320.74 ,"$1,631.24 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$320.74 ,"$1,631.24 ",other,,Not separately reimbursable per contract terms,$601.20 ,60,,,$320.74 ,"$1,631.24 ",percent of total billed charges,,60% of total billed charges for physician settings,$601.20 ,60,,,$320.74 ,"$1,631.24 ",percent of total billed charges,,60% of total billed charges for physician settings,$449.04 ,140,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$320.74 ,"$1,631.24 ",other,,Not separately reimbursible. Not contracted for physician rates,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,$951.90 ,95,,,$320.74 ,"$1,631.24 ",percent of total billed charges,,95% of total billed charges,$320.74 ,100,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,100% CMS Medicare physician fee schedule ,$400.13 ,124.753,CMS physician fee schedule,,$320.74 ,"$1,631.24 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
36590 REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE,8019339,CDM,975,RC,36590,HCPCS,outpatient,,,$607.00 ,$455.25 ,,$273.59 ,135,cms physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$194.57 ,$576.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$276.60 ,100,,,$194.57 ,$576.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$385.70 ,100,physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$282.13 ,145,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$576.65 ,95,,,$194.57 ,$576.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$194.57 ,$576.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$278.92 ,100,,,$194.57 ,$576.65 ,fee schedule,,100% Humana physician fee schedule,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$194.57 ,$576.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$382.47 ,100,,,$194.57 ,$576.65 ,fee schedule,,100% Midlands Choice physician fee schedule,$364.20 ,60,,,$194.57 ,$576.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$364.20 ,60,,,$194.57 ,$576.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$272.40 ,140,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$194.57 ,$576.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$576.65 ,95,,,$194.57 ,$576.65 ,percent of total billed charges,,95% of total billed charges,$194.57 ,100,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$242.73 ,124.753,CMS physician fee schedule,,$194.57 ,$576.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36591 COLLECTION OF BLOOD SPECIMEN FROM A COMPLETELY IMPLANTABLE VENOUS ACCESS DEVICE ProFee,8019340,CDM,981,RC,36591,HCPCS,outpatient,,,$122.00 ,$91.50 ,,$28.16 ,135,cms physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$28.16 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$30.92 ,100,,,$28.16 ,$115.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$49.00 ,100,physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$40.88 ,145,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$115.90 ,95,,,$28.16 ,$115.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$28.16 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.47 ,100,,,$28.16 ,$115.90 ,fee schedule,,100% Humana physician fee schedule,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$28.16 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$28.16 ,$115.90 ,other,,Not separately reimbursable per contract terms,$73.20 ,60,,,$28.16 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.20 ,60,,,$28.16 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$39.47 ,140,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$28.16 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.90 ,95,,,$28.16 ,$115.90 ,percent of total billed charges,,95% of total billed charges,$28.19 ,100,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$35.17 ,124.753,CMS physician fee schedule,,$28.16 ,$115.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36600 ARTERIAL PUNCTURE,8019347,CDM,981,RC,36600,HCPCS,outpatient,,,$122.00 ,$91.50 ,,$20.57 ,135,cms physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$15.90 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$37.37 ,100,,,$15.90 ,$115.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$31.50 ,100,physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$23.06 ,145,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$115.90 ,95,,,$15.90 ,$115.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$15.90 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$22.76 ,100,,,$15.90 ,$115.90 ,fee schedule,,100% Humana physician fee schedule,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$15.90 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$15.90 ,$115.90 ,other,,Not separately reimbursable per contract terms,$73.20 ,60,,,$15.90 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.20 ,60,,,$15.90 ,$115.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$22.26 ,140,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$15.90 ,$115.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.90 ,95,,,$15.90 ,$115.90 ,percent of total billed charges,,95% of total billed charges,$15.90 ,100,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$19.84 ,124.753,CMS physician fee schedule,,$15.90 ,$115.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36620 ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING,8019348,CDM,981,RC,36620,HCPCS,outpatient,,,$59.00 ,$44.25 ,,$68.93 ,135,cms physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,135% of 2011 CMS physician fee schedule,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$35.40 ,$93.09 ,other,,Not separately reimbursible. Not contracted for physician rates,$54.98 ,100,,,$35.40 ,$93.09 ,fee schedule,,100% of the Blue Cross physician fee schedule,$59.00 ,100,physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,$64.63 ,145,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,145% CMS Medicare physician fee schedule ,$56.05 ,95,,,$35.40 ,$93.09 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$35.40 ,$93.09 ,other,,Not separately reimbursible. Not contracted for physician rates,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,$64.55 ,100,,,$35.40 ,$93.09 ,fee schedule,,100% Humana physician fee schedule,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$35.40 ,$93.09 ,other,,Not separately reimbursible. Not contracted for physician rates,$93.09 ,100,,,$35.40 ,$93.09 ,fee schedule,,100% Midlands Choice physician fee schedule,$35.40 ,60,,,$35.40 ,$93.09 ,percent of total billed charges,,60% of total billed charges for physician settings,$35.40 ,60,,,$35.40 ,$93.09 ,percent of total billed charges,,60% of total billed charges for physician settings,$62.40 ,140,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$35.40 ,$93.09 ,other,,Not separately reimbursible. Not contracted for physician rates,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,$56.05 ,95,,,$35.40 ,$93.09 ,percent of total billed charges,,95% of total billed charges,$44.57 ,100,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,100% CMS Medicare physician fee schedule ,$55.60 ,124.753,CMS physician fee schedule,,$35.40 ,$93.09 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
36680 PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION ProFee,8019352,CDM,981,RC,36680,HCPCS,outpatient,,,$445.00 ,$333.75 ,,$77.03 ,135,cms physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,135% of 2011 CMS physician fee schedule,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$59.85 ,$422.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$74.30 ,100,,,$59.85 ,$422.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$121.80 ,100,physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$86.78 ,145,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$422.75 ,95,,,$59.85 ,$422.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$59.85 ,$422.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$87.33 ,100,,,$59.85 ,$422.75 ,fee schedule,,100% Humana physician fee schedule,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$59.85 ,$422.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$59.85 ,$422.75 ,other,,Not separately reimbursable per contract terms,$267.00 ,60,,,$59.85 ,$422.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$267.00 ,60,,,$59.85 ,$422.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$83.79 ,140,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$59.85 ,$422.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$422.75 ,95,,,$59.85 ,$422.75 ,percent of total billed charges,,95% of total billed charges,$59.85 ,100,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$74.66 ,124.753,CMS physician fee schedule,,$59.85 ,$422.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
37195 THROMBOLYSIS,8019394,CDM,981,RC,37195,HCPCS,outpatient,,,,,,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,182.84 ",100,,,"$1,182.84 ","$1,391.77 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursable per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,391.77 ",100,,,"$1,182.84 ","$1,391.77 ",fee schedule,,100% Humana physician fee schedule,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursable per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursable per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursable per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursable per contract terms,,,,,"$1,182.84 ","$1,391.77 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,182.84 ","$1,391.77 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
38505 Needle biopsy/remove lymph node(s),9019087,CDM,975,RC,38505,HCPCS,outpatient,,,$425.00 ,$318.75 ,,$94.19 ,135,cms physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,135% of 2011 CMS physician fee schedule,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$86.93 ,$403.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$155.48 ,100,,,$86.93 ,$403.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$141.40 ,100,physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$126.05 ,145,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$403.75 ,95,,,$86.93 ,$403.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$86.93 ,$403.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$102.82 ,100,,,$86.93 ,$403.75 ,fee schedule,,100% Humana physician fee schedule,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$86.93 ,$403.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$86.93 ,$403.75 ,other,,Not separately reimbursable per contract terms,$255.00 ,60,,,$86.93 ,$403.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$255.00 ,60,,,$86.93 ,$403.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.70 ,140,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$86.93 ,$403.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$403.75 ,95,,,$86.93 ,$403.75 ,percent of total billed charges,,95% of total billed charges,$86.93 ,100,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$108.45 ,124.753,CMS physician fee schedule,,$86.93 ,$403.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
40650 REPAIR LIP,8019550,CDM,981,RC,40650,HCPCS,outpatient,,,$497.00 ,$372.75 ,,$389.38 ,135,cms physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,135% of 2011 CMS physician fee schedule,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$298.20 ,$579.83 ,other,,Not separately reimbursible. Not contracted for physician rates,$579.83 ,100,,,$298.20 ,$579.83 ,fee schedule,,100% of the Blue Cross physician fee schedule,$497.00 ,100,physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,$468.52 ,145,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,145% CMS Medicare physician fee schedule ,$472.15 ,95,,,$298.20 ,$579.83 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$298.20 ,$579.83 ,other,,Not separately reimbursible. Not contracted for physician rates,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,$448.07 ,100,,,$298.20 ,$579.83 ,fee schedule,,100% Humana physician fee schedule,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$298.20 ,$579.83 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$298.20 ,$579.83 ,other,,Not separately reimbursable per contract terms,$298.20 ,60,,,$298.20 ,$579.83 ,percent of total billed charges,,60% of total billed charges for physician settings,$298.20 ,60,,,$298.20 ,$579.83 ,percent of total billed charges,,60% of total billed charges for physician settings,$452.37 ,140,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$298.20 ,$579.83 ,other,,Not separately reimbursible. Not contracted for physician rates,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,$472.15 ,95,,,$298.20 ,$579.83 ,percent of total billed charges,,95% of total billed charges,$323.12 ,100,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,100% CMS Medicare physician fee schedule ,$403.10 ,124.753,CMS physician fee schedule,,$298.20 ,$579.83 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
41250 REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONG ProFee,8019609,CDM,981,RC,41250,HCPCS,outpatient,,,$122.00 ,$91.50 ,,$164.70 ,135,cms physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,135% of 2011 CMS physician fee schedule,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.20 ,$349.18 ,other,,Not separately reimbursible. Not contracted for physician rates,$349.18 ,100,,,$73.20 ,$349.18 ,fee schedule,,100% of the Blue Cross physician fee schedule,$122.00 ,100,physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,$176.90 ,145,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,145% CMS Medicare physician fee schedule ,$115.90 ,95,,,$73.20 ,$349.18 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$73.20 ,$349.18 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,$225.68 ,100,,,$73.20 ,$349.18 ,fee schedule,,100% Humana physician fee schedule,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.20 ,$349.18 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.20 ,$349.18 ,other,,Not separately reimbursable per contract terms,$73.20 ,60,,,$73.20 ,$349.18 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.20 ,60,,,$73.20 ,$349.18 ,percent of total billed charges,,60% of total billed charges for physician settings,$170.80 ,140,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$73.20 ,$349.18 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,$115.90 ,95,,,$73.20 ,$349.18 ,percent of total billed charges,,95% of total billed charges,$122.00 ,100,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,100% CMS Medicare physician fee schedule ,$152.20 ,124.753,CMS physician fee schedule,,$73.20 ,$349.18 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
41251 REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OF TONGUE ProFee,8019610,CDM,981,RC,41251,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$230.35 ,135,cms physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,135% of 2011 CMS physician fee schedule,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$385.69 ,other,,Not separately reimbursible. Not contracted for physician rates,$385.69 ,100,,,$137.40 ,$385.69 ,fee schedule,,100% of the Blue Cross physician fee schedule,$229.00 ,100,physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,$270.25 ,145,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$385.69 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$137.40 ,$385.69 ,other,,Not separately reimbursible. Not contracted for physician rates,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,$268.09 ,100,,,$137.40 ,$385.69 ,fee schedule,,100% Humana physician fee schedule,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$385.69 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$137.40 ,$385.69 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$137.40 ,$385.69 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$137.40 ,$385.69 ,percent of total billed charges,,60% of total billed charges for physician settings,$260.93 ,140,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$137.40 ,$385.69 ,other,,Not separately reimbursible. Not contracted for physician rates,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$385.69 ,percent of total billed charges,,95% of total billed charges,$186.38 ,100,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,100% CMS Medicare physician fee schedule ,$232.51 ,124.753,CMS physician fee schedule,,$137.40 ,$385.69 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
41252 REPAIR OF LACERATION OF TONGUE,8019611,CDM,981,RC,41252,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$289.68 ,135,cms physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,135% of 2011 CMS physician fee schedule,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$400.29 ,other,,Not separately reimbursible. Not contracted for physician rates,$400.29 ,100,,,$137.40 ,$400.29 ,fee schedule,,100% of the Blue Cross physician fee schedule,$229.00 ,100,physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,$311.08 ,145,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$400.29 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$137.40 ,$400.29 ,other,,Not separately reimbursible. Not contracted for physician rates,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,$305.54 ,100,,,$137.40 ,$400.29 ,fee schedule,,100% Humana physician fee schedule,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$400.29 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$137.40 ,$400.29 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$137.40 ,$400.29 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$137.40 ,$400.29 ,percent of total billed charges,,60% of total billed charges for physician settings,$300.36 ,140,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$137.40 ,$400.29 ,other,,Not separately reimbursible. Not contracted for physician rates,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$400.29 ,percent of total billed charges,,95% of total billed charges,$214.54 ,100,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,100% CMS Medicare physician fee schedule ,$267.65 ,124.753,CMS physician fee schedule,,$137.40 ,$400.29 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
41800 DRAINAGE OF ABSCESS,8019618,CDM,981,RC,41800,HCPCS,outpatient,,,,,,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursible per contract terms,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursible. Not contracted for physician rates,$368.94 ,100,,,$224.55 ,$368.94 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursable per contract terms,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$224.55 ,100,,,$224.55 ,$368.94 ,fee schedule,,100% Humana physician fee schedule,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursable per contract terms,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursable per contract terms,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursable per contract terms,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursable per contract terms,,,,,$224.55 ,$368.94 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.55 ,$368.94 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
42000 DRAINAGE OF ABSCESS OF PALATE,8019635,CDM,981,RC,42000,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$143.36 ,135,cms physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$111.37 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$196.28 ,100,,,$111.37 ,$217.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$208.60 ,100,physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$161.49 ,145,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$111.37 ,$217.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$111.37 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$152.24 ,100,,,$111.37 ,$217.55 ,fee schedule,,100% Humana physician fee schedule,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$111.37 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$111.37 ,$217.55 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$111.37 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$111.37 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$155.92 ,140,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$111.37 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$111.37 ,$217.55 ,percent of total billed charges,,95% of total billed charges,$111.37 ,100,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$138.94 ,124.753,CMS physician fee schedule,,$111.37 ,$217.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
42700 INCISION AND DRAINAGE ABSCESS; PERITONSILLAR ProFee,8019688,CDM,981,RC,42700,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$187.06 ,135,cms physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,135% of 2011 CMS physician fee schedule,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$238.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$238.37 ,100,,,$137.40 ,$238.37 ,fee schedule,,100% of the Blue Cross physician fee schedule,$229.00 ,100,physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$202.96 ,145,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$238.37 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$137.40 ,$238.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$197.06 ,100,,,$137.40 ,$238.37 ,fee schedule,,100% Humana physician fee schedule,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$137.40 ,$238.37 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$137.40 ,$238.37 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$137.40 ,$238.37 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$137.40 ,$238.37 ,percent of total billed charges,,60% of total billed charges for physician settings,$195.96 ,140,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$137.40 ,$238.37 ,other,,Not separately reimbursible. Not contracted for physician rates,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$137.40 ,$238.37 ,percent of total billed charges,,95% of total billed charges,$139.97 ,100,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,100% CMS Medicare physician fee schedule ,$174.62 ,124.753,CMS physician fee schedule,,$137.40 ,$238.37 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
42809 REMOVAL OF FOREIGN BODY FROM PHARYNX ProFee,8019696,CDM,981,RC,42809,HCPCS,outpatient,,,$409.00 ,$306.75 ,,$180.05 ,135,cms physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$130.28 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$251.26 ,100,,,$130.28 ,$388.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$249.20 ,100,physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$188.91 ,145,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$388.55 ,95,,,$130.28 ,$388.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$130.28 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$180.89 ,100,,,$130.28 ,$388.55 ,fee schedule,,100% Humana physician fee schedule,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$130.28 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$130.28 ,$388.55 ,other,,Not separately reimbursable per contract terms,$245.40 ,60,,,$130.28 ,$388.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$245.40 ,60,,,$130.28 ,$388.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.39 ,140,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$130.28 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$388.55 ,95,,,$130.28 ,$388.55 ,percent of total billed charges,,95% of total billed charges,$130.28 ,100,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$162.53 ,124.753,CMS physician fee schedule,,$130.28 ,$388.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
43235 ESOPHAGOGASTRODUODENOSCOPY,8019775,CDM,975,RC,43235,HCPCS,outpatient,,,,,,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursible per contract terms,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursible. Not contracted for physician rates,$349.61 ,100,,,$179.59 ,$349.61 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursable per contract terms,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$179.59 ,100,,,$179.59 ,$349.61 ,fee schedule,,100% Humana physician fee schedule,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursible. Not contracted for physician rates,$252.87 ,100,,,$179.59 ,$349.61 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursable per contract terms,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursable per contract terms,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursable per contract terms,,,,,$179.59 ,$349.61 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$179.59 ,$349.61 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43239 ESOPHAGOGASTRODUODENOSCOPY,8019779,CDM,975,RC,43239,HCPCS,outpatient,,,,,,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursible per contract terms,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursible. Not contracted for physician rates,$466.87 ,100,,,$160.57 ,$466.87 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursable per contract terms,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$202.45 ,100,,,$160.57 ,$466.87 ,fee schedule,,100% Humana physician fee schedule,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursible. Not contracted for physician rates,$286.10 ,100,,,$160.57 ,$466.87 ,fee schedule,,100% Midlands Choice physician fee schedule,$160.57 ,100,,,$160.57 ,$466.87 ,fee schedule,,100% Multiplan physician fee schedule,$160.57 ,100,,,$160.57 ,$466.87 ,fee schedule,,100% Multiplan physician fee schedule,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursable per contract terms,,,,,$160.57 ,$466.87 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$160.57 ,$466.87 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43245 ESOPHAGOGASTRODUODENOSCOPY,8019785,CDM,975,RC,43245,HCPCS,outpatient,,,,,,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursible per contract terms,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursible. Not contracted for physician rates,$738.31 ,100,,,$257.35 ,$738.31 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursable per contract terms,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$257.35 ,100,,,$257.35 ,$738.31 ,fee schedule,,100% Humana physician fee schedule,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursible. Not contracted for physician rates,$360.71 ,100,,,$257.35 ,$738.31 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursable per contract terms,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursable per contract terms,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursable per contract terms,,,,,$257.35 ,$738.31 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$257.35 ,$738.31 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43246 ESOPHAGOGASTRODUODENOSCOPY,8019786,CDM,975,RC,43246,HCPCS,outpatient,,,,,,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursible per contract terms,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursible. Not contracted for physician rates,$249.54 ,100,,,$249.54 ,$293.48 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursable per contract terms,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$293.48 ,100,,,$249.54 ,$293.48 ,fee schedule,,100% Humana physician fee schedule,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursable per contract terms,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursable per contract terms,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursable per contract terms,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursable per contract terms,,,,,$249.54 ,$293.48 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$249.54 ,$293.48 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43247 ESOPHAGOGASTRODUODENOSCOPY,8019787,CDM,975,RC,43247,HCPCS,outpatient,,,,,,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursible per contract terms,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursible. Not contracted for physician rates,$462.57 ,100,,,$259.06 ,$462.57 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursable per contract terms,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$259.06 ,100,,,$259.06 ,$462.57 ,fee schedule,,100% Humana physician fee schedule,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursible. Not contracted for physician rates,$365.33 ,100,,,$259.06 ,$462.57 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursable per contract terms,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursable per contract terms,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursable per contract terms,,,,,$259.06 ,$462.57 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$259.06 ,$462.57 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43249 ESOPHAGOGASTRODUODENOSCOPY,8019789,CDM,975,RC,43249,HCPCS,outpatient,,,,,,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursible per contract terms,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,372.25 ",100,,,$224.24 ,"$1,372.25 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursable per contract terms,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$224.24 ,100,,,$224.24 ,"$1,372.25 ",fee schedule,,100% Humana physician fee schedule,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$317.08 ,100,,,$224.24 ,"$1,372.25 ",fee schedule,,100% Midlands Choice physician fee schedule,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursable per contract terms,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursable per contract terms,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursable per contract terms,,,,,$224.24 ,"$1,372.25 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$224.24 ,"$1,372.25 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
43752 NASO- OR ORO-GASTRIC TUBE PLACEMENT,8019885,CDM,981,RC,43752,HCPCS,outpatient,,,$409.00 ,$306.75 ,,$54.12 ,135,cms physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$40.85 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$50.68 ,100,,,$40.85 ,$388.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$82.60 ,100,physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$59.23 ,145,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$388.55 ,95,,,$40.85 ,$388.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$40.85 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$59.65 ,100,,,$40.85 ,$388.55 ,fee schedule,,100% Humana physician fee schedule,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$40.85 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$40.85 ,$388.55 ,other,,Not separately reimbursable per contract terms,$245.40 ,60,,,$40.85 ,$388.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$245.40 ,60,,,$40.85 ,$388.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$57.19 ,140,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$40.85 ,$388.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$388.55 ,95,,,$40.85 ,$388.55 ,percent of total billed charges,,95% of total billed charges,$40.85 ,100,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$50.96 ,124.753,CMS physician fee schedule,,$40.85 ,$388.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
43753 GASTRIC INTUBATION AND ASPIRATION(S) THERAPEUTIC,8019886,CDM,981,RC,43753,HCPCS,outpatient,,,$285.00 ,$213.75 ,,$27.46 ,135,cms physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,135% of 2011 CMS physician fee schedule,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$22.32 ,$270.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$27.92 ,100,,,$22.32 ,$270.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$45.50 ,100,physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$32.36 ,145,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$270.75 ,95,,,$22.32 ,$270.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$22.32 ,$270.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$32.59 ,100,,,$22.32 ,$270.75 ,fee schedule,,100% Humana physician fee schedule,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$22.32 ,$270.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$22.32 ,$270.75 ,other,,Not separately reimbursable per contract terms,$171.00 ,60,,,$22.32 ,$270.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$171.00 ,60,,,$22.32 ,$270.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$31.25 ,140,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$22.32 ,$270.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$270.75 ,95,,,$22.32 ,$270.75 ,percent of total billed charges,,95% of total billed charges,$22.32 ,100,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$27.84 ,124.753,CMS physician fee schedule,,$22.32 ,$270.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
43760 CHANGE OF GASTROSTOMY TUBE,8019891,CDM,521,RC,43760,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
43840 GASTRORRHAPHY,8019906,CDM,975,RC,43840,HCPCS,outpatient,,,,,,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,698.24 ",100,,,"$1,698.24 ","$1,997.56 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursable per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,997.56 ",100,,,"$1,698.24 ","$1,997.56 ",fee schedule,,100% Humana physician fee schedule,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursable per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursable per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursable per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursable per contract terms,,,,,"$1,698.24 ","$1,997.56 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,698.24 ","$1,997.56 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
44950 APPENDECTOMY; ProFee,8020054,CDM,975,RC,44950,HCPCS,outpatient,,,"$3,655.00 ","$2,741.25 ",,$840.48 ,135,cms physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,135% of 2011 CMS physician fee schedule,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$662.16 ,"$3,472.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$802.31 ,100,,,$662.16 ,"$3,472.25 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,311.10 ",100,physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$960.13 ,145,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,472.25 ",95,,,$662.16 ,"$3,472.25 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$662.16 ,"$3,472.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$943.85 ,100,,,$662.16 ,"$3,472.25 ",fee schedule,,100% Humana physician fee schedule,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$662.16 ,"$3,472.25 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$662.16 ,"$3,472.25 ",other,,Not separately reimbursable per contract terms,"$2,193.00 ",60,,,$662.16 ,"$3,472.25 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,193.00 ",60,,,$662.16 ,"$3,472.25 ",percent of total billed charges,,60% of total billed charges for physician settings,$927.02 ,140,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$662.16 ,"$3,472.25 ",other,,Not separately reimbursible. Not contracted for physician rates,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,472.25 ",95,,,$662.16 ,"$3,472.25 ",percent of total billed charges,,95% of total billed charges,$662.16 ,100,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,100% CMS Medicare physician fee schedule ,$826.06 ,124.753,CMS physician fee schedule,,$662.16 ,"$3,472.25 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
44960 APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS OR GENERALIZED PERITONITIS ProFee,8020056,CDM,975,RC,44960,HCPCS,outpatient,,,"$4,269.00 ","$3,201.75 ",,"$1,144.41 ",135,cms physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,135% of 2011 CMS physician fee schedule,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$905.66 ,"$4,055.55 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,094.37 ",100,,,$905.66 ,"$4,055.55 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,789.20 ",100,physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,313.21 ",145,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$4,055.55 ",95,,,$905.66 ,"$4,055.55 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$905.66 ,"$4,055.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,287.62 ",100,,,$905.66 ,"$4,055.55 ",fee schedule,,100% Humana physician fee schedule,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$905.66 ,"$4,055.55 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$905.66 ,"$4,055.55 ",other,,Not separately reimbursable per contract terms,"$2,561.40 ",60,,,$905.66 ,"$4,055.55 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,561.40 ",60,,,$905.66 ,"$4,055.55 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,267.92 ",140,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$905.66 ,"$4,055.55 ",other,,Not separately reimbursible. Not contracted for physician rates,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$4,055.55 ",95,,,$905.66 ,"$4,055.55 ",percent of total billed charges,,95% of total billed charges,$905.66 ,100,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,129.84 ",124.753,CMS physician fee schedule,,$905.66 ,"$4,055.55 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
44970 LAPAROSCOPY,8020057,CDM,975,RC,44970,HCPCS,outpatient,,,,,,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursible per contract terms,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursible. Not contracted for physician rates,$750.34 ,100,,,$692.03 ,$882.74 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursable per contract terms,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$882.74 ,100,,,$692.03 ,$882.74 ,fee schedule,,100% Humana physician fee schedule,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursable per contract terms,$692.03 ,100,,,$692.03 ,$882.74 ,fee schedule,,100% Multiplan physician fee schedule,$692.03 ,100,,,$692.03 ,$882.74 ,fee schedule,,100% Multiplan physician fee schedule,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursable per contract terms,,,,,$692.03 ,$882.74 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$692.03 ,$882.74 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45330 SIGMOIDOSCOPY,8020095,CDM,975,RC,45330,HCPCS,outpatient,,,,,,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursible per contract terms,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$219.05 ,100,,,$81.91 ,$219.05 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursable per contract terms,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$81.91 ,100,,,$81.91 ,$219.05 ,fee schedule,,100% Humana physician fee schedule,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursable per contract terms,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursable per contract terms,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursable per contract terms,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursable per contract terms,,,,,$81.91 ,$219.05 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$81.91 ,$219.05 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45331 SIGMOIDOSCOPY,8020096,CDM,975,RC,45331,HCPCS,outpatient,,,,,,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursible per contract terms,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursible. Not contracted for physician rates,$344.89 ,100,,,$104.78 ,$344.89 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursable per contract terms,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$104.78 ,100,,,$104.78 ,$344.89 ,fee schedule,,100% Humana physician fee schedule,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursable per contract terms,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursable per contract terms,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursable per contract terms,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursable per contract terms,,,,,$104.78 ,$344.89 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$104.78 ,$344.89 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45378 COLONOSCOPY,8020112,CDM,975,RC,45378,HCPCS,outpatient,,,,,,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursible per contract terms,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$411.03 ,100,,,$190.24 ,$411.03 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursable per contract terms,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$271.14 ,100,,,$190.24 ,$411.03 ,fee schedule,,100% Humana physician fee schedule,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursible. Not contracted for physician rates,$190.24 ,100,,,$190.24 ,$411.03 ,fee schedule,,100% Midlands Choice physician fee schedule,$214.47 ,100,,,$190.24 ,$411.03 ,fee schedule,,100% Multiplan physician fee schedule,$214.47 ,100,,,$190.24 ,$411.03 ,fee schedule,,100% Multiplan physician fee schedule,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursable per contract terms,,,,,$190.24 ,$411.03 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$190.24 ,$411.03 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45380 COLONOSCOPY,8020114,CDM,975,RC,45380,HCPCS,outpatient,,,,,,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursible per contract terms,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursible. Not contracted for physician rates,$530.86 ,100,,,$232.66 ,$530.86 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursable per contract terms,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$293.61 ,100,,,$232.66 ,$530.86 ,fee schedule,,100% Humana physician fee schedule,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursible. Not contracted for physician rates,$415.05 ,100,,,$232.66 ,$530.86 ,fee schedule,,100% Midlands Choice physician fee schedule,$232.66 ,100,,,$232.66 ,$530.86 ,fee schedule,,100% Multiplan physician fee schedule,$232.66 ,100,,,$232.66 ,$530.86 ,fee schedule,,100% Multiplan physician fee schedule,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursable per contract terms,,,,,$232.66 ,$530.86 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$232.66 ,$530.86 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45381 COLONOSCOPY,8020115,CDM,975,RC,45381,HCPCS,outpatient,,,,,,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursible per contract terms,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$527.00 ,100,,,$293.61 ,$527.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursable per contract terms,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$293.61 ,100,,,$293.61 ,$527.00 ,fee schedule,,100% Humana physician fee schedule,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$415.05 ,100,,,$293.61 ,$527.00 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursable per contract terms,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursable per contract terms,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursable per contract terms,,,,,$293.61 ,$527.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$293.61 ,$527.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45384 COLONOSCOPY,8020118,CDM,975,RC,45384,HCPCS,outpatient,,,,,,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursible per contract terms,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursible. Not contracted for physician rates,$591.42 ,100,,,$334.07 ,$591.42 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursable per contract terms,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$334.07 ,100,,,$334.07 ,$591.42 ,fee schedule,,100% Humana physician fee schedule,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursible. Not contracted for physician rates,$468.56 ,100,,,$334.07 ,$591.42 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursable per contract terms,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursable per contract terms,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursable per contract terms,,,,,$334.07 ,$591.42 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$334.07 ,$591.42 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45385 COLONOSCOPY,8020119,CDM,975,RC,45385,HCPCS,outpatient,,,,,,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursible per contract terms,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursible. Not contracted for physician rates,$552.77 ,100,,,$295.27 ,$552.77 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursable per contract terms,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$372.64 ,100,,,$295.27 ,$552.77 ,fee schedule,,100% Humana physician fee schedule,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursible. Not contracted for physician rates,$526.52 ,100,,,$295.27 ,$552.77 ,fee schedule,,100% Midlands Choice physician fee schedule,$295.27 ,100,,,$295.27 ,$552.77 ,fee schedule,,100% Multiplan physician fee schedule,$295.27 ,100,,,$295.27 ,$552.77 ,fee schedule,,100% Multiplan physician fee schedule,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursable per contract terms,,,,,$295.27 ,$552.77 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$295.27 ,$552.77 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45386 COLONOSCOPY,8020120,CDM,975,RC,45386,HCPCS,outpatient,,,"$2,168.00 ","$1,626.00 ",,$355.50 ,135,cms physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,135% of 2011 CMS physician fee schedule,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$214.66 ,"$2,059.60 ",other,,Not separately reimbursible. Not contracted for physician rates,$764.51 ,100,,,$214.66 ,"$2,059.60 ",fee schedule,,100% of the Blue Cross physician fee schedule,$427.70 ,100,physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,$311.26 ,145,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,059.60 ",95,,,$214.66 ,"$2,059.60 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$214.66 ,"$2,059.60 ",other,,Not separately reimbursible. Not contracted for physician rates,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,$309.76 ,100,,,$214.66 ,"$2,059.60 ",fee schedule,,100% Humana physician fee schedule,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$214.66 ,"$2,059.60 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$214.66 ,"$2,059.60 ",other,,Not separately reimbursable per contract terms,"$1,300.80 ",60,,,$214.66 ,"$2,059.60 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,300.80 ",60,,,$214.66 ,"$2,059.60 ",percent of total billed charges,,60% of total billed charges for physician settings,$300.52 ,140,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$214.66 ,"$2,059.60 ",other,,Not separately reimbursible. Not contracted for physician rates,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,059.60 ",95,,,$214.66 ,"$2,059.60 ",percent of total billed charges,,95% of total billed charges,$214.66 ,100,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,100% CMS Medicare physician fee schedule ,$267.79 ,124.753,CMS physician fee schedule,,$214.66 ,"$2,059.60 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
45388 COLONOSCOPY,8020121,CDM,975,RC,45388,HCPCS,outpatient,,,,,,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursible per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursible. Not contracted for physician rates,"$3,667.93 ",100,,,$396.65 ,"$3,667.93 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursable per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$396.65 ,100,,,$396.65 ,"$3,667.93 ",fee schedule,,100% Humana physician fee schedule,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursable per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursable per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursable per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursable per contract terms,,,,,$396.65 ,"$3,667.93 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$396.65 ,"$3,667.93 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
45915 REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA ProFee,8020150,CDM,981,RC,45915,HCPCS,outpatient,,,"$1,131.00 ",$848.25 ,,$295.46 ,135,cms physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,135% of 2011 CMS physician fee schedule,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$238.70 ,"$1,074.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$431.65 ,100,,,$238.70 ,"$1,074.45 ",fee schedule,,100% of the Blue Cross physician fee schedule,$465.50 ,100,physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$346.12 ,145,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,074.45 ",95,,,$238.70 ,"$1,074.45 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$238.70 ,"$1,074.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$338.27 ,100,,,$238.70 ,"$1,074.45 ",fee schedule,,100% Humana physician fee schedule,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$238.70 ,"$1,074.45 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$238.70 ,"$1,074.45 ",other,,Not separately reimbursable per contract terms,$678.60 ,60,,,$238.70 ,"$1,074.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$678.60 ,60,,,$238.70 ,"$1,074.45 ",percent of total billed charges,,60% of total billed charges for physician settings,$334.18 ,140,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$238.70 ,"$1,074.45 ",other,,Not separately reimbursible. Not contracted for physician rates,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,074.45 ",95,,,$238.70 ,"$1,074.45 ",percent of total billed charges,,95% of total billed charges,$238.70 ,100,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,100% CMS Medicare physician fee schedule ,$297.79 ,124.753,CMS physician fee schedule,,$238.70 ,"$1,074.45 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
46040 INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTAL ABSCESS (SEPARATE PROCEDURE) ProFee,8020155,CDM,975,RC,46040,HCPCS,outpatient,,,"$1,130.00 ",$847.50 ,,$538.04 ,135,cms physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$443.80 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$684.19 ,100,,,$443.80 ,"$1,073.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,$851.20 ,100,physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$643.51 ,145,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,073.50 ",95,,,$443.80 ,"$1,073.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$443.80 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$618.41 ,100,,,$443.80 ,"$1,073.50 ",fee schedule,,100% Humana physician fee schedule,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$443.80 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$443.80 ,"$1,073.50 ",other,,Not separately reimbursable per contract terms,$678.00 ,60,,,$443.80 ,"$1,073.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$678.00 ,60,,,$443.80 ,"$1,073.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$621.32 ,140,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$443.80 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,073.50 ",95,,,$443.80 ,"$1,073.50 ",percent of total billed charges,,95% of total billed charges,$443.80 ,100,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$553.65 ,124.753,CMS physician fee schedule,,$443.80 ,"$1,073.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
46050 INCISION AND DRAINAGE,8020157,CDM,975,RC,46050,HCPCS,outpatient,,,,,,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursible per contract terms,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursible. Not contracted for physician rates,$274.88 ,100,,,$145.07 ,$274.88 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursable per contract terms,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$145.07 ,100,,,$145.07 ,$274.88 ,fee schedule,,100% Humana physician fee schedule,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursable per contract terms,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursable per contract terms,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursable per contract terms,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursable per contract terms,,,,,$145.07 ,$274.88 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$145.07 ,$274.88 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
46083 INCISION OF THROMBOSED HEMORRHOID,8020161,CDM,975,RC,46083,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$139.35 ,135,cms physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$114.04 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$241.38 ,100,,,$114.04 ,$250.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$219.10 ,100,physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$165.36 ,145,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$250.80 ,95,,,$114.04 ,$250.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$114.04 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$159.19 ,100,,,$114.04 ,$250.80 ,fee schedule,,100% Humana physician fee schedule,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$114.04 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$114.04 ,$250.80 ,other,,Not separately reimbursable per contract terms,$158.40 ,60,,,$114.04 ,$250.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$158.40 ,60,,,$114.04 ,$250.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$159.66 ,140,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$114.04 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$250.80 ,95,,,$114.04 ,$250.80 ,percent of total billed charges,,95% of total billed charges,$114.04 ,100,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.27 ,124.753,CMS physician fee schedule,,$114.04 ,$250.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
46221 HEMORRHOIDECTOMY,8020164,CDM,975,RC,46221,HCPCS,outpatient,,,,,,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursible per contract terms,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursible. Not contracted for physician rates,$342.74 ,100,,,$282.10 ,$386.49 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursable per contract terms,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$282.10 ,100,,,$282.10 ,$386.49 ,fee schedule,,100% Humana physician fee schedule,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursible. Not contracted for physician rates,$386.49 ,100,,,$282.10 ,$386.49 ,fee schedule,,100% Midlands Choice physician fee schedule,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursable per contract terms,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursable per contract terms,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursable per contract terms,,,,,$282.10 ,$386.49 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$282.10 ,$386.49 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
46320 EXCISION OF THROMBOSED HEMORRHOID,8020178,CDM,975,RC,46320,HCPCS,outpatient,,,"$1,130.00 ",$847.50 ,,$145.71 ,135,cms physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$117.00 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$246.96 ,100,,,$117.00 ,"$1,073.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,$225.40 ,100,physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$169.65 ,145,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,073.50 ",95,,,$117.00 ,"$1,073.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$117.00 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$163.52 ,100,,,$117.00 ,"$1,073.50 ",fee schedule,,100% Humana physician fee schedule,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$117.00 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$117.00 ,"$1,073.50 ",other,,Not separately reimbursable per contract terms,$678.00 ,60,,,$117.00 ,"$1,073.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$678.00 ,60,,,$117.00 ,"$1,073.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$163.80 ,140,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$117.00 ,"$1,073.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,073.50 ",95,,,$117.00 ,"$1,073.50 ",percent of total billed charges,,95% of total billed charges,$117.00 ,100,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$145.96 ,124.753,CMS physician fee schedule,,$117.00 ,"$1,073.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
46505 CHEMODENERVATION OF INTERNAL ANAL SPHINCTER ProFee,8020180,CDM,975,RC,46505,HCPCS,outpatient,,,$825.00 ,$618.75 ,,$314.42 ,135,cms physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,135% of 2011 CMS physician fee schedule,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$262.71 ,$783.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$371.95 ,100,,,$262.71 ,$783.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$490.00 ,100,physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$380.93 ,145,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$783.75 ,95,,,$262.71 ,$783.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$262.71 ,$783.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$356.62 ,100,,,$262.71 ,$783.75 ,fee schedule,,100% Humana physician fee schedule,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$262.71 ,$783.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$262.71 ,$783.75 ,other,,Not separately reimbursable per contract terms,$495.00 ,60,,,$262.71 ,$783.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$495.00 ,60,,,$262.71 ,$783.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$367.79 ,140,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$262.71 ,$783.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$783.75 ,95,,,$262.71 ,$783.75 ,percent of total billed charges,,95% of total billed charges,$262.71 ,100,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$327.74 ,124.753,CMS physician fee schedule,,$262.71 ,$783.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
46600 ANOSCOPY; DIAGNOSTIC,8020181,CDM,975,RC,46600,HCPCS,outpatient,,,$983.00 ,$737.25 ,,$53.61 ,135,cms physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$41.87 ,$933.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$129.28 ,100,,,$41.87 ,$933.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$81.90 ,100,physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.71 ,145,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$933.85 ,95,,,$41.87 ,$933.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$41.87 ,$933.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$59.57 ,100,,,$41.87 ,$933.85 ,fee schedule,,100% Humana physician fee schedule,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$41.87 ,$933.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$82.48 ,100,,,$41.87 ,$933.85 ,fee schedule,,100% Midlands Choice physician fee schedule,$589.80 ,60,,,$41.87 ,$933.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$589.80 ,60,,,$41.87 ,$933.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$58.62 ,140,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$41.87 ,$933.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$933.85 ,95,,,$41.87 ,$933.85 ,percent of total billed charges,,95% of total billed charges,$41.87 ,100,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$52.23 ,124.753,CMS physician fee schedule,,$41.87 ,$933.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
47562 LAPAROSCOPY,8020287,CDM,975,RC,47562,HCPCS,outpatient,,,"$2,204.00 ","$1,653.00 ",,$980.09 ,135,cms physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,135% of 2011 CMS physician fee schedule,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$682.86 ,"$2,093.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$822.92 ,100,,,$682.86 ,"$2,093.80 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,343.30 ",100,physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$990.15 ,145,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,093.80 ",95,,,$682.86 ,"$2,093.80 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$682.86 ,"$2,093.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$967.96 ,100,,,$682.86 ,"$2,093.80 ",fee schedule,,100% Humana physician fee schedule,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$682.86 ,"$2,093.80 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,298.19 ",100,,,$682.86 ,"$2,093.80 ",fee schedule,,100% Midlands Choice physician fee schedule,$757.52 ,100,,,$682.86 ,"$2,093.80 ",fee schedule,,100% Multiplan physician fee schedule,$757.52 ,100,,,$682.86 ,"$2,093.80 ",fee schedule,,100% Multiplan physician fee schedule,$956.00 ,140,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$682.86 ,"$2,093.80 ",other,,Not separately reimbursible. Not contracted for physician rates,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,093.80 ",95,,,$682.86 ,"$2,093.80 ",percent of total billed charges,,95% of total billed charges,$682.86 ,100,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,100% CMS Medicare physician fee schedule ,$851.89 ,124.753,CMS physician fee schedule,,$682.86 ,"$2,093.80 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
49082 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE ProFee,8020355,CDM,975,RC,49082,HCPCS,outpatient,,,$885.00 ,$663.75 ,,,,,,$74.95 ,$840.75 ,other,,Not seperately reimbursible per contract terms,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$74.95 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$255.55 ,100,,,$74.95 ,$840.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$149.80 ,100,physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$108.68 ,145,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$840.75 ,95,,,$74.95 ,$840.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$74.95 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$108.46 ,100,,,$74.95 ,$840.75 ,fee schedule,,100% Humana physician fee schedule,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$74.95 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$74.95 ,$840.75 ,other,,Not separately reimbursable per contract terms,$531.00 ,60,,,$74.95 ,$840.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$531.00 ,60,,,$74.95 ,$840.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$104.93 ,140,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$74.95 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$840.75 ,95,,,$74.95 ,$840.75 ,percent of total billed charges,,95% of total billed charges,$74.95 ,100,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$93.50 ,124.753,CMS physician fee schedule,,$74.95 ,$840.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE ProFee,8020356,CDM,981,RC,49083,HCPCS,outpatient,,,$885.00 ,$663.75 ,,,,,,$107.69 ,$840.75 ,other,,Not seperately reimbursible per contract terms,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$107.69 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$375.81 ,100,,,$107.69 ,$840.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$217.70 ,100,physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$156.15 ,145,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$840.75 ,95,,,$107.69 ,$840.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$107.69 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$157.82 ,100,,,$107.69 ,$840.75 ,fee schedule,,100% Humana physician fee schedule,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$107.69 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$223.83 ,100,,,$107.69 ,$840.75 ,fee schedule,,100% Midlands Choice physician fee schedule,$531.00 ,60,,,$107.69 ,$840.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$531.00 ,60,,,$107.69 ,$840.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$150.77 ,140,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$107.69 ,$840.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$840.75 ,95,,,$107.69 ,$840.75 ,percent of total billed charges,,95% of total billed charges,$107.69 ,100,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$134.35 ,124.753,CMS physician fee schedule,,$107.69 ,$840.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
49500 REPAIR INITIAL INGUINAL HERNIA,8020409,CDM,975,RC,49500,HCPCS,outpatient,,,"$2,018.00 ","$1,513.50 ",,$484.31 ,135,cms physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,135% of 2011 CMS physician fee schedule,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$431.88 ,"$1,917.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$515.83 ,100,,,$431.88 ,"$1,917.10 ",fee schedule,,100% of the Blue Cross physician fee schedule,$839.30 ,100,physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$626.23 ,145,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,917.10 ",95,,,$431.88 ,"$1,917.10 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$431.88 ,"$1,917.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$606.87 ,100,,,$431.88 ,"$1,917.10 ",fee schedule,,100% Humana physician fee schedule,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$431.88 ,"$1,917.10 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$431.88 ,"$1,917.10 ",other,,Not separately reimbursable per contract terms,"$1,210.80 ",60,,,$431.88 ,"$1,917.10 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,210.80 ",60,,,$431.88 ,"$1,917.10 ",percent of total billed charges,,60% of total billed charges for physician settings,$604.63 ,140,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$431.88 ,"$1,917.10 ",other,,Not separately reimbursible. Not contracted for physician rates,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,917.10 ",95,,,$431.88 ,"$1,917.10 ",percent of total billed charges,,95% of total billed charges,$431.88 ,100,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,100% CMS Medicare physician fee schedule ,$538.78 ,124.753,CMS physician fee schedule,,$431.88 ,"$1,917.10 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
49505 REPAIR INITIAL INGUINAL HERNIA,8020411,CDM,975,RC,49505,HCPCS,outpatient,,,"$1,682.00 ","$1,261.50 ",,$678.87 ,135,cms physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$541.95 ,"$1,597.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$651.55 ,100,,,$541.95 ,"$1,597.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,061.90 ",100,physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$785.83 ,145,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,597.90 ",95,,,$541.95 ,"$1,597.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$541.95 ,"$1,597.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$766.28 ,100,,,$541.95 ,"$1,597.90 ",fee schedule,,100% Humana physician fee schedule,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$541.95 ,"$1,597.90 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,027.09 ",100,,,$541.95 ,"$1,597.90 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,009.20 ",60,,,$541.95 ,"$1,597.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,009.20 ",60,,,$541.95 ,"$1,597.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$758.73 ,140,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$541.95 ,"$1,597.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,597.90 ",95,,,$541.95 ,"$1,597.90 ",percent of total billed charges,,95% of total billed charges,$541.95 ,100,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$676.10 ,124.753,CMS physician fee schedule,,$541.95 ,"$1,597.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
49585 REPAIR UMBILICAL HERNIA,8020430,CDM,975,RC,49585,HCPCS,outpatient,,,"$2,062.00 ","$1,546.50 ",,$579.19 ,135,cms physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,135% of 2011 CMS physician fee schedule,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$464.68 ,"$1,958.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$557.06 ,100,,,$464.68 ,"$1,958.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,$907.20 ,100,physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$673.79 ,145,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,958.90 ",95,,,$464.68 ,"$1,958.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$464.68 ,"$1,958.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$655.41 ,100,,,$464.68 ,"$1,958.90 ",fee schedule,,100% Humana physician fee schedule,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$464.68 ,"$1,958.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$878.76 ,100,,,$464.68 ,"$1,958.90 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,237.20 ",60,,,$464.68 ,"$1,958.90 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,237.20 ",60,,,$464.68 ,"$1,958.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$650.55 ,140,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$464.68 ,"$1,958.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,958.90 ",95,,,$464.68 ,"$1,958.90 ",percent of total billed charges,,95% of total billed charges,$464.68 ,100,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,100% CMS Medicare physician fee schedule ,$579.70 ,124.753,CMS physician fee schedule,,$464.68 ,"$1,958.90 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
49594 RPR AA HRN 1ST 3-10 NCR/STRN,10807799,CDM,975,RC,49594,HCPCS,outpatient,,,"$2,340.00 ","$1,755.00 ",,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursible per contract terms,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursable per contract terms,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$2,223.00 ",95,,,"$1,404.00 ","$2,340.00 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$2,340.00 ",100,,,"$1,404.00 ","$2,340.00 ",fee schedule,,100% Humana physician fee schedule,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursable per contract terms,"$1,404.00 ",60,,,"$1,404.00 ","$2,340.00 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,404.00 ",60,,,"$1,404.00 ","$2,340.00 ",percent of total billed charges,,60% of total billed charges for physician settings,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursable per contract terms,,,,,"$1,404.00 ","$2,340.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$2,223.00 ",95,,,"$1,404.00 ","$2,340.00 ",percent of total billed charges,,95% of total billed charges,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,"$1,404.00 ","$2,340.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
49650 LAPAROSCOPY,8020438,CDM,975,RC,49650,HCPCS,outpatient,,,"$1,505.00 ","$1,128.75 ",,$557.87 ,135,cms physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$448.72 ,"$1,429.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$537.30 ,100,,,$448.72 ,"$1,429.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$875.00 ,100,physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$650.64 ,145,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,429.75 ",95,,,$448.72 ,"$1,429.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$448.72 ,"$1,429.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$632.04 ,100,,,$448.72 ,"$1,429.75 ",fee schedule,,100% Humana physician fee schedule,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$448.72 ,"$1,429.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$448.72 ,"$1,429.75 ",other,,Not separately reimbursable per contract terms,$903.00 ,60,,,$448.72 ,"$1,429.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$903.00 ,60,,,$448.72 ,"$1,429.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$628.21 ,140,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$448.72 ,"$1,429.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,429.75 ",95,,,$448.72 ,"$1,429.75 ",percent of total billed charges,,95% of total billed charges,$448.72 ,100,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$559.79 ,124.753,CMS physician fee schedule,,$448.72 ,"$1,429.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
51700 BLADDER IRRIGATION,8020626,CDM,981,RC,51700,HCPCS,outpatient,,,,,,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursible per contract terms,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursible. Not contracted for physician rates,$93.63 ,100,,,$45.39 ,$93.63 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursable per contract terms,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$45.39 ,100,,,$45.39 ,$93.63 ,fee schedule,,100% Humana physician fee schedule,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursable per contract terms,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursable per contract terms,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursable per contract terms,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursable per contract terms,,,,,$45.39 ,$93.63 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$45.39 ,$93.63 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
51701 INSERTION OF NON-INDWELLING BLADDER CATHETER (EG,8020627,CDM,981,RC,51701,HCPCS,outpatient,,,$196.00 ,$147.00 ,,$36.27 ,135,cms physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$26.24 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$55.84 ,100,,,$26.24 ,$186.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$53.20 ,100,physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$38.05 ,145,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$186.20 ,95,,,$26.24 ,$186.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$26.24 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$38.32 ,100,,,$26.24 ,$186.20 ,fee schedule,,100% Humana physician fee schedule,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$26.24 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$52.41 ,100,,,$26.24 ,$186.20 ,fee schedule,,100% Midlands Choice physician fee schedule,$117.60 ,60,,,$26.24 ,$186.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$117.60 ,60,,,$26.24 ,$186.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$36.74 ,140,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$26.24 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$186.20 ,95,,,$26.24 ,$186.20 ,percent of total billed charges,,95% of total billed charges,$26.24 ,100,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$32.74 ,124.753,CMS physician fee schedule,,$26.24 ,$186.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
51702 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE (EG,8020628,CDM,981,RC,51702,HCPCS,outpatient,,,$196.00 ,$147.00 ,,$39.47 ,135,cms physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.93 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$76.02 ,100,,,$25.93 ,$186.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$51.80 ,100,physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$37.60 ,145,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$186.20 ,95,,,$25.93 ,$186.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$25.93 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$37.39 ,100,,,$25.93 ,$186.20 ,fee schedule,,100% Humana physician fee schedule,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.93 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$25.93 ,$186.20 ,other,,Not separately reimbursable per contract terms,$117.60 ,60,,,$25.93 ,$186.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$117.60 ,60,,,$25.93 ,$186.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$36.30 ,140,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$25.93 ,$186.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$186.20 ,95,,,$25.93 ,$186.20 ,percent of total billed charges,,95% of total billed charges,$25.93 ,100,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$32.35 ,124.753,CMS physician fee schedule,,$25.93 ,$186.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
51703 INSERTION OF TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED (EG,8020629,CDM,981,RC,51703,HCPCS,outpatient,,,$154.00 ,$115.50 ,,$107.16 ,135,cms physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,135% of 2011 CMS physician fee schedule,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.55 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,$173.52 ,100,,,$77.55 ,$173.52 ,fee schedule,,100% of the Blue Cross physician fee schedule,$154.00 ,100,physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,$112.45 ,145,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,145% CMS Medicare physician fee schedule ,$146.30 ,95,,,$77.55 ,$173.52 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$77.55 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,$112.77 ,100,,,$77.55 ,$173.52 ,fee schedule,,100% Humana physician fee schedule,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$77.55 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$77.55 ,$173.52 ,other,,Not separately reimbursable per contract terms,$92.40 ,60,,,$77.55 ,$173.52 ,percent of total billed charges,,60% of total billed charges for physician settings,$92.40 ,60,,,$77.55 ,$173.52 ,percent of total billed charges,,60% of total billed charges for physician settings,$108.57 ,140,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$77.55 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,$146.30 ,95,,,$77.55 ,$173.52 ,percent of total billed charges,,95% of total billed charges,$77.55 ,100,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,100% CMS Medicare physician fee schedule ,$96.75 ,124.753,CMS physician fee schedule,,$77.55 ,$173.52 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
51705 CHANGE OF CYSTOSTOMY TUBE; SIMPLE ProFee,8020630,CDM,981,RC,51705,HCPCS,outpatient,,,$62.00 ,$46.50 ,,$83.70 ,135,cms physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,135% of 2011 CMS physician fee schedule,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$37.20 ,$118.54 ,other,,Not separately reimbursible. Not contracted for physician rates,$118.54 ,100,,,$37.20 ,$118.54 ,fee schedule,,100% of the Blue Cross physician fee schedule,$62.00 ,100,physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,$75.55 ,145,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,145% CMS Medicare physician fee schedule ,$58.90 ,95,,,$37.20 ,$118.54 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$37.20 ,$118.54 ,other,,Not separately reimbursible. Not contracted for physician rates,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,$76.08 ,100,,,$37.20 ,$118.54 ,fee schedule,,100% Humana physician fee schedule,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$37.20 ,$118.54 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$37.20 ,$118.54 ,other,,Not separately reimbursable per contract terms,$37.20 ,60,,,$37.20 ,$118.54 ,percent of total billed charges,,60% of total billed charges for physician settings,$37.20 ,60,,,$37.20 ,$118.54 ,percent of total billed charges,,60% of total billed charges for physician settings,$72.94 ,140,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$37.20 ,$118.54 ,other,,Not separately reimbursible. Not contracted for physician rates,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,$58.90 ,95,,,$37.20 ,$118.54 ,percent of total billed charges,,95% of total billed charges,$52.10 ,100,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,100% CMS Medicare physician fee schedule ,$65.00 ,124.753,CMS physician fee schedule,,$37.20 ,$118.54 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
53620 DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER,8020772,CDM,981,RC,53620,HCPCS,outpatient,,,$626.00 ,$469.50 ,,$115.10 ,135,cms physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$88.06 ,$594.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$183.83 ,100,,,$88.06 ,$594.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$175.70 ,100,physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$127.69 ,145,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$594.70 ,95,,,$88.06 ,$594.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$88.06 ,$594.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$127.13 ,100,,,$88.06 ,$594.70 ,fee schedule,,100% Humana physician fee schedule,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$88.06 ,$594.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$88.06 ,$594.70 ,other,,Not separately reimbursable per contract terms,$375.60 ,60,,,$88.06 ,$594.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$375.60 ,60,,,$88.06 ,$594.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$123.28 ,140,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$88.06 ,$594.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$594.70 ,95,,,$88.06 ,$594.70 ,percent of total billed charges,,95% of total billed charges,$88.06 ,100,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$109.86 ,124.753,CMS physician fee schedule,,$88.06 ,$594.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM ProFee,8020809,CDM,981,RC,54220,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$177.57 ,135,cms physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,135% of 2011 CMS physician fee schedule,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$135.01 ,$264.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$264.14 ,100,,,$135.01 ,$264.14 ,fee schedule,,100% of the Blue Cross physician fee schedule,$264.00 ,100,physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$195.76 ,145,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,145% CMS Medicare physician fee schedule ,$250.80 ,95,,,$135.01 ,$264.14 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$135.01 ,$264.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$195.16 ,100,,,$135.01 ,$264.14 ,fee schedule,,100% Humana physician fee schedule,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$135.01 ,$264.14 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$135.01 ,$264.14 ,other,,Not separately reimbursable per contract terms,$158.40 ,60,,,$135.01 ,$264.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$158.40 ,60,,,$135.01 ,$264.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$189.01 ,140,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$135.01 ,$264.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$250.80 ,95,,,$135.01 ,$264.14 ,percent of total billed charges,,95% of total billed charges,$135.01 ,100,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$168.43 ,124.753,CMS physician fee schedule,,$135.01 ,$264.14 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
54235 INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG,8020812,CDM,981,RC,54235,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$96.19 ,135,cms physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.53 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$109.95 ,100,,,$73.53 ,$250.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$147.00 ,100,physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$106.62 ,145,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$250.80 ,95,,,$73.53 ,$250.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$73.53 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$106.78 ,100,,,$73.53 ,$250.80 ,fee schedule,,100% Humana physician fee schedule,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$73.53 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.53 ,$250.80 ,other,,Not separately reimbursable per contract terms,$158.40 ,60,,,$73.53 ,$250.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$158.40 ,60,,,$73.53 ,$250.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$102.94 ,140,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$73.53 ,$250.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$250.80 ,95,,,$73.53 ,$250.80 ,percent of total billed charges,,95% of total billed charges,$73.53 ,100,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$91.73 ,124.753,CMS physician fee schedule,,$73.53 ,$250.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
54700 INCISION AND DRAINAGE OF EPIDIDYMIS,8020871,CDM,981,RC,54700,HCPCS,outpatient,,,"$1,994.00 ","$1,495.50 ",,$279.81 ,135,cms physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$217.47 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$266.72 ,100,,,$217.47 ,"$1,894.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,$432.60 ,100,physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$315.33 ,145,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,894.30 ",95,,,$217.47 ,"$1,894.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$217.47 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$313.73 ,100,,,$217.47 ,"$1,894.30 ",fee schedule,,100% Humana physician fee schedule,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$217.47 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$217.47 ,"$1,894.30 ",other,,Not separately reimbursable per contract terms,"$1,196.40 ",60,,,$217.47 ,"$1,894.30 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,196.40 ",60,,,$217.47 ,"$1,894.30 ",percent of total billed charges,,60% of total billed charges for physician settings,$304.46 ,140,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$217.47 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,894.30 ",95,,,$217.47 ,"$1,894.30 ",percent of total billed charges,,95% of total billed charges,$217.47 ,100,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$271.30 ,124.753,CMS physician fee schedule,,$217.47 ,"$1,894.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
55100 DRAINAGE OF SCROTAL WALL ABSCESS ProFee,8020884,CDM,981,RC,55100,HCPCS,outpatient,,,"$1,545.00 ","$1,158.75 ",,$217.58 ,135,cms physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$171.53 ,"$1,467.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$280.03 ,100,,,$171.53 ,"$1,467.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$336.00 ,100,physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$248.72 ,145,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,467.75 ",95,,,$171.53 ,"$1,467.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$171.53 ,"$1,467.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$244.17 ,100,,,$171.53 ,"$1,467.75 ",fee schedule,,100% Humana physician fee schedule,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$171.53 ,"$1,467.75 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$171.53 ,"$1,467.75 ",other,,Not separately reimbursable per contract terms,$927.00 ,60,,,$171.53 ,"$1,467.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$927.00 ,60,,,$171.53 ,"$1,467.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$240.14 ,140,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$171.53 ,"$1,467.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,467.75 ",95,,,$171.53 ,"$1,467.75 ",percent of total billed charges,,95% of total billed charges,$171.53 ,100,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$213.99 ,124.753,CMS physician fee schedule,,$171.53 ,"$1,467.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
55120 REMOVAL OF FOREIGN BODY IN SCROTUM ProFee,8020886,CDM,981,RC,55120,HCPCS,outpatient,,,"$1,994.00 ","$1,495.50 ",,$466.68 ,135,cms physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$362.63 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$440.67 ,100,,,$362.63 ,"$1,894.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,$713.30 ,100,physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$525.81 ,145,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,894.30 ",95,,,$362.63 ,"$1,894.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$362.63 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$518.17 ,100,,,$362.63 ,"$1,894.30 ",fee schedule,,100% Humana physician fee schedule,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$362.63 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$362.63 ,"$1,894.30 ",other,,Not separately reimbursable per contract terms,"$1,196.40 ",60,,,$362.63 ,"$1,894.30 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,196.40 ",60,,,$362.63 ,"$1,894.30 ",percent of total billed charges,,60% of total billed charges for physician settings,$507.68 ,140,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$362.63 ,"$1,894.30 ",other,,Not separately reimbursible. Not contracted for physician rates,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,894.30 ",95,,,$362.63 ,"$1,894.30 ",percent of total billed charges,,95% of total billed charges,$362.63 ,100,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,$452.39 ,124.753,CMS physician fee schedule,,$362.63 ,"$1,894.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
55250 VASECTOMY,8020891,CDM,975,RC,55250,HCPCS,outpatient,,,"$1,343.00 ","$1,007.25 ",,$298.58 ,135,cms physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$233.89 ,"$1,275.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$450.98 ,100,,,$233.89 ,"$1,275.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,$458.50 ,100,physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$339.14 ,145,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,275.85 ",95,,,$233.89 ,"$1,275.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$233.89 ,"$1,275.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$333.72 ,100,,,$233.89 ,"$1,275.85 ",fee schedule,,100% Humana physician fee schedule,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$233.89 ,"$1,275.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$467.64 ,100,,,$233.89 ,"$1,275.85 ",fee schedule,,100% Midlands Choice physician fee schedule,$805.80 ,60,,,$233.89 ,"$1,275.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$805.80 ,60,,,$233.89 ,"$1,275.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$327.45 ,140,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$233.89 ,"$1,275.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,275.85 ",95,,,$233.89 ,"$1,275.85 ",percent of total billed charges,,95% of total billed charges,$233.89 ,100,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$291.78 ,124.753,CMS physician fee schedule,,$233.89 ,"$1,275.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
55500 EXCISION OF HYDROCELE OF SPERMATIC CORD,8020895,CDM,975,RC,55500,HCPCS,outpatient,,,"$1,267.00 ",$950.25 ,,$523.60 ,135,cms physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,135% of 2011 CMS physician fee schedule,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$403.45 ,"$1,203.65 ",other,,Not separately reimbursible. Not contracted for physician rates,$489.63 ,100,,,$403.45 ,"$1,203.65 ",fee schedule,,100% of the Blue Cross physician fee schedule,$794.50 ,100,physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,$585.00 ,145,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,203.65 ",95,,,$403.45 ,"$1,203.65 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$403.45 ,"$1,203.65 ",other,,Not separately reimbursible. Not contracted for physician rates,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,$576.20 ,100,,,$403.45 ,"$1,203.65 ",fee schedule,,100% Humana physician fee schedule,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$403.45 ,"$1,203.65 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$403.45 ,"$1,203.65 ",other,,Not separately reimbursable per contract terms,$760.20 ,60,,,$403.45 ,"$1,203.65 ",percent of total billed charges,,60% of total billed charges for physician settings,$760.20 ,60,,,$403.45 ,"$1,203.65 ",percent of total billed charges,,60% of total billed charges for physician settings,$564.83 ,140,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$403.45 ,"$1,203.65 ",other,,Not separately reimbursible. Not contracted for physician rates,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,203.65 ",95,,,$403.45 ,"$1,203.65 ",percent of total billed charges,,95% of total billed charges,$403.45 ,100,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,100% CMS Medicare physician fee schedule ,$503.32 ,124.753,CMS physician fee schedule,,$403.45 ,"$1,203.65 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
56405 INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS ProFee,8020932,CDM,981,RC,56405,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$143.14 ,135,cms physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$133.03 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$160.20 ,100,,,$133.03 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$240.10 ,100,physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.89 ,145,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$133.03 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$133.03 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$174.86 ,100,,,$133.03 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$133.03 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$133.03 ,$288.80 ,other,,Not separately reimbursable per contract terms,$182.40 ,60,,,$133.03 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.40 ,60,,,$133.03 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$186.24 ,140,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$133.03 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$133.03 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$133.03 ,100,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$165.96 ,124.753,CMS physician fee schedule,,$133.03 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
56420 INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS ProFee,8020933,CDM,981,RC,56420,HCPCS,outpatient,,,$187.00 ,$140.25 ,,$121.07 ,135,cms physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,135% of 2011 CMS physician fee schedule,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$112.20 ,$194.99 ,other,,Not separately reimbursible. Not contracted for physician rates,$194.99 ,100,,,$112.20 ,$194.99 ,fee schedule,,100% of the Blue Cross physician fee schedule,$187.00 ,100,physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,$168.61 ,145,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,145% CMS Medicare physician fee schedule ,$177.65 ,95,,,$112.20 ,$194.99 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$112.20 ,$194.99 ,other,,Not separately reimbursible. Not contracted for physician rates,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,$150.99 ,100,,,$112.20 ,$194.99 ,fee schedule,,100% Humana physician fee schedule,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$112.20 ,$194.99 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$112.20 ,$194.99 ,other,,Not separately reimbursable per contract terms,$112.20 ,60,,,$112.20 ,$194.99 ,percent of total billed charges,,60% of total billed charges for physician settings,$112.20 ,60,,,$112.20 ,$194.99 ,percent of total billed charges,,60% of total billed charges for physician settings,$162.79 ,140,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$112.20 ,$194.99 ,other,,Not separately reimbursible. Not contracted for physician rates,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,$177.65 ,95,,,$112.20 ,$194.99 ,percent of total billed charges,,95% of total billed charges,$116.28 ,100,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,100% CMS Medicare physician fee schedule ,$145.06 ,124.753,CMS physician fee schedule,,$112.20 ,$194.99 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
58301 REMOVAL OF INTRAUTERINE DEVICE (IUD) ProFee,8021071,CDM,981,RC,58301,HCPCS,outpatient,,,$305.00 ,$228.75 ,,$91.67 ,135,cms physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,135% of 2011 CMS physician fee schedule,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$67.73 ,$289.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$126.27 ,100,,,$67.73 ,$289.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$136.50 ,100,physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$98.21 ,145,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$289.75 ,95,,,$67.73 ,$289.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$67.73 ,$289.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$98.43 ,100,,,$67.73 ,$289.75 ,fee schedule,,100% Humana physician fee schedule,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$67.73 ,$289.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$135.97 ,100,,,$67.73 ,$289.75 ,fee schedule,,100% Midlands Choice physician fee schedule,$183.00 ,60,,,$67.73 ,$289.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$183.00 ,60,,,$67.73 ,$289.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$94.82 ,140,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$67.73 ,$289.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$289.75 ,95,,,$67.73 ,$289.75 ,percent of total billed charges,,95% of total billed charges,$67.73 ,100,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$84.50 ,124.753,CMS physician fee schedule,,$67.73 ,$289.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
59409 VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); ProFee,8021182,CDM,981,RC,59409,HCPCS,outpatient,,,"$2,812.00 ","$2,109.00 ",,$966.51 ,135,cms physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$815.37 ,"$2,671.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,003.74 ",100,,,$815.37 ,"$2,671.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,647.10 ",100,physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,182.29 ",145,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$2,671.40 ",95,,,$815.37 ,"$2,671.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$815.37 ,"$2,671.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,180.91 ",100,,,$815.37 ,"$2,671.40 ",fee schedule,,100% Humana physician fee schedule,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$815.37 ,"$2,671.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,244.02 ",100,,,$815.37 ,"$2,671.40 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,687.20 ",60,,,$815.37 ,"$2,671.40 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,687.20 ",60,,,$815.37 ,"$2,671.40 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,141.52 ",140,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$815.37 ,"$2,671.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,671.40 ",95,,,$815.37 ,"$2,671.40 ",percent of total billed charges,,95% of total billed charges,$815.37 ,100,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,017.20 ",124.753,CMS physician fee schedule,,$815.37 ,"$2,671.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
59414 Deliver Placenta ProFee,9049172,CDM,981,RC,59414,HCPCS,outpatient,,,$306.00 ,$229.50 ,,$108.70 ,135,cms physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$91.30 ,$290.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$113.39 ,100,,,$91.30 ,$290.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$186.20 ,100,physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$132.39 ,145,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$290.70 ,95,,,$91.30 ,$290.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$91.30 ,$290.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.31 ,100,,,$91.30 ,$290.70 ,fee schedule,,100% Humana physician fee schedule,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$91.30 ,$290.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$91.30 ,$290.70 ,other,,Not separately reimbursable per contract terms,$183.60 ,60,,,$91.30 ,$290.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$183.60 ,60,,,$91.30 ,$290.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$127.82 ,140,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$91.30 ,$290.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$290.70 ,95,,,$91.30 ,$290.70 ,percent of total billed charges,,95% of total billed charges,$91.30 ,100,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$113.90 ,124.753,CMS physician fee schedule,,$91.30 ,$290.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
62270 SPINAL PUNCTURE,8021453,CDM,981,RC,62270,HCPCS,outpatient,,,,,,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursible per contract terms,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,$173.52 ,100,,,$90.36 ,$173.52 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$90.36 ,100,,,$90.36 ,$173.52 ,fee schedule,,100% Humana physician fee schedule,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursable per contract terms,,,,,$90.36 ,$173.52 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$90.36 ,$173.52 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
62273 INJECTION,8021455,CDM,981,RC,62273,HCPCS,outpatient,,,,,,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursible per contract terms,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursible. Not contracted for physician rates,$213.46 ,100,,,$165.34 ,$213.46 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursable per contract terms,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$165.34 ,100,,,$165.34 ,$213.46 ,fee schedule,,100% Humana physician fee schedule,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursable per contract terms,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursable per contract terms,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursable per contract terms,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursable per contract terms,,,,,$165.34 ,$213.46 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$165.34 ,$213.46 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
62284 INJECTION PROCEDURE FOR MYELOGRAPHY AND/OR COMPUTED TOMOGRAPHY,8021459,CDM,320,RC,62284,HCPCS,outpatient,,,$279.00 ,$209.25 ,,$256.68 ,92,,,$153.45 ,$270.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.45 ,$270.63 ,other,,Not applicable. No negotiated rates per contract,$239.94 ,86,,,$153.45 ,$270.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.20 ,80,,,$153.45 ,$270.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,95,,,$153.45 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$265.05 ,95,,,$153.45 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.25 ,75,,,$153.45 ,$270.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$237.15 ,85,,,$153.45 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.10 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.15 ,85,,,$153.45 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.10 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.47 ,93,,,$153.45 ,$270.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
62305 MYELOGRAPHY VIA LUMBAR INJECTION,8021468,CDM,320,RC,62305,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
64400 INJECTION,8021606,CDM,981,RC,64400,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$91.83 ,135,cms physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$133.15 ,100,,,$51.52 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$100.80 ,100,physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$74.70 ,145,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$51.52 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$51.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$72.74 ,100,,,$51.52 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$51.52 ,$288.80 ,other,,Not separately reimbursable per contract terms,$182.40 ,60,,,$51.52 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.40 ,60,,,$51.52 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$72.13 ,140,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$51.52 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$51.52 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$51.52 ,100,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$64.27 ,124.753,CMS physician fee schedule,,$51.52 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64402 INJECTION,8021607,CDM,981,RC,64402,HCPCS,outpatient,,,$123.00 ,$92.25 ,,$98.25 ,135,cms physician fee schedule,,$73.80 ,$123.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursible per contract terms,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursable per contract terms,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$116.85 ,95,,,$73.80 ,$123.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$123.00 ,100,,,$73.80 ,$123.00 ,fee schedule,,100% Humana physician fee schedule,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursable per contract terms,$73.80 ,60,,,$73.80 ,$123.00 ,percent of total billed charges,,60% of total billed charges for physician settings,$73.80 ,60,,,$73.80 ,$123.00 ,percent of total billed charges,,60% of total billed charges for physician settings,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursable per contract terms,,,,,$73.80 ,$123.00 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$116.85 ,95,,,$73.80 ,$123.00 ,percent of total billed charges,,95% of total billed charges,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$73.80 ,$123.00 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
64405 INJECTION,8021608,CDM,981,RC,64405,HCPCS,outpatient,,,$304.00 ,$228.00 ,,$109.30 ,135,cms physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,135% of 2011 CMS physician fee schedule,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.76 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$89.34 ,100,,,$53.76 ,$288.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$108.50 ,100,physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.95 ,145,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$288.80 ,95,,,$53.76 ,$288.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$53.76 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.98 ,100,,,$53.76 ,$288.80 ,fee schedule,,100% Humana physician fee schedule,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.76 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$53.76 ,$288.80 ,other,,Not separately reimbursable per contract terms,$182.40 ,60,,,$53.76 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$182.40 ,60,,,$53.76 ,$288.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$75.26 ,140,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$53.76 ,$288.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$288.80 ,95,,,$53.76 ,$288.80 ,percent of total billed charges,,95% of total billed charges,$53.76 ,100,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$67.07 ,124.753,CMS physician fee schedule,,$53.76 ,$288.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64447 FEMORAL NERVE BLOCK PRO FEE,8986988,CDM,964,RC,64447,HCPCS,outpatient,,,$229.00 ,$171.75 ,,$88.48 ,135,cms physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$110.38 ,100,,,$53.39 ,$217.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$107.10 ,100,physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.42 ,145,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$217.55 ,95,,,$53.39 ,$217.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.43 ,100,,,$53.39 ,$217.55 ,fee schedule,,100% Humana physician fee schedule,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursable per contract terms,$137.40 ,60,,,$53.39 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.40 ,60,,,$53.39 ,$217.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$74.75 ,140,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$53.39 ,$217.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.55 ,95,,,$53.39 ,$217.55 ,percent of total billed charges,,95% of total billed charges,$53.39 ,100,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$66.61 ,124.753,CMS physician fee schedule,,$53.39 ,$217.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64450 INJECTION,8021626,CDM,981,RC,64450,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$92.08 ,135,cms physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,135% of 2011 CMS physician fee schedule,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$43.07 ,$143.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$95.35 ,100,,,$43.07 ,$143.45 ,fee schedule,,100% of the Blue Cross physician fee schedule,$86.10 ,100,physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$62.45 ,145,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,145% CMS Medicare physician fee schedule ,$143.45 ,95,,,$43.07 ,$143.45 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$43.07 ,$143.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$62.37 ,100,,,$43.07 ,$143.45 ,fee schedule,,100% Humana physician fee schedule,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$43.07 ,$143.45 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$43.07 ,$143.45 ,other,,Not separately reimbursable per contract terms,$90.60 ,60,,,$43.07 ,$143.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$90.60 ,60,,,$43.07 ,$143.45 ,percent of total billed charges,,60% of total billed charges for physician settings,$60.30 ,140,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$43.07 ,$143.45 ,other,,Not separately reimbursible. Not contracted for physician rates,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$143.45 ,95,,,$43.07 ,$143.45 ,percent of total billed charges,,95% of total billed charges,$43.07 ,100,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.73 ,124.753,CMS physician fee schedule,,$43.07 ,$143.45 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64486 Transversus abdominis plane (TAP) block (abd plane block,8941537,CDM,975,RC,64486,HCPCS,outpatient,,,$205.00 ,$153.75 ,,,,,,$56.33 ,$194.75 ,other,,Not seperately reimbursible per contract terms,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$56.33 ,$194.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$138.30 ,100,,,$56.33 ,$194.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,$113.40 ,100,physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$81.68 ,145,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,145% CMS Medicare physician fee schedule ,$194.75 ,95,,,$56.33 ,$194.75 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$56.33 ,$194.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$81.72 ,100,,,$56.33 ,$194.75 ,fee schedule,,100% Humana physician fee schedule,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$56.33 ,$194.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$56.33 ,$194.75 ,other,,Not separately reimbursable per contract terms,$123.00 ,60,,,$56.33 ,$194.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$123.00 ,60,,,$56.33 ,$194.75 ,percent of total billed charges,,60% of total billed charges for physician settings,$78.86 ,140,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$56.33 ,$194.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$194.75 ,95,,,$56.33 ,$194.75 ,percent of total billed charges,,95% of total billed charges,$56.33 ,100,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,100% CMS Medicare physician fee schedule ,$70.27 ,124.753,CMS physician fee schedule,,$56.33 ,$194.75 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
64630 DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE ProFee,8021675,CDM,975,RC,64630,HCPCS,outpatient,,,$636.00 ,$477.00 ,,$248.56 ,135,cms physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,135% of 2011 CMS physician fee schedule,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$198.60 ,$604.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$301.51 ,100,,,$198.60 ,$604.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$380.80 ,100,physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$287.97 ,145,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$604.20 ,95,,,$198.60 ,$604.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$198.60 ,$604.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$276.19 ,100,,,$198.60 ,$604.20 ,fee schedule,,100% Humana physician fee schedule,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$198.60 ,$604.20 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$198.60 ,$604.20 ,other,,Not separately reimbursable per contract terms,$381.60 ,60,,,$198.60 ,$604.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$381.60 ,60,,,$198.60 ,$604.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$278.04 ,140,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$198.60 ,$604.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$604.20 ,95,,,$198.60 ,$604.20 ,percent of total billed charges,,95% of total billed charges,$198.60 ,100,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$247.76 ,124.753,CMS physician fee schedule,,$198.60 ,$604.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
65205 REMOVAL OF FOREIGN BODY,8021791,CDM,981,RC,65205,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$58.79 ,135,cms physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$29.64 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$46.39 ,100,,,$29.64 ,$119.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$58.10 ,100,physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$42.98 ,145,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$119.70 ,95,,,$29.64 ,$119.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$29.64 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$42.38 ,100,,,$29.64 ,$119.70 ,fee schedule,,100% Humana physician fee schedule,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$29.64 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$29.64 ,$119.70 ,other,,Not separately reimbursable per contract terms,$75.60 ,60,,,$29.64 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$75.60 ,60,,,$29.64 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$41.50 ,140,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$29.64 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.70 ,95,,,$29.64 ,$119.70 ,percent of total billed charges,,95% of total billed charges,$29.64 ,100,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.98 ,124.753,CMS physician fee schedule,,$29.64 ,$119.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
65220 REMOVAL OF FOREIGN BODY,8021793,CDM,981,RC,65220,HCPCS,outpatient,,,$422.00 ,$316.50 ,,$56.35 ,135,cms physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$41.68 ,$400.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$73.87 ,100,,,$41.68 ,$400.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$83.30 ,100,physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.44 ,145,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$400.90 ,95,,,$41.68 ,$400.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$41.68 ,$400.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.34 ,100,,,$41.68 ,$400.90 ,fee schedule,,100% Humana physician fee schedule,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$41.68 ,$400.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$41.68 ,$400.90 ,other,,Not separately reimbursable per contract terms,$253.20 ,60,,,$41.68 ,$400.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$253.20 ,60,,,$41.68 ,$400.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$58.35 ,140,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$41.68 ,$400.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$400.90 ,95,,,$41.68 ,$400.90 ,percent of total billed charges,,95% of total billed charges,$41.68 ,100,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$52.00 ,124.753,CMS physician fee schedule,,$41.68 ,$400.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
65222 REMOVAL OF FOREIGN BODY,8021794,CDM,981,RC,65222,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$79.20 ,135,cms physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.01 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$84.18 ,100,,,$51.01 ,$119.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$102.20 ,100,physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$73.96 ,145,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$119.70 ,95,,,$51.01 ,$119.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$51.01 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$74.48 ,100,,,$51.01 ,$119.70 ,fee schedule,,100% Humana physician fee schedule,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$51.01 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$107.38 ,100,,,$51.01 ,$119.70 ,fee schedule,,100% Midlands Choice physician fee schedule,$75.60 ,60,,,$51.01 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$75.60 ,60,,,$51.01 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$71.41 ,140,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$51.01 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.70 ,95,,,$51.01 ,$119.70 ,percent of total billed charges,,95% of total billed charges,$51.01 ,100,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$63.64 ,124.753,CMS physician fee schedule,,$51.01 ,$119.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
67700 BLEPHAROTOMY,8021970,CDM,981,RC,67700,HCPCS,outpatient,,,,,,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursible per contract terms,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursible. Not contracted for physician rates,$348.75 ,100,,,$168.14 ,$348.75 ,fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursable per contract terms,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,Not applicable for 92% of charges due to charge amount,95% of total billed charges for physician setting,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$168.14 ,100,,,$168.14 ,$348.75 ,fee schedule,,100% Humana physician fee schedule,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursable per contract terms,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursable per contract terms,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursable per contract terms,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursable per contract terms,,,,,$168.14 ,$348.75 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$168.14 ,$348.75 ,other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
67938 REMOVAL OF EMBEDDED FOREIGN BODY,8022007,CDM,981,RC,67938,HCPCS,outpatient,,,$313.00 ,$234.75 ,,$154.74 ,135,cms physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,135% of 2011 CMS physician fee schedule,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$119.56 ,$324.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$324.27 ,100,,,$119.56 ,$324.27 ,fee schedule,,100% of the Blue Cross physician fee schedule,$229.60 ,100,physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$173.36 ,145,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,145% CMS Medicare physician fee schedule ,$297.35 ,95,,,$119.56 ,$324.27 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$119.56 ,$324.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$168.31 ,100,,,$119.56 ,$324.27 ,fee schedule,,100% Humana physician fee schedule,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$119.56 ,$324.27 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$119.56 ,$324.27 ,other,,Not separately reimbursable per contract terms,$187.80 ,60,,,$119.56 ,$324.27 ,percent of total billed charges,,60% of total billed charges for physician settings,$187.80 ,60,,,$119.56 ,$324.27 ,percent of total billed charges,,60% of total billed charges for physician settings,$167.38 ,140,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$119.56 ,$324.27 ,other,,Not separately reimbursible. Not contracted for physician rates,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$297.35 ,95,,,$119.56 ,$324.27 ,percent of total billed charges,,95% of total billed charges,$119.56 ,100,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,100% CMS Medicare physician fee schedule ,$149.15 ,124.753,CMS physician fee schedule,,$119.56 ,$324.27 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
69000 DRAINAGE EXTERNAL EAR,8022062,CDM,981,RC,69000,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$161.61 ,135,cms physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$128.46 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$233.65 ,100,,,$128.46 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$242.90 ,100,physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$186.27 ,145,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$128.46 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$128.46 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$177.11 ,100,,,$128.46 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$128.46 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$128.46 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$128.46 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$128.46 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$179.84 ,140,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$128.46 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$128.46 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$128.46 ,100,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$160.26 ,124.753,CMS physician fee schedule,,$128.46 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
69020 DRAINAGE EXTERNAL AUDITORY CANAL,8022064,CDM,981,RC,69020,HCPCS,outpatient,,,$707.00 ,$530.25 ,,$194.37 ,135,cms physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.92 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$287.34 ,100,,,$149.92 ,$671.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$280.70 ,100,physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$217.38 ,145,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$671.65 ,95,,,$149.92 ,$671.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$149.92 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$205.32 ,100,,,$149.92 ,$671.65 ,fee schedule,,100% Humana physician fee schedule,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$149.92 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$149.92 ,$671.65 ,other,,Not separately reimbursable per contract terms,$424.20 ,60,,,$149.92 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$424.20 ,60,,,$149.92 ,$671.65 ,percent of total billed charges,,60% of total billed charges for physician settings,$209.89 ,140,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$149.92 ,$671.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$671.65 ,95,,,$149.92 ,$671.65 ,percent of total billed charges,,95% of total billed charges,$149.92 ,100,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$187.03 ,124.753,CMS physician fee schedule,,$149.92 ,$671.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL; WITHOUT GENERAL ANESTHESIA ProFee,8022074,CDM,981,RC,69200,HCPCS,outpatient,,,$126.00 ,$94.50 ,,$78.45 ,135,cms physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,135% of 2011 CMS physician fee schedule,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$48.32 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$100.93 ,100,,,$48.32 ,$119.70 ,fee schedule,,100% of the Blue Cross physician fee schedule,$94.50 ,100,physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$70.06 ,145,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,145% CMS Medicare physician fee schedule ,$119.70 ,95,,,$48.32 ,$119.70 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$48.32 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$68.46 ,100,,,$48.32 ,$119.70 ,fee schedule,,100% Humana physician fee schedule,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$48.32 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$48.32 ,$119.70 ,other,,Not separately reimbursable per contract terms,$75.60 ,60,,,$48.32 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$75.60 ,60,,,$48.32 ,$119.70 ,percent of total billed charges,,60% of total billed charges for physician settings,$67.65 ,140,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$48.32 ,$119.70 ,other,,Not separately reimbursible. Not contracted for physician rates,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$119.70 ,95,,,$48.32 ,$119.70 ,percent of total billed charges,,95% of total billed charges,$48.32 ,100,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.28 ,124.753,CMS physician fee schedule,,$48.32 ,$119.70 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
69209 REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE,8022076,CDM,981,RC,69209,HCPCS,outpatient,,,$64.00 ,$48.00 ,,,,,,$16.04 ,$60.80 ,other,,Not seperately reimbursible per contract terms,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.04 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$17.61 ,100,,,$16.04 ,$60.80 ,fee schedule,,100% of the Blue Cross physician fee schedule,$28.00 ,100,physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$23.26 ,145,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,145% CMS Medicare physician fee schedule ,$60.80 ,95,,,$16.04 ,$60.80 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$16.04 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$20.82 ,100,,,$16.04 ,$60.80 ,fee schedule,,100% Humana physician fee schedule,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$16.04 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$16.04 ,$60.80 ,other,,Not separately reimbursable per contract terms,$38.40 ,60,,,$16.04 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.40 ,60,,,$16.04 ,$60.80 ,percent of total billed charges,,60% of total billed charges for physician settings,$22.46 ,140,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$16.04 ,$60.80 ,other,,Not separately reimbursible. Not contracted for physician rates,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.80 ,95,,,$16.04 ,$60.80 ,percent of total billed charges,,95% of total billed charges,$16.04 ,100,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,100% CMS Medicare physician fee schedule ,$20.01 ,124.753,CMS physician fee schedule,,$16.04 ,$60.80 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
69210 REMOVAL IMPACTED CERUMEN REQUIRING INSTRUMENTATION,8022077,CDM,981,RC,69210,HCPCS,outpatient,,,$64.00 ,$48.00 ,,$44.64 ,135,cms physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,135% of 2011 CMS physician fee schedule,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$33.58 ,$66.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$58.84 ,100,,,$33.58 ,$66.98 ,fee schedule,,100% of the Blue Cross physician fee schedule,$64.00 ,100,physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$48.69 ,145,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,145% CMS Medicare physician fee schedule ,$60.80 ,95,,,$33.58 ,$66.98 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$33.58 ,$66.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$48.51 ,100,,,$33.58 ,$66.98 ,fee schedule,,100% Humana physician fee schedule,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$33.58 ,$66.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$66.98 ,100,,,$33.58 ,$66.98 ,fee schedule,,100% Midlands Choice physician fee schedule,$38.40 ,60,,,$33.58 ,$66.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$38.40 ,60,,,$33.58 ,$66.98 ,percent of total billed charges,,60% of total billed charges for physician settings,$47.01 ,140,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$33.58 ,$66.98 ,other,,Not separately reimbursible. Not contracted for physician rates,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$60.80 ,95,,,$33.58 ,$66.98 ,percent of total billed charges,,95% of total billed charges,$33.58 ,100,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,100% CMS Medicare physician fee schedule ,$41.89 ,124.753,CMS physician fee schedule,,$33.58 ,$66.98 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
90882 COMPLEX CARE MGMT-15 MIN ProFee,8022243,CDM,983,RC,90882,HCPCS,outpatient,,,"$1,082.00 ",$811.50 ,,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursible per contract terms,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursible. Not contracted for physician rates,$105.66 ,100,,,$105.66 ,"$1,027.90 ",fee schedule,,100% of the Blue Cross physician fee schedule,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursable per contract terms,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,027.90 ",95,,,$105.66 ,"$1,027.90 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$124.42 ,100,,,$105.66 ,"$1,027.90 ",fee schedule,,100% Humana physician fee schedule,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursable per contract terms,$649.20 ,60,,,$105.66 ,"$1,027.90 ",percent of total billed charges,,60% of total billed charges for physician settings,$649.20 ,60,,,$105.66 ,"$1,027.90 ",percent of total billed charges,,60% of total billed charges for physician settings,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursable per contract terms,,,,,$105.66 ,"$1,027.90 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,027.90 ",95,,,$105.66 ,"$1,027.90 ",percent of total billed charges,,95% of total billed charges,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$105.66 ,"$1,027.90 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology
92950 PHY CPR ProFee,8022252,CDM,981,RC,92950,HCPCS,outpatient,,,$669.00 ,$501.75 ,,$231.54 ,135,cms physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,135% of 2011 CMS physician fee schedule,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$186.34 ,$635.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$398.58 ,100,,,$186.34 ,$635.55 ,fee schedule,,100% of the Blue Cross physician fee schedule,$375.20 ,100,physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$270.19 ,145,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,145% CMS Medicare physician fee schedule ,$635.55 ,95,,,$186.34 ,$635.55 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$186.34 ,$635.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$270.56 ,100,,,$186.34 ,$635.55 ,fee schedule,,100% Humana physician fee schedule,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$186.34 ,$635.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$322.45 ,100,,,$186.34 ,$635.55 ,fee schedule,,100% Midlands Choice physician fee schedule,$401.40 ,60,,,$186.34 ,$635.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$401.40 ,60,,,$186.34 ,$635.55 ,percent of total billed charges,,60% of total billed charges for physician settings,$260.88 ,140,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$186.34 ,$635.55 ,other,,Not separately reimbursible. Not contracted for physician rates,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$635.55 ,95,,,$186.34 ,$635.55 ,percent of total billed charges,,95% of total billed charges,$186.34 ,100,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,100% CMS Medicare physician fee schedule ,$232.46 ,124.753,CMS physician fee schedule,,$186.34 ,$635.55 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
92960 PHY CARDIOVERSION EXTERNAL ProFee,8022254,CDM,981,RC,92960,HCPCS,outpatient,,,"$1,350.00 ","$1,012.50 ",,$158.94 ,135,cms physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,135% of 2011 CMS physician fee schedule,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$110.06 ,"$1,282.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$196.71 ,100,,,$110.06 ,"$1,282.50 ",fee schedule,,100% of the Blue Cross physician fee schedule,$218.40 ,100,physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$159.59 ,145,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,282.50 ",95,,,$110.06 ,"$1,282.50 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$110.06 ,"$1,282.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$158.66 ,100,,,$110.06 ,"$1,282.50 ",fee schedule,,100% Humana physician fee schedule,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$110.06 ,"$1,282.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$189.37 ,100,,,$110.06 ,"$1,282.50 ",fee schedule,,100% Midlands Choice physician fee schedule,$810.00 ,60,,,$110.06 ,"$1,282.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$810.00 ,60,,,$110.06 ,"$1,282.50 ",percent of total billed charges,,60% of total billed charges for physician settings,$154.08 ,140,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$110.06 ,"$1,282.50 ",other,,Not separately reimbursible. Not contracted for physician rates,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,282.50 ",95,,,$110.06 ,"$1,282.50 ",percent of total billed charges,,95% of total billed charges,$110.06 ,100,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,100% CMS Medicare physician fee schedule ,$137.30 ,124.753,CMS physician fee schedule,,$110.06 ,"$1,282.50 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
93015 STRESS TEST ProFee,8022259,CDM,482,RC,93015,HCPCS,outpatient,,,$300.00 ,$225.00 ,,$276.00 ,92,,,$165.00 ,$291.00 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$165.00 ,55,,,$165.00 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$165.00 ,$291.00 ,other,,Not applicable. No negotiated rates per contract,$258.00 ,86,,,$165.00 ,$291.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$240.00 ,80,,,$165.00 ,$291.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$165.00 ,55,,,$165.00 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.00 ,95,,,$165.00 ,$291.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$285.00 ,95,,,$165.00 ,$291.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.00 ,75,,,$165.00 ,$291.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$255.00 ,85,,,$165.00 ,$291.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$291.00 ,97,,,$165.00 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.00 ,55,,,$165.00 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.00 ,90,,,$165.00 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.00 ,97,,,$165.00 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.00 ,97,,,$165.00 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.00 ,97,,,$165.00 ,$291.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.00 ,85,,,$165.00 ,$291.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.00 ,90,,,$165.00 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.00 ,55,,,$165.00 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.00 ,90,,,$165.00 ,$291.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.00 ,55,,,$165.00 ,$291.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$279.00 ,93,,,$165.00 ,$291.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
93016 STRESS TEST SUPERVISION ProFee,8022260,CDM,982,RC,93016,HCPCS,outpatient,,,$135.00 ,$101.25 ,,$29.15 ,135,cms physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,135% of 2011 CMS physician fee schedule,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$21.91 ,$128.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$27.06 ,100,,,$21.91 ,$128.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$44.10 ,100,physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$31.77 ,145,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$128.25 ,95,,,$21.91 ,$128.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$21.91 ,$128.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$32.00 ,100,,,$21.91 ,$128.25 ,fee schedule,,100% Humana physician fee schedule,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$21.91 ,$128.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$38.70 ,100,,,$21.91 ,$128.25 ,fee schedule,,100% Midlands Choice physician fee schedule,$81.00 ,60,,,$21.91 ,$128.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$81.00 ,60,,,$21.91 ,$128.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$30.67 ,140,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$21.91 ,$128.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$128.25 ,95,,,$21.91 ,$128.25 ,percent of total billed charges,,95% of total billed charges,$21.91 ,100,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$27.33 ,124.753,CMS physician fee schedule,,$21.91 ,$128.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
93018 STRESS TEST INTERPRETATION ProFee,8022262,CDM,982,RC,93018,HCPCS,outpatient,,,$141.00 ,$105.75 ,,$19.53 ,135,cms physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,135% of 2011 CMS physician fee schedule,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$14.62 ,$133.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$18.04 ,100,,,$14.62 ,$133.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,$29.40 ,100,physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$21.20 ,145,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,145% CMS Medicare physician fee schedule ,$133.95 ,95,,,$14.62 ,$133.95 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$14.62 ,$133.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$21.35 ,100,,,$14.62 ,$133.95 ,fee schedule,,100% Humana physician fee schedule,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$14.62 ,$133.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$25.92 ,100,,,$14.62 ,$133.95 ,fee schedule,,100% Midlands Choice physician fee schedule,$84.60 ,60,,,$14.62 ,$133.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$84.60 ,60,,,$14.62 ,$133.95 ,percent of total billed charges,,60% of total billed charges for physician settings,$20.47 ,140,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$14.62 ,$133.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$133.95 ,95,,,$14.62 ,$133.95 ,percent of total billed charges,,95% of total billed charges,$14.62 ,100,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$18.24 ,124.753,CMS physician fee schedule,,$14.62 ,$133.95 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
95992 CANALITH REPOSITIONING PROCEDURE ProFee,8859262,CDM,981,RC,95992,HCPCS,outpatient,,,$82.00 ,$61.50 ,,$50.94 ,135,cms physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,135% of 2011 CMS physician fee schedule,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$37.21 ,$77.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$54.98 ,100,,,$37.21 ,$77.90 ,fee schedule,,100% of the Blue Cross physician fee schedule,$75.59 ,100,physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.95 ,145,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,145% CMS Medicare physician fee schedule ,$77.90 ,95,,,$37.21 ,$77.90 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$37.21 ,$77.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$54.80 ,100,,,$37.21 ,$77.90 ,fee schedule,,100% Humana physician fee schedule,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$37.21 ,$77.90 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$37.21 ,$77.90 ,other,,Not separately reimbursable per contract terms,$49.20 ,60,,,$37.21 ,$77.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$49.20 ,60,,,$37.21 ,$77.90 ,percent of total billed charges,,60% of total billed charges for physician settings,$52.09 ,140,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$37.21 ,$77.90 ,other,,Not separately reimbursible. Not contracted for physician rates,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$77.90 ,95,,,$37.21 ,$77.90 ,percent of total billed charges,,95% of total billed charges,$37.21 ,100,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,100% CMS Medicare physician fee schedule ,$46.42 ,124.753,CMS physician fee schedule,,$37.21 ,$77.90 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
96127 Brief emotional/behavioral assessment (eg,8967269,CDM,521,RC,96127,HCPCS,outpatient,,,$21.00 ,$15.75 ,,$19.32 ,92,,,$15.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$15.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$15.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$18.06 ,86,,,$15.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$16.80 ,80,,,$15.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,95,,,$15.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.95 ,95,,,$15.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$15.75 ,75,,,$15.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$17.85 ,85,,,$15.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$15.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$18.90 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.37 ,97,,,$15.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.85 ,85,,,$15.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$18.90 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$19.95 ,90,,,$15.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$15.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
97597 WOUND DEBRIDEMENT ProFee,8022376,CDM,981,RC,97597,HCPCS,outpatient,,,$203.00 ,$152.25 ,,$31.71 ,135,cms physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,135% of 2011 CMS physician fee schedule,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$31.71 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$120.26 ,100,,,$31.71 ,$192.85 ,fee schedule,,100% of the Blue Cross physician fee schedule,$49.35 ,100,physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.22 ,145,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,145% CMS Medicare physician fee schedule ,$192.85 ,95,,,$31.71 ,$192.85 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$31.71 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$53.13 ,100,,,$31.71 ,$192.85 ,fee schedule,,100% Humana physician fee schedule,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$31.71 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$35.87 ,100,,,$31.71 ,$192.85 ,fee schedule,,100% Midlands Choice physician fee schedule,$121.80 ,60,,,$31.71 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$121.80 ,60,,,$31.71 ,$192.85 ,percent of total billed charges,,60% of total billed charges for physician settings,$51.38 ,140,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$31.71 ,$192.85 ,other,,Not separately reimbursible. Not contracted for physician rates,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$192.85 ,95,,,$31.71 ,$192.85 ,percent of total billed charges,,95% of total billed charges,$36.70 ,100,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,100% CMS Medicare physician fee schedule ,$45.78 ,124.753,CMS physician fee schedule,,$31.71 ,$192.85 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99151 CONS SEDATE <5 YO 1ST 15M SAME PROV ProFee,8022396,CDM,981,RC,99151,HCPCS,outpatient,,,$83.00 ,$62.25 ,,,,,,$25.34 ,$92.34 ,other,,Not seperately reimbursible per contract terms,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.34 ,$92.34 ,other,,Not separately reimbursible. Not contracted for physician rates,$92.34 ,100,,,$25.34 ,$92.34 ,fee schedule,,100% of the Blue Cross physician fee schedule,$46.90 ,100,physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,$36.74 ,145,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,145% CMS Medicare physician fee schedule ,$78.85 ,95,,,$25.34 ,$92.34 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$25.34 ,$92.34 ,other,,Not separately reimbursible. Not contracted for physician rates,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,$33.81 ,100,,,$25.34 ,$92.34 ,fee schedule,,100% Humana physician fee schedule,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$25.34 ,$92.34 ,other,,Not separately reimbursible. Not contracted for physician rates,,,,,$25.34 ,$92.34 ,other,,Not separately reimbursable per contract terms,$49.80 ,60,,,$25.34 ,$92.34 ,percent of total billed charges,,60% of total billed charges for physician settings,$49.80 ,60,,,$25.34 ,$92.34 ,percent of total billed charges,,60% of total billed charges for physician settings,$35.48 ,140,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$25.34 ,$92.34 ,other,,Not separately reimbursible. Not contracted for physician rates,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,$78.85 ,95,,,$25.34 ,$92.34 ,percent of total billed charges,,95% of total billed charges,$25.34 ,100,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,100% CMS Medicare physician fee schedule ,$31.61 ,124.753,CMS physician fee schedule,,$25.34 ,$92.34 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99152 Mod Sed same phys qhp 5/>yrs,9090650,CDM,981,RC,99152,HCPCS,outpatient,,,$44.00 ,$33.00 ,,,,,,$12.76 ,$63.14 ,other,,Not seperately reimbursible per contract terms,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$63.14 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% of the Blue Cross physician fee schedule,$24.50 ,100,physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$18.50 ,145,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,145% CMS Medicare physician fee schedule ,$41.80 ,95,,,$12.76 ,$63.14 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$17.72 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% Humana physician fee schedule,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.16 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% Midlands Choice physician fee schedule,$26.40 ,60,,,$12.76 ,$63.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$26.40 ,60,,,$12.76 ,$63.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$17.86 ,140,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$41.80 ,95,,,$12.76 ,$63.14 ,percent of total billed charges,,95% of total billed charges,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$15.92 ,124.753,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99152 Mod sed same phys/qhp 5/>yrs,9148189,CDM,981,RC,99152,HCPCS,outpatient,,,$44.00 ,$33.00 ,,,,,,$12.76 ,$63.14 ,other,,Not seperately reimbursible per contract terms,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$63.14 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% of the Blue Cross physician fee schedule,$24.50 ,100,physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$18.50 ,145,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,145% CMS Medicare physician fee schedule ,$41.80 ,95,,,$12.76 ,$63.14 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$17.72 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% Humana physician fee schedule,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$21.16 ,100,,,$12.76 ,$63.14 ,fee schedule,,100% Midlands Choice physician fee schedule,$26.40 ,60,,,$12.76 ,$63.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$26.40 ,60,,,$12.76 ,$63.14 ,percent of total billed charges,,60% of total billed charges for physician settings,$17.86 ,140,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$12.76 ,$63.14 ,other,,Not separately reimbursible. Not contracted for physician rates,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$41.80 ,95,,,$12.76 ,$63.14 ,percent of total billed charges,,95% of total billed charges,$12.76 ,100,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,100% CMS Medicare physician fee schedule ,$15.92 ,124.753,CMS physician fee schedule,,$12.76 ,$63.14 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99153 Mod Sed same phys qhp ea,9090651,CDM,981,RC,99153,HCPCS,outpatient,,,$36.00 ,$27.00 ,,,,,,$11.35 ,$34.20 ,other,,Not seperately reimbursible per contract terms,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$13.31 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$21.00 ,100,physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.46 ,145,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$34.20 ,95,,,$11.35 ,$34.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$15.60 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% Humana physician fee schedule,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$17.18 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% Midlands Choice physician fee schedule,$21.60 ,60,,,$11.35 ,$34.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$21.60 ,60,,,$11.35 ,$34.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$15.89 ,140,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$34.20 ,95,,,$11.35 ,$34.20 ,percent of total billed charges,,95% of total billed charges,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$14.16 ,124.753,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99153 Mod sed same phys/qhp ea,9148191,CDM,981,RC,99153,HCPCS,outpatient,,,$36.00 ,$27.00 ,,,,,,$11.35 ,$34.20 ,other,,Not seperately reimbursible per contract terms,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$13.31 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% of the Blue Cross physician fee schedule,$21.00 ,100,physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$16.46 ,145,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,145% CMS Medicare physician fee schedule ,$34.20 ,95,,,$11.35 ,$34.20 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$15.60 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% Humana physician fee schedule,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$17.18 ,100,,,$11.35 ,$34.20 ,fee schedule,,100% Midlands Choice physician fee schedule,$21.60 ,60,,,$11.35 ,$34.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$21.60 ,60,,,$11.35 ,$34.20 ,percent of total billed charges,,60% of total billed charges for physician settings,$15.89 ,140,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$11.35 ,$34.20 ,other,,Not separately reimbursible. Not contracted for physician rates,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$34.20 ,95,,,$11.35 ,$34.20 ,percent of total billed charges,,95% of total billed charges,$11.35 ,100,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,100% CMS Medicare physician fee schedule ,$14.16 ,124.753,CMS physician fee schedule,,$11.35 ,$34.20 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99173 Vision Screening,10977122,CDM,521,RC,99173,HCPCS,outpatient,,,$33.00 ,$24.75 ,,$30.36 ,92,,,$24.75 ,$197.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.64 ,100,,,$24.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$24.75 ,$197.64 ,other,,Not applicable. No negotiated rates per contract,$28.38 ,86,,,$24.75 ,$197.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.40 ,80,,,$24.75 ,$197.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.64 ,55,,,$24.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,95,,,$24.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.35 ,95,,,$24.75 ,$197.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.75 ,75,,,$24.75 ,$197.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.05 ,85,,,$24.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.01 ,97,,,$24.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.64 ,100,,,$24.75 ,$197.64 ,case rate,,100% of clinic case rate per visit,$29.70 ,90,,,$24.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.01 ,97,,,$24.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$24.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.01 ,97,,,$24.75 ,$197.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.05 ,85,,,$24.75 ,$197.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.70 ,90,,,$24.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$24.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$24.75 ,$197.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.64 ,55,,,$24.75 ,$197.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.75 ,$197.64 ,other,,Not separately reimbursable per table 3 referenced in contract
99218 LEVEL 1: DETAILED HX/EXAM: STRAIGHTFORWARD 30 MIN ProFee,8022418,CDM,982,RC,99218,HCPCS,outpatient,,,$337.00 ,$252.75 ,,$87.55 ,135,cms physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,135% of 2011 CMS physician fee schedule,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$87.55 ,$320.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$121.55 ,100,,,$87.55 ,$320.15 ,fee schedule,,100% of the Blue Cross physician fee schedule,$157.91 ,100,physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.35 ,145,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,145% CMS Medicare physician fee schedule ,$320.15 ,95,,,$87.55 ,$320.15 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$87.55 ,$320.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$142.95 ,100,,,$87.55 ,$320.15 ,fee schedule,,100% Humana physician fee schedule,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$87.55 ,$320.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$166.35 ,100,,,$87.55 ,$320.15 ,fee schedule,,100% Midlands Choice physician fee schedule,$202.20 ,60,,,$87.55 ,$320.15 ,percent of total billed charges,,60% of total billed charges for physician settings,$202.20 ,60,,,$87.55 ,$320.15 ,percent of total billed charges,,60% of total billed charges for physician settings,$137.44 ,140,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$87.55 ,$320.15 ,other,,Not separately reimbursible. Not contracted for physician rates,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$320.15 ,95,,,$87.55 ,$320.15 ,percent of total billed charges,,95% of total billed charges,$98.17 ,100,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,100% CMS Medicare physician fee schedule ,$122.47 ,124.753,CMS physician fee schedule,,$87.55 ,$320.15 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99225 SUBSEQUENT OBSERVATION CARE ProFee,8022425,CDM,982,RC,99225,HCPCS,outpatient,,,$318.00 ,$238.50 ,,$65.60 ,135,cms physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,135% of 2011 CMS physician fee schedule,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$65.60 ,$302.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$88.48 ,100,,,$65.60 ,$302.10 ,fee schedule,,100% of the Blue Cross physician fee schedule,$114.80 ,100,physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$103.31 ,145,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,145% CMS Medicare physician fee schedule ,$302.10 ,95,,,$65.60 ,$302.10 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$65.60 ,$302.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$104.09 ,100,,,$65.60 ,$302.10 ,fee schedule,,100% Humana physician fee schedule,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$65.60 ,$302.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.49 ,100,,,$65.60 ,$302.10 ,fee schedule,,100% Midlands Choice physician fee schedule,$190.80 ,60,,,$65.60 ,$302.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$190.80 ,60,,,$65.60 ,$302.10 ,percent of total billed charges,,60% of total billed charges for physician settings,$99.75 ,140,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$65.60 ,$302.10 ,other,,Not separately reimbursible. Not contracted for physician rates,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$302.10 ,95,,,$65.60 ,$302.10 ,percent of total billed charges,,95% of total billed charges,$71.25 ,100,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,100% CMS Medicare physician fee schedule ,$88.89 ,124.753,CMS physician fee schedule,,$65.60 ,$302.10 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99226 SBSQ OBS STAY 25 MIN ProFee,8022426,CDM,987,RC,99226,HCPCS,outpatient,,,$375.00 ,$281.25 ,,$98.09 ,135,cms physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,135% of 2011 CMS physician fee schedule,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$98.09 ,$356.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$127.13 ,100,,,$98.09 ,$356.25 ,fee schedule,,100% of the Blue Cross physician fee schedule,$165.20 ,100,physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$147.26 ,145,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,145% CMS Medicare physician fee schedule ,$356.25 ,95,,,$98.09 ,$356.25 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$98.09 ,$356.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$149.80 ,100,,,$98.09 ,$356.25 ,fee schedule,,100% Humana physician fee schedule,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$98.09 ,$356.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$175.97 ,100,,,$98.09 ,$356.25 ,fee schedule,,100% Midlands Choice physician fee schedule,$225.00 ,60,,,$98.09 ,$356.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$225.00 ,60,,,$98.09 ,$356.25 ,percent of total billed charges,,60% of total billed charges for physician settings,$142.18 ,140,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$98.09 ,$356.25 ,other,,Not separately reimbursible. Not contracted for physician rates,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$356.25 ,95,,,$98.09 ,$356.25 ,percent of total billed charges,,95% of total billed charges,$101.56 ,100,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,100% CMS Medicare physician fee schedule ,$126.70 ,124.753,CMS physician fee schedule,,$98.09 ,$356.25 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99238 HSP INPT,8022433,CDM,987,RC,99238,HCPCS,outpatient,,,$307.00 ,$230.25 ,,$94.57 ,135,cms physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,135% of 2011 CMS physician fee schedule,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$72.49 ,$291.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$88.91 ,100,,,$72.49 ,$291.65 ,fee schedule,,100% of the Blue Cross physician fee schedule,$115.36 ,100,physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$105.11 ,145,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,145% CMS Medicare physician fee schedule ,$291.65 ,95,,,$72.49 ,$291.65 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$72.49 ,$291.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$104.80 ,100,,,$72.49 ,$291.65 ,fee schedule,,100% Humana physician fee schedule,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$72.49 ,$291.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.24 ,100,,,$72.49 ,$291.65 ,fee schedule,,100% Midlands Choice physician fee schedule,$74.07 ,100,,,$72.49 ,$291.65 ,fee schedule,,100% Multiplan physician fee schedule,$74.07 ,100,,,$72.49 ,$291.65 ,fee schedule,,100% Multiplan physician fee schedule,$101.49 ,140,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$72.49 ,$291.65 ,other,,Not separately reimbursible. Not contracted for physician rates,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$291.65 ,95,,,$72.49 ,$291.65 ,percent of total billed charges,,95% of total billed charges,$72.49 ,100,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,100% CMS Medicare physician fee schedule ,$90.43 ,124.753,CMS physician fee schedule,,$72.49 ,$291.65 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99239 HSP INPT,8022434,CDM,987,RC,99239,HCPCS,outpatient,,,$420.00 ,$315.00 ,,$140.17 ,135,cms physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,135% of 2011 CMS physician fee schedule,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$105.97 ,$399.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$130.57 ,100,,,$105.97 ,$399.00 ,fee schedule,,100% of the Blue Cross physician fee schedule,$169.12 ,100,physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$153.66 ,145,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,145% CMS Medicare physician fee schedule ,$399.00 ,95,,,$105.97 ,$399.00 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$105.97 ,$399.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$153.68 ,100,,,$105.97 ,$399.00 ,fee schedule,,100% Humana physician fee schedule,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$105.97 ,$399.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$179.80 ,100,,,$105.97 ,$399.00 ,fee schedule,,100% Midlands Choice physician fee schedule,$108.57 ,100,,,$105.97 ,$399.00 ,fee schedule,,100% Multiplan physician fee schedule,$108.57 ,100,,,$105.97 ,$399.00 ,fee schedule,,100% Multiplan physician fee schedule,$148.36 ,140,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$105.97 ,$399.00 ,other,,Not separately reimbursible. Not contracted for physician rates,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$399.00 ,95,,,$105.97 ,$399.00 ,percent of total billed charges,,95% of total billed charges,$105.97 ,100,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,100% CMS Medicare physician fee schedule ,$132.20 ,124.753,CMS physician fee schedule,,$105.97 ,$399.00 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99283 ED VISIT E&M PATIENT,8022450,CDM,981,RC,99283,HCPCS,outpatient,,,$981.00 ,$735.75 ,,$82.22 ,135,cms physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,135% of 2011 CMS physician fee schedule,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$62.81 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$79.03 ,100,,,$62.81 ,$931.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,$103.04 ,100,physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$105.56 ,145,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,145% CMS Medicare physician fee schedule ,$931.95 ,95,,,$62.81 ,$931.95 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$62.81 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$92.82 ,100,,,$62.81 ,$931.95 ,fee schedule,,100% Humana physician fee schedule,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$62.81 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$103.66 ,100,,,$62.81 ,$931.95 ,fee schedule,,100% Midlands Choice physician fee schedule,$62.81 ,100,,,$62.81 ,$931.95 ,fee schedule,,100% Multiplan physician fee schedule,$62.81 ,100,,,$62.81 ,$931.95 ,fee schedule,,100% Multiplan physician fee schedule,$101.92 ,140,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$62.81 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$931.95 ,95,,,$62.81 ,$931.95 ,percent of total billed charges,,95% of total billed charges,$72.80 ,100,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$90.82 ,124.753,CMS physician fee schedule,,$62.81 ,$931.95 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99284 ED VISIT E&M PATIENT,8022451,CDM,981,RC,99284,HCPCS,outpatient,,,$981.00 ,$735.75 ,,$154.49 ,135,cms physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,135% of 2011 CMS physician fee schedule,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$119.14 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$144.74 ,100,,,$119.14 ,$931.95 ,fee schedule,,100% of the Blue Cross physician fee schedule,$189.28 ,100,physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$178.19 ,145,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,145% CMS Medicare physician fee schedule ,$931.95 ,95,,,$119.14 ,$931.95 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$119.14 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$170.32 ,100,,,$119.14 ,$931.95 ,fee schedule,,100% Humana physician fee schedule,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$119.14 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$196.66 ,100,,,$119.14 ,$931.95 ,fee schedule,,100% Midlands Choice physician fee schedule,$119.14 ,100,,,$119.14 ,$931.95 ,fee schedule,,100% Multiplan physician fee schedule,$119.14 ,100,,,$119.14 ,$931.95 ,fee schedule,,100% Multiplan physician fee schedule,$172.05 ,140,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$119.14 ,$931.95 ,other,,Not separately reimbursible. Not contracted for physician rates,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$931.95 ,95,,,$119.14 ,$931.95 ,percent of total billed charges,,95% of total billed charges,$122.89 ,100,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,100% CMS Medicare physician fee schedule ,$153.31 ,124.753,CMS physician fee schedule,,$119.14 ,$931.95 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
99291 ED PF - CRITICAL CARE Initial,8022454,CDM,981,RC,99291,HCPCS,outpatient,,,"$1,783.00 ","$1,337.25 ",,$292.69 ,135,cms physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$219.33 ,"$1,693.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$341.45 ,100,,,$219.33 ,"$1,693.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,$351.68 ,100,physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$318.03 ,145,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,693.85 ",95,,,$219.33 ,"$1,693.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$219.33 ,"$1,693.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$317.67 ,100,,,$219.33 ,"$1,693.85 ",fee schedule,,100% Humana physician fee schedule,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$219.33 ,"$1,693.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$371.73 ,100,,,$219.33 ,"$1,693.85 ",fee schedule,,100% Midlands Choice physician fee schedule,$225.54 ,100,,,$219.33 ,"$1,693.85 ",fee schedule,,100% Multiplan physician fee schedule,$225.54 ,100,,,$219.33 ,"$1,693.85 ",fee schedule,,100% Multiplan physician fee schedule,$307.06 ,140,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$219.33 ,"$1,693.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,693.85 ",95,,,$219.33 ,"$1,693.85 ",percent of total billed charges,,95% of total billed charges,$219.33 ,100,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$273.62 ,124.753,CMS physician fee schedule,,$219.33 ,"$1,693.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
99292 ED PF CRITICAL CARE ADDL',8022455,CDM,981,RC,99292,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$146.87 ,135,cms physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,135% of 2011 CMS physician fee schedule,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$110.17 ,$360.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$150.33 ,100,,,$110.17 ,$360.05 ,fee schedule,,100% of the Blue Cross physician fee schedule,$176.96 ,100,physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$159.75 ,145,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,145% CMS Medicare physician fee schedule ,$360.05 ,95,,,$110.17 ,$360.05 ,percent of total billed charges,,95% of total billed charges for physician setting,,,,,$110.17 ,$360.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$159.82 ,100,,,$110.17 ,$360.05 ,fee schedule,,100% Humana physician fee schedule,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$110.17 ,$360.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$186.26 ,100,,,$110.17 ,$360.05 ,fee schedule,,100% Midlands Choice physician fee schedule,$227.40 ,60,,,$110.17 ,$360.05 ,percent of total billed charges,,60% of total billed charges for physician settings,$227.40 ,60,,,$110.17 ,$360.05 ,percent of total billed charges,,60% of total billed charges for physician settings,$154.24 ,140,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$110.17 ,$360.05 ,other,,Not separately reimbursible. Not contracted for physician rates,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$360.05 ,95,,,$110.17 ,$360.05 ,percent of total billed charges,,95% of total billed charges,$110.17 ,100,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,100% CMS Medicare physician fee schedule ,$137.44 ,124.753,CMS physician fee schedule,,$110.17 ,$360.05 ,fee schedule,,124.753% CMS Medicare physician fee schedule 
Carpal Tunnel Surgery,9091718,CDM,975,RC,64721,HCPCS,outpatient,,,"$1,463.00 ","$1,097.25 ",,$560.12 ,135,cms physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,135% of 2011 CMS physician fee schedule,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$453.59 ,"$1,389.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$544.18 ,100,,,$453.59 ,"$1,389.85 ",fee schedule,,100% of the Blue Cross physician fee schedule,$865.90 ,100,physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$657.71 ,145,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,389.85 ",95,,,$453.59 ,"$1,389.85 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$453.59 ,"$1,389.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$631.13 ,100,,,$453.59 ,"$1,389.85 ",fee schedule,,100% Humana physician fee schedule,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$453.59 ,"$1,389.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$853.13 ,100,,,$453.59 ,"$1,389.85 ",fee schedule,,100% Midlands Choice physician fee schedule,$877.80 ,60,,,$453.59 ,"$1,389.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$877.80 ,60,,,$453.59 ,"$1,389.85 ",percent of total billed charges,,60% of total billed charges for physician settings,$635.03 ,140,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$453.59 ,"$1,389.85 ",other,,Not separately reimbursible. Not contracted for physician rates,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,389.85 ",95,,,$453.59 ,"$1,389.85 ",percent of total billed charges,,95% of total billed charges,$453.59 ,100,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,100% CMS Medicare physician fee schedule ,$565.87 ,124.753,CMS physician fee schedule,,$453.59 ,"$1,389.85 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
G0121 SCRN COLONOSCOPY ProFee,8022522,CDM,975,RC,G0121,HCPCS,outpatient,,,"$1,185.00 ",$888.75 ,,$289.85 ,135,cms physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,135% of 2011 CMS physician fee schedule,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$187.85 ,"$1,125.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$411.46 ,100,,,$187.85 ,"$1,125.75 ",fee schedule,,100% of the Blue Cross physician fee schedule,$375.20 ,100,physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$272.38 ,145,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,125.75 ",95,,,$187.85 ,"$1,125.75 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$187.85 ,"$1,125.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$271.60 ,100,,,$187.85 ,"$1,125.75 ",fee schedule,,100% Humana physician fee schedule,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$187.85 ,"$1,125.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$260.29 ,100,,,$187.85 ,"$1,125.75 ",fee schedule,,100% Midlands Choice physician fee schedule,$711.00 ,60,,,$187.85 ,"$1,125.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$711.00 ,60,,,$187.85 ,"$1,125.75 ",percent of total billed charges,,60% of total billed charges for physician settings,$262.99 ,140,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$187.85 ,"$1,125.75 ",other,,Not separately reimbursible. Not contracted for physician rates,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,125.75 ",95,,,$187.85 ,"$1,125.75 ",percent of total billed charges,,95% of total billed charges,$187.85 ,100,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,100% CMS Medicare physician fee schedule ,$234.35 ,124.753,CMS physician fee schedule,,$187.85 ,"$1,125.75 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
Revise Ulnar Nerve at Elbow,9091720,CDM,975,RC,64718,HCPCS,outpatient,,,"$2,032.00 ","$1,524.00 ",,$781.73 ,135,cms physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$623.79 ,"$1,930.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$742.18 ,100,,,$623.79 ,"$1,930.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,199.80 ",100,physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$904.50 ,145,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,930.40 ",95,,,$623.79 ,"$1,930.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$623.79 ,"$1,930.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$873.29 ,100,,,$623.79 ,"$1,930.40 ",fee schedule,,100% Humana physician fee schedule,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$623.79 ,"$1,930.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,181.42 ",100,,,$623.79 ,"$1,930.40 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,219.20 ",60,,,$623.79 ,"$1,930.40 ",percent of total billed charges,,60% of total billed charges for physician settings,"$1,219.20 ",60,,,$623.79 ,"$1,930.40 ",percent of total billed charges,,60% of total billed charges for physician settings,$873.31 ,140,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$623.79 ,"$1,930.40 ",other,,Not separately reimbursible. Not contracted for physician rates,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,930.40 ",95,,,$623.79 ,"$1,930.40 ",percent of total billed charges,,95% of total billed charges,$623.79 ,100,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,$778.20 ,124.753,CMS physician fee schedule,,$623.79 ,"$1,930.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
A9500 tc-99m SESTAMIBI PER STDY DOSE,7578597,CDM,343,RC,A9500,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BD Bone Density DEXA Axial Skeleton,1167839,CDM,320,RC,77080,HCPCS,outpatient,,,$561.00 ,$420.75 ,,$516.12 ,92,,,$308.55 ,$544.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$308.55 ,$544.17 ,other,,Not applicable. No negotiated rates per contract,$482.46 ,86,,,$308.55 ,$544.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$448.80 ,80,,,$308.55 ,$544.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.95 ,95,,,$308.55 ,$544.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.95 ,95,,,$308.55 ,$544.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.75 ,75,,,$308.55 ,$544.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$476.85 ,85,,,$308.55 ,$544.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.90 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$544.17 ,97,,,$308.55 ,$544.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$476.85 ,85,,,$308.55 ,$544.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.90 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.95 ,90,,,$308.55 ,$544.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.55 ,55,,,$308.55 ,$544.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$521.73 ,93,,,$308.55 ,$544.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen and Pelvis w/ + w/o Contrast,2424644,CDM,352,RC,74178,HCPCS,outpatient,,,"$4,248.00 ","$3,186.00 ",,"$3,908.16 ",92,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,336.40 ","$4,120.56 ",other,,Not applicable. No negotiated rates per contract,"$3,653.28 ",86,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,398.40 ",80,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,035.60 ",95,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,035.60 ",95,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,186.00 ",75,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,610.80 ",85,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,823.20 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,120.56 ",97,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,610.80 ",85,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,823.20 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,035.60 ",90,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,336.40 ",55,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,950.64 ",93,,,"$2,336.40 ","$4,120.56 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen and Pelvis w/ Contrast,2424647,CDM,352,RC,74177,HCPCS,outpatient,,,"$3,869.00 ","$2,901.75 ",,"$3,559.48 ",92,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,127.95 ",55,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,127.95 ","$3,752.93 ",other,,Not applicable. No negotiated rates per contract,"$3,327.34 ",86,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,095.20 ",80,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,127.95 ",55,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,675.55 ",95,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,675.55 ",95,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,901.75 ",75,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,288.65 ",85,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,752.93 ",97,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,127.95 ",55,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,482.10 ",90,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,752.93 ",97,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,752.93 ",97,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,752.93 ",97,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,288.65 ",85,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,482.10 ",90,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,127.95 ",55,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,675.55 ",90,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,127.95 ",55,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,598.17 ",93,,,"$2,127.95 ","$3,752.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen and Pelvis w/o Contrast,2424650,CDM,352,RC,74176,HCPCS,outpatient,,,"$3,792.00 ","$2,844.00 ",,"$3,488.64 ",92,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,085.60 ","$3,678.24 ",other,,Not applicable. No negotiated rates per contract,"$3,261.12 ",86,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,033.60 ",80,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,602.40 ",95,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,602.40 ",95,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,844.00 ",75,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,223.20 ",85,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,412.80 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,678.24 ",97,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,223.20 ",85,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,412.80 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,602.40 ",90,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,085.60 ",55,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,526.56 ",93,,,"$2,085.60 ","$3,678.24 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen w/ + w/o Contrast,1167845,CDM,352,RC,74170,HCPCS,outpatient,,,"$2,886.00 ","$2,164.50 ",,"$2,655.12 ",92,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,587.30 ",55,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,587.30 ","$2,799.42 ",other,,Not applicable. No negotiated rates per contract,"$2,481.96 ",86,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,308.80 ",80,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,587.30 ",55,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,741.70 ",95,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,741.70 ",95,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,164.50 ",75,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,453.10 ",85,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,799.42 ",97,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,587.30 ",55,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,597.40 ",90,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,799.42 ",97,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,799.42 ",97,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,799.42 ",97,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,453.10 ",85,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,597.40 ",90,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,587.30 ",55,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,741.70 ",90,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,587.30 ",55,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,683.98 ",93,,,"$1,587.30 ","$2,799.42 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen w/ Contrast,1167847,CDM,352,RC,74160,HCPCS,outpatient,,,"$2,888.00 ","$2,166.00 ",,"$2,656.96 ",92,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,588.40 ","$2,801.36 ",other,,Not applicable. No negotiated rates per contract,"$2,483.68 ",86,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,310.40 ",80,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,166.00 ",75,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,685.84 ",93,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Abdomen w/o Contrast,1167849,CDM,352,RC,74150,HCPCS,outpatient,,,"$2,807.00 ","$2,105.25 ",,"$2,582.44 ",92,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,543.85 ",55,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,543.85 ","$2,722.79 ",other,,Not applicable. No negotiated rates per contract,"$2,414.02 ",86,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,245.60 ",80,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,543.85 ",55,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,666.65 ",95,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,666.65 ",95,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,105.25 ",75,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,385.95 ",85,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,722.79 ",97,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,543.85 ",55,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,526.30 ",90,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,722.79 ",97,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,722.79 ",97,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,722.79 ",97,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,385.95 ",85,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,526.30 ",90,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,543.85 ",55,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,666.65 ",90,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,543.85 ",55,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,610.51 ",93,,,"$1,543.85 ","$2,722.79 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Abdomen,1167853,CDM,352,RC,74175,HCPCS,outpatient,,,"$2,888.00 ","$2,166.00 ",,"$2,656.96 ",92,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,588.40 ","$2,801.36 ",other,,Not applicable. No negotiated rates per contract,"$2,483.68 ",86,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,310.40 ",80,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,166.00 ",75,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,685.84 ",93,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Abdomen Aorta + Iliofemoral,1167851,CDM,352,RC,75635,HCPCS,outpatient,,,"$4,126.00 ","$3,094.50 ",,"$3,795.92 ",92,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,269.30 ","$4,002.22 ",other,,Not applicable. No negotiated rates per contract,"$3,548.36 ",86,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,300.80 ",80,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,094.50 ",75,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,837.18 ",93,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Abdomen and Pelvis,2424686,CDM,352,RC,74174,HCPCS,outpatient,,,"$4,126.00 ","$3,094.50 ",,"$3,795.92 ",92,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,269.30 ","$4,002.22 ",other,,Not applicable. No negotiated rates per contract,"$3,548.36 ",86,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,300.80 ",80,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,094.50 ",75,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,837.18 ",93,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Brain/ Head,8099792,CDM,352,RC,70496,HCPCS,outpatient,,,"$2,888.00 ","$2,166.00 ",,"$2,656.96 ",92,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,588.40 ","$2,801.36 ",other,,Not applicable. No negotiated rates per contract,"$2,483.68 ",86,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,310.40 ",80,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,166.00 ",75,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,685.84 ",93,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Brain/Head,1167871,CDM,351,RC,70496,HCPCS,outpatient,,,"$2,888.00 ","$2,166.00 ",,"$2,656.96 ",92,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,588.40 ","$2,801.36 ",other,,Not applicable. No negotiated rates per contract,"$2,483.68 ",86,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,310.40 ",80,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,166.00 ",75,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,685.84 ",93,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Chest,1167863,CDM,352,RC,71275,HCPCS,outpatient,,,"$3,299.00 ","$2,474.25 ",,"$3,035.08 ",92,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,814.45 ","$3,200.03 ",other,,Not applicable. No negotiated rates per contract,"$2,837.14 ",86,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,639.20 ",80,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,134.05 ",95,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,134.05 ",95,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,474.25 ",75,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,804.15 ",85,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,969.10 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,200.03 ",97,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,804.15 ",85,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,969.10 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,134.05 ",90,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,814.45 ",55,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,068.07 ",93,,,"$1,814.45 ","$3,200.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Chest/Abdomen/Pelvis,8393945,CDM,352,RC,74174,HCPCS,outpatient,,,"$4,126.00 ","$3,094.50 ",,"$3,795.92 ",92,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,269.30 ","$4,002.22 ",other,,Not applicable. No negotiated rates per contract,"$3,548.36 ",86,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,300.80 ",80,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,919.70 ",95,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,094.50 ",75,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,002.22 ",97,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,507.10 ",85,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,713.40 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.70 ",90,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.30 ",55,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,837.18 ",93,,,"$2,269.30 ","$4,002.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Lower Extremity Left,1167875,CDM,352,RC,73706,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Lower Extremity Right,1167877,CDM,352,RC,73706,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Neck,1167879,CDM,351,RC,70498,HCPCS,outpatient,,,"$2,888.00 ","$2,166.00 ",,"$2,656.96 ",92,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,588.40 ","$2,801.36 ",other,,Not applicable. No negotiated rates per contract,"$2,483.68 ",86,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,310.40 ",80,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,743.60 ",95,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,166.00 ",75,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,801.36 ",97,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,454.80 ",85,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,599.20 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,743.60 ",90,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,588.40 ",55,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,685.84 ",93,,,"$1,588.40 ","$2,801.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Pelvis,1167881,CDM,352,RC,72191,HCPCS,outpatient,,,"$2,464.00 ","$1,848.00 ",,"$2,266.88 ",92,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,355.20 ",55,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,355.20 ","$2,390.08 ",other,,Not applicable. No negotiated rates per contract,"$2,119.04 ",86,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,971.20 ",80,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,355.20 ",55,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,340.80 ",95,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,340.80 ",95,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,848.00 ",75,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,094.40 ",85,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,390.08 ",97,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,355.20 ",55,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,217.60 ",90,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,390.08 ",97,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,390.08 ",97,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,390.08 ",97,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,094.40 ",85,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,217.60 ",90,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,355.20 ",55,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,340.80 ",90,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,355.20 ",55,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,291.52 ",93,,,"$1,355.20 ","$2,390.08 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Upper Extremity Left,1167885,CDM,352,RC,73206,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Angio Upper Extremity Right,1167887,CDM,352,RC,73206,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Brain/Head w/ + w/o Contrast,1168090,CDM,351,RC,70470,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Brain/Head w/ Contrast,1168092,CDM,351,RC,70460,HCPCS,outpatient,,,"$2,063.00 ","$1,547.25 ",,"$1,897.96 ",92,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,134.65 ","$2,001.11 ",other,,Not applicable. No negotiated rates per contract,"$1,774.18 ",86,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,650.40 ",80,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,959.85 ",95,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,959.85 ",95,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,547.25 ",75,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,753.55 ",85,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,856.70 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,753.55 ",85,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,856.70 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,959.85 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,918.59 ",93,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Brain/Head w/o Contrast,1168094,CDM,351,RC,70450,HCPCS,outpatient,,,"$1,930.00 ","$1,447.50 ",,"$1,775.60 ",92,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,061.50 ","$1,872.10 ",other,,Not applicable. No negotiated rates per contract,"$1,659.80 ",86,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,544.00 ",80,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,447.50 ",75,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,794.90 ",93,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest w/ + w/o Contrast,1168283,CDM,352,RC,71270,HCPCS,outpatient,,,"$2,641.00 ","$1,980.75 ",,"$2,429.72 ",92,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,452.55 ","$2,561.77 ",other,,Not applicable. No negotiated rates per contract,"$2,271.26 ",86,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,112.80 ",80,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,980.75 ",75,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,456.13 ",93,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest w/ Contrast,1168285,CDM,352,RC,71260,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest w/o Contrast,1168287,CDM,352,RC,71250,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest/Abd/Pelvis w/ + w/o Contrast,8099516,CDM,352,RC,71270,HCPCS,outpatient,,,"$2,641.00 ","$1,980.75 ",,"$2,429.72 ",92,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,452.55 ","$2,561.77 ",other,,Not applicable. No negotiated rates per contract,"$2,271.26 ",86,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,112.80 ",80,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,980.75 ",75,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,456.13 ",93,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest/Abd/Pelvis w/ Contrast,8099519,CDM,352,RC,71260,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Chest/Abd/Pelvis w/o Contrast,8099522,CDM,352,RC,71250,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Facet Injection Cerv/Thor Lv1,8743809,CDM,320,RC,64490,HCPCS,outpatient,,,$663.00 ,$497.25 ,,$609.96 ,92,,,$364.65 ,$643.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$364.65 ,55,,,$364.65 ,$643.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$364.65 ,$643.11 ,other,,Not applicable. No negotiated rates per contract,$570.18 ,86,,,$364.65 ,$643.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$530.40 ,80,,,$364.65 ,$643.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$364.65 ,55,,,$364.65 ,$643.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.85 ,95,,,$364.65 ,$643.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$629.85 ,95,,,$364.65 ,$643.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$497.25 ,75,,,$364.65 ,$643.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$563.55 ,85,,,$364.65 ,$643.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$643.11 ,97,,,$364.65 ,$643.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.65 ,55,,,$364.65 ,$643.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$596.70 ,90,,,$364.65 ,$643.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$643.11 ,97,,,$364.65 ,$643.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$643.11 ,97,,,$364.65 ,$643.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$643.11 ,97,,,$364.65 ,$643.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$563.55 ,85,,,$364.65 ,$643.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$596.70 ,90,,,$364.65 ,$643.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$364.65 ,55,,,$364.65 ,$643.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.85 ,90,,,$364.65 ,$643.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$364.65 ,55,,,$364.65 ,$643.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$616.59 ,93,,,$364.65 ,$643.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CT Facet Injection Lumb/Sacr Lv1,8743812,CDM,320,RC,64493,HCPCS,outpatient,,,$610.00 ,$457.50 ,,$561.20 ,92,,,$335.50 ,$591.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$335.50 ,55,,,$335.50 ,$591.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$335.50 ,$591.70 ,other,,Not applicable. No negotiated rates per contract,$524.60 ,86,,,$335.50 ,$591.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$488.00 ,80,,,$335.50 ,$591.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$335.50 ,55,,,$335.50 ,$591.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$579.50 ,95,,,$335.50 ,$591.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$579.50 ,95,,,$335.50 ,$591.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$457.50 ,75,,,$335.50 ,$591.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$518.50 ,85,,,$335.50 ,$591.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$591.70 ,97,,,$335.50 ,$591.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.50 ,55,,,$335.50 ,$591.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$549.00 ,90,,,$335.50 ,$591.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$591.70 ,97,,,$335.50 ,$591.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$591.70 ,97,,,$335.50 ,$591.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$591.70 ,97,,,$335.50 ,$591.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.50 ,85,,,$335.50 ,$591.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$549.00 ,90,,,$335.50 ,$591.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$335.50 ,55,,,$335.50 ,$591.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$579.50 ,90,,,$335.50 ,$591.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$335.50 ,55,,,$335.50 ,$591.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.30 ,93,,,$335.50 ,$591.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CT Guided Needle Placement,8211234,CDM,352,RC,77012,HCPCS,outpatient,,,"$1,622.00 ","$1,216.50 ",,"$1,492.24 ",92,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$892.10 ,55,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$892.10 ,"$1,573.34 ",other,,Not applicable. No negotiated rates per contract,"$1,394.92 ",86,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,297.60 ",80,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$892.10 ,55,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,540.90 ",95,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,540.90 ",95,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,216.50 ",75,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,378.70 ",85,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,573.34 ",97,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$892.10 ,55,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,459.80 ",90,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,573.34 ",97,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,573.34 ",97,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,573.34 ",97,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,378.70 ",85,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,459.80 ",90,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$892.10 ,55,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,540.90 ",90,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$892.10 ,55,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,508.46 ",93,,,$892.10 ,"$1,573.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT IAC w/ + w/o Contrast,8125416,CDM,351,RC,70482,HCPCS,outpatient,,,"$2,641.00 ","$1,980.75 ",,"$2,429.72 ",92,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,452.55 ","$2,561.77 ",other,,Not applicable. No negotiated rates per contract,"$2,271.26 ",86,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,112.80 ",80,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,508.95 ",95,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,980.75 ",75,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,561.77 ",97,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,244.85 ",85,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,376.90 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,508.95 ",90,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,452.55 ",55,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,456.13 ",93,,,"$1,452.55 ","$2,561.77 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT IAC w/ Contrast,8125417,CDM,351,RC,70481,HCPCS,outpatient,,,"$2,011.00 ","$1,508.25 ",,"$1,850.12 ",92,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,106.05 ",55,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,106.05 ","$1,950.67 ",other,,Not applicable. No negotiated rates per contract,"$1,729.46 ",86,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,608.80 ",80,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,106.05 ",55,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,910.45 ",95,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,910.45 ",95,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,508.25 ",75,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,709.35 ",85,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,950.67 ",97,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,106.05 ",55,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,809.90 ",90,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,950.67 ",97,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,950.67 ",97,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,950.67 ",97,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,709.35 ",85,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,809.90 ",90,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,106.05 ",55,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,910.45 ",90,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,106.05 ",55,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,870.23 ",93,,,"$1,106.05 ","$1,950.67 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT IAC w/o Contrast,8125418,CDM,351,RC,70480,HCPCS,outpatient,,,"$1,930.00 ","$1,447.50 ",,"$1,775.60 ",92,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,061.50 ","$1,872.10 ",other,,Not applicable. No negotiated rates per contract,"$1,659.80 ",86,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,544.00 ",80,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,447.50 ",75,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,794.90 ",93,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/ Contrast Left,1168166,CDM,352,RC,73701,HCPCS,outpatient,,,"$2,226.00 ","$1,669.50 ",,"$2,047.92 ",92,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,224.30 ","$2,159.22 ",other,,Not applicable. No negotiated rates per contract,"$1,914.36 ",86,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,780.80 ",80,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.70 ",95,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,114.70 ",95,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,669.50 ",75,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,892.10 ",85,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.40 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,892.10 ",85,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,003.40 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.70 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,070.18 ",93,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/ Contrast Right,1168168,CDM,352,RC,73701,HCPCS,outpatient,,,"$2,226.00 ","$1,669.50 ",,"$2,047.92 ",92,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,224.30 ","$2,159.22 ",other,,Not applicable. No negotiated rates per contract,"$1,914.36 ",86,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,780.80 ",80,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.70 ",95,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,114.70 ",95,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,669.50 ",75,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,892.10 ",85,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.40 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,159.22 ",97,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,892.10 ",85,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,003.40 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.70 ",90,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,224.30 ",55,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,070.18 ",93,,,"$1,224.30 ","$2,159.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/+w/o Contrast Left,1168172,CDM,352,RC,73702,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/+w/o Contrast Right,1168174,CDM,352,RC,73702,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/o Contrast Left,1168178,CDM,352,RC,73700,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lower Extremity w/o Contrast Right,1168180,CDM,352,RC,73700,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Lung Cancer Screening,2424812,CDM,352,RC,71271,HCPCS,outpatient,,,"$1,114.00 ",$835.50 ,,"$1,024.88 ",92,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$612.70 ,55,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$612.70 ,"$1,080.58 ",other,,Not applicable. No negotiated rates per contract,$958.04 ,86,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$891.20 ,80,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$612.70 ,55,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,058.30 ",95,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,058.30 ",95,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$835.50 ,75,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$946.90 ,85,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,080.58 ",97,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$612.70 ,55,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,002.60 ",90,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,080.58 ",97,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,080.58 ",97,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,080.58 ",97,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$946.90 ,85,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,002.60 ",90,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$612.70 ,55,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,058.30 ",90,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$612.70 ,55,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,036.02 ",93,,,$612.70 ,"$1,080.58 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Maxillofacial w/ + w/o Contrast,1168182,CDM,351,RC,70488,HCPCS,outpatient,,,"$2,176.00 ","$1,632.00 ",,"$2,001.92 ",92,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,196.80 ","$2,110.72 ",other,,Not applicable. No negotiated rates per contract,"$1,871.36 ",86,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,740.80 ",80,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,067.20 ",95,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,067.20 ",95,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,632.00 ",75,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,849.60 ",85,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,958.40 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,849.60 ",85,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,958.40 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,067.20 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,023.68 ",93,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Maxillofacial w/ Contrast,1168184,CDM,351,RC,70487,HCPCS,outpatient,,,"$2,144.00 ","$1,608.00 ",,"$1,972.48 ",92,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,179.20 ",55,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,179.20 ","$2,079.68 ",other,,Not applicable. No negotiated rates per contract,"$1,843.84 ",86,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,715.20 ",80,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,179.20 ",55,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,036.80 ",95,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,036.80 ",95,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,608.00 ",75,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,822.40 ",85,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,079.68 ",97,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,179.20 ",55,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,929.60 ",90,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,079.68 ",97,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,079.68 ",97,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,079.68 ",97,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,822.40 ",85,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,929.60 ",90,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,179.20 ",55,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,036.80 ",90,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,179.20 ",55,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,993.92 ",93,,,"$1,179.20 ","$2,079.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Maxillofacial w/o Contrast,1168186,CDM,351,RC,70486,HCPCS,outpatient,,,"$1,930.00 ","$1,447.50 ",,"$1,775.60 ",92,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,061.50 ","$1,872.10 ",other,,Not applicable. No negotiated rates per contract,"$1,659.80 ",86,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,544.00 ",80,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.50 ",95,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,447.50 ",75,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,872.10 ",97,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,640.50 ",85,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,737.00 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,833.50 ",90,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.50 ",55,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,794.90 ",93,,,"$1,061.50 ","$1,872.10 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Myelogram Injection,2424818,CDM,320,RC,62284,HCPCS,outpatient,,,$279.00 ,$209.25 ,,$256.68 ,92,,,$153.45 ,$270.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.45 ,$270.63 ,other,,Not applicable. No negotiated rates per contract,$239.94 ,86,,,$153.45 ,$270.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.20 ,80,,,$153.45 ,$270.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,95,,,$153.45 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$265.05 ,95,,,$153.45 ,$270.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.25 ,75,,,$153.45 ,$270.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$237.15 ,85,,,$153.45 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.10 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.63 ,97,,,$153.45 ,$270.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.15 ,85,,,$153.45 ,$270.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.10 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,90,,,$153.45 ,$270.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.45 ,55,,,$153.45 ,$270.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.47 ,93,,,$153.45 ,$270.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CT Neck Soft Tissue w/ + w/o Contrast,1168230,CDM,351,RC,70492,HCPCS,outpatient,,,"$2,475.00 ","$1,856.25 ",,"$2,277.00 ",92,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,361.25 ","$2,400.75 ",other,,Not applicable. No negotiated rates per contract,"$2,128.50 ",86,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,980.00 ",80,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,351.25 ",95,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,856.25 ",75,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,400.75 ",97,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.75 ",85,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,227.50 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,351.25 ",90,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,361.25 ",55,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,301.75 ",93,,,"$1,361.25 ","$2,400.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Neck Soft Tissue w/ Contrast,1168232,CDM,351,RC,70491,HCPCS,outpatient,,,"$2,063.00 ","$1,547.25 ",,"$1,897.96 ",92,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,134.65 ","$2,001.11 ",other,,Not applicable. No negotiated rates per contract,"$1,774.18 ",86,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,650.40 ",80,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,959.85 ",95,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,959.85 ",95,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,547.25 ",75,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,753.55 ",85,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,856.70 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,001.11 ",97,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,753.55 ",85,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,856.70 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,959.85 ",90,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.65 ",55,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,918.59 ",93,,,"$1,134.65 ","$2,001.11 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Neck Soft Tissue w/o Contrast,1168234,CDM,351,RC,70490,HCPCS,outpatient,,,"$1,755.00 ","$1,316.25 ",,"$1,614.60 ",92,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$965.25 ,55,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$965.25 ,"$1,702.35 ",other,,Not applicable. No negotiated rates per contract,"$1,509.30 ",86,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,404.00 ",80,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$965.25 ,55,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,667.25 ",95,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,667.25 ",95,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,316.25 ",75,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,491.75 ",85,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,702.35 ",97,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$965.25 ,55,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,579.50 ",90,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,702.35 ",97,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,702.35 ",97,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,702.35 ",97,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,491.75 ",85,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,579.50 ",90,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$965.25 ,55,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,667.25 ",90,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$965.25 ,55,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,632.15 ",93,,,$965.25 ,"$1,702.35 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Pelvis w/ + w/o Contrast,1168194,CDM,352,RC,72194,HCPCS,outpatient,,,"$2,667.00 ","$2,000.25 ",,"$2,453.64 ",92,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,466.85 ",55,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,466.85 ","$2,586.99 ",other,,Not applicable. No negotiated rates per contract,"$2,293.62 ",86,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,133.60 ",80,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,466.85 ",55,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,533.65 ",95,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,533.65 ",95,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,000.25 ",75,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,266.95 ",85,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,586.99 ",97,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,466.85 ",55,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,400.30 ",90,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,586.99 ",97,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,586.99 ",97,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,586.99 ",97,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,266.95 ",85,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,400.30 ",90,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,466.85 ",55,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,533.65 ",90,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,466.85 ",55,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,480.31 ",93,,,"$1,466.85 ","$2,586.99 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Pelvis w/ Contrast,1168196,CDM,352,RC,72193,HCPCS,outpatient,,,"$2,343.00 ","$1,757.25 ",,"$2,155.56 ",92,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,288.65 ",55,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,288.65 ","$2,272.71 ",other,,Not applicable. No negotiated rates per contract,"$2,014.98 ",86,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,874.40 ",80,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,288.65 ",55,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,225.85 ",95,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,225.85 ",95,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,757.25 ",75,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,991.55 ",85,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,272.71 ",97,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,288.65 ",55,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,108.70 ",90,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,272.71 ",97,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,272.71 ",97,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,272.71 ",97,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,991.55 ",85,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,108.70 ",90,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,288.65 ",55,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,225.85 ",90,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,288.65 ",55,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,178.99 ",93,,,"$1,288.65 ","$2,272.71 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Pelvis w/o Contrast,1168198,CDM,352,RC,72192,HCPCS,outpatient,,,"$2,457.00 ","$1,842.75 ",,"$2,260.44 ",92,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,351.35 ",55,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,351.35 ","$2,383.29 ",other,,Not applicable. No negotiated rates per contract,"$2,113.02 ",86,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,965.60 ",80,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,351.35 ",55,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,334.15 ",95,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,334.15 ",95,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,842.75 ",75,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,088.45 ",85,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,383.29 ",97,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,351.35 ",55,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,211.30 ",90,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,383.29 ",97,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,383.29 ",97,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,383.29 ",97,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,088.45 ",85,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,211.30 ",90,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,351.35 ",55,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,334.15 ",90,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,351.35 ",55,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,285.01 ",93,,,"$1,351.35 ","$2,383.29 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Sacroiliac Joint Injection,8211268,CDM,352,RC,27096,HCPCS,outpatient,,,"$2,422.00 ","$1,816.50 ",,"$2,228.24 ",92,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,332.10 ",55,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,332.10 ","$2,349.34 ",other,,Not applicable. No negotiated rates per contract,"$2,082.92 ",86,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,937.60 ",80,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,332.10 ",55,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,300.90 ",95,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,300.90 ",95,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,816.50 ",75,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,058.70 ",85,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,349.34 ",97,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,332.10 ",55,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,179.80 ",90,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,349.34 ",97,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,349.34 ",97,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,349.34 ",97,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,058.70 ",85,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,179.80 ",90,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,332.10 ",55,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,300.90 ",90,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,332.10 ",55,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,252.46 ",93,,,"$1,332.10 ","$2,349.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Cervical w/ + w/o Contrast,1168236,CDM,352,RC,72127,HCPCS,outpatient,,,"$2,169.00 ","$1,626.75 ",,"$1,995.48 ",92,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,192.95 ",55,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,192.95 ","$2,103.93 ",other,,Not applicable. No negotiated rates per contract,"$1,865.34 ",86,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,735.20 ",80,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,192.95 ",55,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,060.55 ",95,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,060.55 ",95,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,626.75 ",75,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,843.65 ",85,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,103.93 ",97,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,192.95 ",55,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,952.10 ",90,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,103.93 ",97,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.93 ",97,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,103.93 ",97,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,843.65 ",85,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,952.10 ",90,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,192.95 ",55,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,060.55 ",90,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,192.95 ",55,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,017.17 ",93,,,"$1,192.95 ","$2,103.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Cervical w/ Contrast,1168238,CDM,352,RC,72126,HCPCS,outpatient,,,"$2,137.00 ","$1,602.75 ",,"$1,966.04 ",92,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,175.35 ",55,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,175.35 ","$2,072.89 ",other,,Not applicable. No negotiated rates per contract,"$1,837.82 ",86,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,709.60 ",80,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,175.35 ",55,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,030.15 ",95,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,030.15 ",95,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,602.75 ",75,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,816.45 ",85,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,072.89 ",97,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,175.35 ",55,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,923.30 ",90,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,072.89 ",97,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,072.89 ",97,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,072.89 ",97,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,816.45 ",85,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,923.30 ",90,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,175.35 ",55,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,030.15 ",90,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,175.35 ",55,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,987.41 ",93,,,"$1,175.35 ","$2,072.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Cervical w/o Contrast,1168240,CDM,352,RC,72125,HCPCS,outpatient,,,"$2,176.00 ","$1,632.00 ",,"$2,001.92 ",92,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,196.80 ","$2,110.72 ",other,,Not applicable. No negotiated rates per contract,"$1,871.36 ",86,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,740.80 ",80,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,067.20 ",95,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,067.20 ",95,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,632.00 ",75,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,849.60 ",85,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,958.40 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,110.72 ",97,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,849.60 ",85,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,958.40 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,067.20 ",90,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,196.80 ",55,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,023.68 ",93,,,"$1,196.80 ","$2,110.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Lumbar w/ + w/o Contrast,1168242,CDM,352,RC,72133,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Lumbar w/ Contrast,1168244,CDM,352,RC,72132,HCPCS,outpatient,,,"$2,574.00 ","$1,930.50 ",,"$2,368.08 ",92,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,415.70 ",55,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,415.70 ","$2,496.78 ",other,,Not applicable. No negotiated rates per contract,"$2,213.64 ",86,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,059.20 ",80,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,415.70 ",55,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,445.30 ",95,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,445.30 ",95,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,930.50 ",75,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,187.90 ",85,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,496.78 ",97,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,415.70 ",55,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,316.60 ",90,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,496.78 ",97,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,496.78 ",97,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,496.78 ",97,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,187.90 ",85,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,316.60 ",90,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,415.70 ",55,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,445.30 ",90,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,415.70 ",55,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,393.82 ",93,,,"$1,415.70 ","$2,496.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Lumbar w/o Contrast,1168246,CDM,352,RC,72131,HCPCS,outpatient,,,"$2,405.00 ","$1,803.75 ",,"$2,212.60 ",92,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,322.75 ",55,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,322.75 ","$2,332.85 ",other,,Not applicable. No negotiated rates per contract,"$2,068.30 ",86,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,924.00 ",80,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,322.75 ",55,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,284.75 ",95,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,284.75 ",95,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,803.75 ",75,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,044.25 ",85,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,332.85 ",97,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,322.75 ",55,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,164.50 ",90,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,332.85 ",97,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,332.85 ",97,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,332.85 ",97,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,044.25 ",85,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,164.50 ",90,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,322.75 ",55,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,284.75 ",90,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,322.75 ",55,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,236.65 ",93,,,"$1,322.75 ","$2,332.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Thoracic w/ + w/o Contrast,1168248,CDM,352,RC,72130,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Thoracic w/ Contrast,1168250,CDM,352,RC,72129,HCPCS,outpatient,,,"$2,088.00 ","$1,566.00 ",,"$1,920.96 ",92,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,148.40 ",55,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,148.40 ","$2,025.36 ",other,,Not applicable. No negotiated rates per contract,"$1,795.68 ",86,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,670.40 ",80,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,148.40 ",55,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,983.60 ",95,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,983.60 ",95,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,566.00 ",75,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,774.80 ",85,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,025.36 ",97,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,148.40 ",55,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,879.20 ",90,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,025.36 ",97,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,025.36 ",97,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,025.36 ",97,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,774.80 ",85,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,879.20 ",90,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,148.40 ",55,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,983.60 ",90,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,148.40 ",55,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,941.84 ",93,,,"$1,148.40 ","$2,025.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Spine Thoracic w/o Contrast,1168252,CDM,352,RC,72128,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/ Contrast Left,1168311,CDM,352,RC,73201,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/ Contrast Right,1168313,CDM,352,RC,73201,HCPCS,outpatient,,,"$2,109.00 ","$1,581.75 ",,"$1,940.28 ",92,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,159.95 ","$2,045.73 ",other,,Not applicable. No negotiated rates per contract,"$1,813.74 ",86,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,687.20 ",80,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,003.55 ",95,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,581.75 ",75,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,045.73 ",97,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,792.65 ",85,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,898.10 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,003.55 ",90,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,159.95 ",55,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,961.37 ",93,,,"$1,159.95 ","$2,045.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/+w/o Contrast Left,1168317,CDM,352,RC,73202,HCPCS,outpatient,,,"$2,444.00 ","$1,833.00 ",,"$2,248.48 ",92,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,344.20 ","$2,370.68 ",other,,Not applicable. No negotiated rates per contract,"$2,101.84 ",86,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,955.20 ",80,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.80 ",95,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,321.80 ",95,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.00 ",75,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,077.40 ",85,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,199.60 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,077.40 ",85,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,199.60 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.80 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,272.92 ",93,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/+w/o Contrast Right,1168319,CDM,352,RC,73202,HCPCS,outpatient,,,"$2,444.00 ","$1,833.00 ",,"$2,248.48 ",92,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,344.20 ","$2,370.68 ",other,,Not applicable. No negotiated rates per contract,"$2,101.84 ",86,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,955.20 ",80,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.80 ",95,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,321.80 ",95,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,833.00 ",75,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,077.40 ",85,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,199.60 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.68 ",97,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,077.40 ",85,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,199.60 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.80 ",90,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.20 ",55,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,272.92 ",93,,,"$1,344.20 ","$2,370.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/o Contrast Left,1168323,CDM,352,RC,73200,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CT Upper Extremity w/o Contrast Right,1168325,CDM,352,RC,73200,HCPCS,outpatient,,,"$2,105.00 ","$1,578.75 ",,"$1,936.60 ",92,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,157.75 ","$2,041.85 ",other,,Not applicable. No negotiated rates per contract,"$1,810.30 ",86,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,684.00 ",80,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,999.75 ",95,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.75 ",75,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,041.85 ",97,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,789.25 ",85,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,894.50 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,999.75 ",90,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,157.75 ",55,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,957.65 ",93,,,"$1,157.75 ","$2,041.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MG Breast Tomo 3D Digital Diag Bilateral,2425793,CDM,401,RC,77062,HCPCS,outpatient,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Breast Tomo 3D Digital Diag Left,2425796,CDM,401,RC,77061,HCPCS,outpatient,,,$298.00 ,$223.50 ,,$274.16 ,92,,,$163.90 ,$289.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.90 ,$289.06 ,other,,Not applicable. No negotiated rates per contract,$256.28 ,86,,,$163.90 ,$289.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$238.40 ,80,,,$163.90 ,$289.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$223.50 ,75,,,$163.90 ,$289.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.14 ,93,,,$163.90 ,$289.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Breast Tomo 3D Digital Diag Right,2425799,CDM,401,RC,77061,HCPCS,outpatient,,,$298.00 ,$223.50 ,,$274.16 ,92,,,$163.90 ,$289.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.90 ,$289.06 ,other,,Not applicable. No negotiated rates per contract,$256.28 ,86,,,$163.90 ,$289.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$238.40 ,80,,,$163.90 ,$289.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$223.50 ,75,,,$163.90 ,$289.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.14 ,93,,,$163.90 ,$289.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Bilateral w/ Tomo.,8033179,CDM,403,RC,77066,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$242.88 ,92,,,$145.20 ,$256.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$145.20 ,$256.08 ,other,,Not applicable. No negotiated rates per contract,$227.04 ,86,,,$145.20 ,$256.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$211.20 ,80,,,$145.20 ,$256.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.00 ,75,,,$145.20 ,$256.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.52 ,93,,,$145.20 ,$256.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Bilateral,8127650,CDM,401,RC,77066,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$149.05 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.05 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$233.06 ,86,,,$149.05 ,$262.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.80 ,80,,,$149.05 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$149.05 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$149.05 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Bilateral w/ Tomo,8420275,CDM,401,RC,77062,HCPCS,outpatient,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Left,8127656,CDM,401,RC,77065,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Left w/ Tomo,8420278,CDM,401,RC,77061,HCPCS,outpatient,,,$213.00 ,$159.75 ,,$195.96 ,92,,,$117.15 ,$206.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.15 ,$206.61 ,other,,Not applicable. No negotiated rates per contract,$183.18 ,86,,,$117.15 ,$206.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$170.40 ,80,,,$117.15 ,$206.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.75 ,75,,,$117.15 ,$206.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.09 ,93,,,$117.15 ,$206.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Right,8127662,CDM,401,RC,77065,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Diagnostic Right w/ Tomo,8420281,CDM,401,RC,77061,HCPCS,outpatient,,,$213.00 ,$159.75 ,,$195.96 ,92,,,$117.15 ,$206.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.15 ,$206.61 ,other,,Not applicable. No negotiated rates per contract,$183.18 ,86,,,$117.15 ,$206.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$170.40 ,80,,,$117.15 ,$206.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.35 ,95,,,$117.15 ,$206.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.75 ,75,,,$117.15 ,$206.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.61 ,97,,,$117.15 ,$206.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.05 ,85,,,$117.15 ,$206.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$191.70 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.35 ,90,,,$117.15 ,$206.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.15 ,55,,,$117.15 ,$206.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.09 ,93,,,$117.15 ,$206.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Digital Screening Bilateral,969805,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Digital Screening Left,2425802,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Digital Screening Right,2425805,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Implant Diag Left w/ Tomo,8818497,CDM,401,RC,77061,HCPCS,outpatient,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Implant Diag Right w/ Tomo,8818500,CDM,401,RC,77061,HCPCS,outpatient,,,$414.00 ,$310.50 ,,$380.88 ,92,,,$227.70 ,$401.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.70 ,$401.58 ,other,,Not applicable. No negotiated rates per contract,$356.04 ,86,,,$227.70 ,$401.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.20 ,80,,,$227.70 ,$401.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.30 ,95,,,$227.70 ,$401.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.50 ,75,,,$227.70 ,$401.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.58 ,97,,,$227.70 ,$401.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.90 ,85,,,$227.70 ,$401.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.60 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$227.70 ,$401.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.70 ,55,,,$227.70 ,$401.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.02 ,93,,,$227.70 ,$401.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Screening Bilateral w/ Tomo,8352756,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Screening Left w/ Tomo,8352759,CDM,403,RC,77067,HCPCS,outpatient,,,$193.00 ,$144.75 ,,$177.56 ,92,,,$106.15 ,$187.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.15 ,55,,,$106.15 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$106.15 ,$187.21 ,other,,Not applicable. No negotiated rates per contract,$165.98 ,86,,,$106.15 ,$187.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.40 ,80,,,$106.15 ,$187.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.15 ,55,,,$106.15 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,95,,,$106.15 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.35 ,95,,,$106.15 ,$187.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.75 ,75,,,$106.15 ,$187.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.05 ,85,,,$106.15 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.21 ,97,,,$106.15 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.15 ,55,,,$106.15 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.70 ,90,,,$106.15 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.21 ,97,,,$106.15 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$106.15 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.21 ,97,,,$106.15 ,$187.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.05 ,85,,,$106.15 ,$187.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.70 ,90,,,$106.15 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$106.15 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.35 ,90,,,$106.15 ,$187.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.15 ,55,,,$106.15 ,$187.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.49 ,93,,,$106.15 ,$187.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MG Mammo Screening Right w/ Tomo,8352762,CDM,403,RC,77067,HCPCS,outpatient,,,$226.00 ,$169.50 ,,$207.92 ,92,,,$124.30 ,$219.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.30 ,$219.22 ,other,,Not applicable. No negotiated rates per contract,$194.36 ,86,,,$124.30 ,$219.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.80 ,80,,,$124.30 ,$219.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.70 ,95,,,$124.30 ,$219.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.50 ,75,,,$124.30 ,$219.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.22 ,97,,,$124.30 ,$219.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.10 ,85,,,$124.30 ,$219.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.40 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.70 ,90,,,$124.30 ,$219.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.30 ,55,,,$124.30 ,$219.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.18 ,93,,,$124.30 ,$219.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MRA + MRI Brain w/ + w/o Contrast,9581983,CDM,615,RC,70553,HCPCS,outpatient,,,"$6,668.00 ","$5,001.00 ",,"$6,134.56 ",92,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,667.40 ","$6,467.96 ",other,,Not applicable. No negotiated rates per contract,"$5,734.48 ",86,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,334.40 ",80,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,334.60 ",95,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,334.60 ",95,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,001.00 ",75,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,667.80 ",85,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,001.20 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,667.80 ",85,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,001.20 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,334.60 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,201.24 ",93,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Abdomen w/ + w/o Contrast,1168635,CDM,618,RC,74185,HCPCS,outpatient,,,"$3,595.00 ","$2,696.25 ",,"$3,307.40 ",92,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,977.25 ",55,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,977.25 ","$3,487.15 ",other,,Not applicable. No negotiated rates per contract,"$3,091.70 ",86,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,876.00 ",80,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,977.25 ",55,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,415.25 ",95,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,415.25 ",95,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,696.25 ",75,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,055.75 ",85,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,487.15 ",97,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,977.25 ",55,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,235.50 ",90,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,487.15 ",97,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,487.15 ",97,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,487.15 ",97,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,055.75 ",85,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,235.50 ",90,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,977.25 ",55,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,415.25 ",90,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,977.25 ",55,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,343.35 ",93,,,"$1,977.25 ","$3,487.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Brain/Head w/ + w/o Contrast,1168649,CDM,615,RC,70546,HCPCS,outpatient,,,"$2,991.00 ","$2,243.25 ",,"$2,751.72 ",92,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,645.05 ",55,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,645.05 ","$2,901.27 ",other,,Not applicable. No negotiated rates per contract,"$2,572.26 ",86,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,392.80 ",80,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,645.05 ",55,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,841.45 ",95,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,841.45 ",95,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,243.25 ",75,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,542.35 ",85,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,901.27 ",97,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,645.05 ",55,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,691.90 ",90,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,901.27 ",97,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,901.27 ",97,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,901.27 ",97,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,542.35 ",85,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,691.90 ",90,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,645.05 ",55,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,841.45 ",90,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,645.05 ",55,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,781.63 ",93,,,"$1,645.05 ","$2,901.27 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Brain/Head w/ Contrast,1168651,CDM,615,RC,70545,HCPCS,outpatient,,,"$3,142.00 ","$2,356.50 ",,"$2,890.64 ",92,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,728.10 ","$3,047.74 ",other,,Not applicable. No negotiated rates per contract,"$2,702.12 ",86,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,513.60 ",80,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,356.50 ",75,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,922.06 ",93,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Brain/Head w/o Contrast,1168653,CDM,615,RC,70544,HCPCS,outpatient,,,"$2,874.00 ","$2,155.50 ",,"$2,644.08 ",92,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,580.70 ",55,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,580.70 ","$2,787.78 ",other,,Not applicable. No negotiated rates per contract,"$2,471.64 ",86,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,299.20 ",80,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,580.70 ",55,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,730.30 ",95,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,730.30 ",95,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,155.50 ",75,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,442.90 ",85,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,787.78 ",97,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,580.70 ",55,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,586.60 ",90,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.78 ",97,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,787.78 ",97,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,787.78 ",97,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,442.90 ",85,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,586.60 ",90,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,580.70 ",55,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,730.30 ",90,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,580.70 ",55,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,672.82 ",93,,,"$1,580.70 ","$2,787.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Neck w/ + w/o Contrast,1168679,CDM,615,RC,70549,HCPCS,outpatient,,,"$2,497.00 ","$1,872.75 ",,"$2,297.24 ",92,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,373.35 ",55,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,373.35 ","$2,422.09 ",other,,Not applicable. No negotiated rates per contract,"$2,147.42 ",86,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,997.60 ",80,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,373.35 ",55,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,372.15 ",95,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,372.15 ",95,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,872.75 ",75,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,122.45 ",85,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,422.09 ",97,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,373.35 ",55,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,247.30 ",90,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,422.09 ",97,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,422.09 ",97,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,422.09 ",97,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,122.45 ",85,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,247.30 ",90,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,373.35 ",55,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,372.15 ",90,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,373.35 ",55,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,322.21 ",93,,,"$1,373.35 ","$2,422.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Neck w/ Contrast,1168681,CDM,615,RC,70548,HCPCS,outpatient,,,"$3,142.00 ","$2,356.50 ",,"$2,890.64 ",92,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,728.10 ","$3,047.74 ",other,,Not applicable. No negotiated rates per contract,"$2,702.12 ",86,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,513.60 ",80,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,356.50 ",75,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,922.06 ",93,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRA Neck w/o Contrast,1168683,CDM,615,RC,70547,HCPCS,outpatient,,,"$2,266.00 ","$1,699.50 ",,"$2,084.72 ",92,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,246.30 ",55,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,246.30 ","$2,198.02 ",other,,Not applicable. No negotiated rates per contract,"$1,948.76 ",86,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,812.80 ",80,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,246.30 ",55,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,152.70 ",95,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,152.70 ",95,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,699.50 ",75,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,926.10 ",85,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,198.02 ",97,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,246.30 ",55,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,039.40 ",90,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,198.02 ",97,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,198.02 ",97,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,198.02 ",97,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,926.10 ",85,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,039.40 ",90,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,246.30 ",55,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,152.70 ",90,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,246.30 ",55,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,107.38 ",93,,,"$1,246.30 ","$2,198.02 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Abdomen w/ + w/o Contrast,1168730,CDM,614,RC,74183,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Abdomen w/ Contrast,1168732,CDM,614,RC,74182,HCPCS,outpatient,,,"$3,168.00 ","$2,376.00 ",,"$2,914.56 ",92,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,742.40 ",55,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,742.40 ","$3,072.96 ",other,,Not applicable. No negotiated rates per contract,"$2,724.48 ",86,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,534.40 ",80,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,742.40 ",55,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,009.60 ",95,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,009.60 ",95,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,376.00 ",75,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,692.80 ",85,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,072.96 ",97,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,742.40 ",55,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,851.20 ",90,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,072.96 ",97,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,072.96 ",97,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,072.96 ",97,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,692.80 ",85,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,851.20 ",90,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,742.40 ",55,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,009.60 ",90,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,742.40 ",55,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,946.24 ",93,,,"$1,742.40 ","$3,072.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Abdomen w/o Contrast,1168734,CDM,614,RC,74181,HCPCS,outpatient,,,"$3,069.00 ","$2,301.75 ",,"$2,823.48 ",92,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,687.95 ","$2,976.93 ",other,,Not applicable. No negotiated rates per contract,"$2,639.34 ",86,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,455.20 ",80,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,301.75 ",75,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,854.17 ",93,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Brain w/ + w/o Contrast,1168796,CDM,611,RC,70553,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Brain w/ Contrast,1168798,CDM,611,RC,70552,HCPCS,outpatient,,,"$3,139.00 ","$2,354.25 ",,"$2,887.88 ",92,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,726.45 ",55,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,726.45 ","$3,044.83 ",other,,Not applicable. No negotiated rates per contract,"$2,699.54 ",86,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,511.20 ",80,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,726.45 ",55,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,982.05 ",95,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,982.05 ",95,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,354.25 ",75,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,668.15 ",85,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,044.83 ",97,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,726.45 ",55,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,825.10 ",90,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,044.83 ",97,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,044.83 ",97,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,044.83 ",97,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,668.15 ",85,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,825.10 ",90,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,726.45 ",55,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,982.05 ",90,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,726.45 ",55,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,919.27 ",93,,,"$1,726.45 ","$3,044.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Brain w/o Contrast,1168800,CDM,611,RC,70551,HCPCS,outpatient,,,"$3,449.00 ","$2,586.75 ",,"$3,173.08 ",92,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,896.95 ",55,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,896.95 ","$3,345.53 ",other,,Not applicable. No negotiated rates per contract,"$2,966.14 ",86,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,759.20 ",80,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,896.95 ",55,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,276.55 ",95,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,276.55 ",95,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,586.75 ",75,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,931.65 ",85,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,345.53 ",97,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,896.95 ",55,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,104.10 ",90,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,345.53 ",97,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,345.53 ",97,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,345.53 ",97,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,931.65 ",85,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,104.10 ",90,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,896.95 ",55,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,276.55 ",90,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,896.95 ",55,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,207.57 ",93,,,"$1,896.95 ","$3,345.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Face Neck Orbit w/ + w/o Contrast,1168852,CDM,614,RC,70543,HCPCS,outpatient,,,"$3,584.00 ","$2,688.00 ",,"$3,297.28 ",92,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,971.20 ",55,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,971.20 ","$3,476.48 ",other,,Not applicable. No negotiated rates per contract,"$3,082.24 ",86,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,867.20 ",80,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,971.20 ",55,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,404.80 ",95,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,404.80 ",95,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,688.00 ",75,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,046.40 ",85,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,476.48 ",97,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,971.20 ",55,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,225.60 ",90,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,476.48 ",97,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,476.48 ",97,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,476.48 ",97,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,046.40 ",85,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,225.60 ",90,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,971.20 ",55,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,404.80 ",90,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,971.20 ",55,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,333.12 ",93,,,"$1,971.20 ","$3,476.48 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Face Neck Orbit w/ Contrast,1168854,CDM,614,RC,70542,HCPCS,outpatient,,,"$2,894.00 ","$2,170.50 ",,"$2,662.48 ",92,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,591.70 ",55,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,591.70 ","$2,807.18 ",other,,Not applicable. No negotiated rates per contract,"$2,488.84 ",86,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,315.20 ",80,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,591.70 ",55,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,749.30 ",95,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,749.30 ",95,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,170.50 ",75,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,459.90 ",85,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,807.18 ",97,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,591.70 ",55,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,604.60 ",90,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,807.18 ",97,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,807.18 ",97,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,807.18 ",97,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,459.90 ",85,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,604.60 ",90,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,591.70 ",55,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,749.30 ",90,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,591.70 ",55,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,691.42 ",93,,,"$1,591.70 ","$2,807.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Face Neck Orbit w/o Contrast,1168856,CDM,614,RC,70540,HCPCS,outpatient,,,"$2,216.00 ","$1,662.00 ",,"$2,038.72 ",92,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,218.80 ",55,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,218.80 ","$2,149.52 ",other,,Not applicable. No negotiated rates per contract,"$1,905.76 ",86,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,772.80 ",80,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,218.80 ",55,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,105.20 ",95,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,105.20 ",95,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,662.00 ",75,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,883.60 ",85,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,149.52 ",97,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,218.80 ",55,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,994.40 ",90,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,149.52 ",97,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,149.52 ",97,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,149.52 ",97,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,883.60 ",85,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,994.40 ",90,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,218.80 ",55,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,105.20 ",90,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,218.80 ",55,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,060.88 ",93,,,"$1,218.80 ","$2,149.52 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/ + w/o Contrast Left,8211277,CDM,614,RC,73723,HCPCS,outpatient,,,"$4,046.00 ","$3,034.50 ",,"$3,722.32 ",92,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,225.30 ","$3,924.62 ",other,,Not applicable. No negotiated rates per contract,"$3,479.56 ",86,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,236.80 ",80,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,843.70 ",95,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,843.70 ",95,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,034.50 ",75,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,439.10 ",85,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,641.40 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,439.10 ",85,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,641.40 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,843.70 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,762.78 ",93,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/ + w/o Contrast Right,8211280,CDM,614,RC,73723,HCPCS,outpatient,,,"$4,046.00 ","$3,034.50 ",,"$3,722.32 ",92,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,225.30 ","$3,924.62 ",other,,Not applicable. No negotiated rates per contract,"$3,479.56 ",86,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,236.80 ",80,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,843.70 ",95,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,843.70 ",95,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,034.50 ",75,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,439.10 ",85,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,641.40 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,924.62 ",97,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,439.10 ",85,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,641.40 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,843.70 ",90,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,225.30 ",55,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,762.78 ",93,,,"$2,225.30 ","$3,924.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/ Contrast Left,8211743,CDM,614,RC,73722,HCPCS,outpatient,,,"$3,625.00 ","$2,718.75 ",,"$3,335.00 ",92,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,993.75 ","$3,516.25 ",other,,Not applicable. No negotiated rates per contract,"$3,117.50 ",86,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,900.00 ",80,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,718.75 ",75,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,371.25 ",93,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/ Contrast Right,8211746,CDM,614,RC,73722,HCPCS,outpatient,,,"$3,625.00 ","$2,718.75 ",,"$3,335.00 ",92,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,993.75 ","$3,516.25 ",other,,Not applicable. No negotiated rates per contract,"$3,117.50 ",86,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,900.00 ",80,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,718.75 ",75,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,371.25 ",93,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/o Contrast Left,8211749,CDM,614,RC,73721,HCPCS,outpatient,,,"$3,349.00 ","$2,511.75 ",,"$3,081.08 ",92,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,841.95 ","$3,248.53 ",other,,Not applicable. No negotiated rates per contract,"$2,880.14 ",86,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,679.20 ",80,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,511.75 ",75,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,114.57 ",93,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI LE Joint w/o Contrast Right,8211752,CDM,614,RC,73721,HCPCS,outpatient,,,"$3,349.00 ","$2,511.75 ",,"$3,081.08 ",92,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,841.95 ","$3,248.53 ",other,,Not applicable. No negotiated rates per contract,"$2,880.14 ",86,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,679.20 ",80,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,511.75 ",75,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,114.57 ",93,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/ + w/o Cnt Left,8207921,CDM,614,RC,73720,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/ + w/o Cnt Right,8207924,CDM,614,RC,73720,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/ Contrast Left,8211160,CDM,614,RC,73719,HCPCS,outpatient,,,"$3,142.00 ","$2,356.50 ",,"$2,890.64 ",92,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,728.10 ","$3,047.74 ",other,,Not applicable. No negotiated rates per contract,"$2,702.12 ",86,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,513.60 ",80,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,356.50 ",75,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,922.06 ",93,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/ Contrast Right,8211163,CDM,614,RC,73719,HCPCS,outpatient,,,"$3,142.00 ","$2,356.50 ",,"$2,890.64 ",92,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,728.10 ","$3,047.74 ",other,,Not applicable. No negotiated rates per contract,"$2,702.12 ",86,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,513.60 ",80,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,984.90 ",95,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,356.50 ",75,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,047.74 ",97,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,670.70 ",85,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,827.80 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.90 ",90,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,728.10 ",55,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,922.06 ",93,,,"$1,728.10 ","$3,047.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/o Contrast Left,8207927,CDM,614,RC,73718,HCPCS,outpatient,,,"$3,069.00 ","$2,301.75 ",,"$2,823.48 ",92,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,687.95 ","$2,976.93 ",other,,Not applicable. No negotiated rates per contract,"$2,639.34 ",86,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,455.20 ",80,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,301.75 ",75,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,854.17 ",93,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Lower Extremity w/o Contrast Right,8207930,CDM,614,RC,73718,HCPCS,outpatient,,,"$3,069.00 ","$2,301.75 ",,"$2,823.48 ",92,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,687.95 ","$2,976.93 ",other,,Not applicable. No negotiated rates per contract,"$2,639.34 ",86,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,455.20 ",80,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,915.55 ",95,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,301.75 ",75,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,976.93 ",97,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,608.65 ",85,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,762.10 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,915.55 ",90,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,687.95 ",55,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,854.17 ",93,,,"$1,687.95 ","$2,976.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Pelvis w/ + w/o Contrast,1169024,CDM,614,RC,72197,HCPCS,outpatient,,,"$3,162.00 ","$2,371.50 ",,"$2,909.04 ",92,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,739.10 ",55,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,739.10 ","$3,067.14 ",other,,Not applicable. No negotiated rates per contract,"$2,719.32 ",86,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,529.60 ",80,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,739.10 ",55,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,003.90 ",95,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,003.90 ",95,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,371.50 ",75,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,687.70 ",85,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,067.14 ",97,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,739.10 ",55,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,845.80 ",90,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,067.14 ",97,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,067.14 ",97,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,067.14 ",97,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,687.70 ",85,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,845.80 ",90,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,739.10 ",55,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,003.90 ",90,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,739.10 ",55,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,940.66 ",93,,,"$1,739.10 ","$3,067.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Pelvis w/ Contrast,1169026,CDM,614,RC,72196,HCPCS,outpatient,,,"$2,983.00 ","$2,237.25 ",,"$2,744.36 ",92,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,640.65 ",55,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,640.65 ","$2,893.51 ",other,,Not applicable. No negotiated rates per contract,"$2,565.38 ",86,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,386.40 ",80,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,640.65 ",55,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,833.85 ",95,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,833.85 ",95,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,237.25 ",75,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,535.55 ",85,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,893.51 ",97,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,640.65 ",55,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,684.70 ",90,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,893.51 ",97,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,893.51 ",97,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,893.51 ",97,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,535.55 ",85,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,684.70 ",90,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,640.65 ",55,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,833.85 ",90,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,640.65 ",55,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,774.19 ",93,,,"$1,640.65 ","$2,893.51 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Pelvis w/o Contrast,1169028,CDM,614,RC,72195,HCPCS,outpatient,,,"$2,481.00 ","$1,860.75 ",,"$2,282.52 ",92,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,364.55 ",55,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,364.55 ","$2,406.57 ",other,,Not applicable. No negotiated rates per contract,"$2,133.66 ",86,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,984.80 ",80,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,364.55 ",55,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,356.95 ",95,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,356.95 ",95,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,860.75 ",75,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,108.85 ",85,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,406.57 ",97,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,364.55 ",55,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,232.90 ",90,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,406.57 ",97,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,406.57 ",97,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,406.57 ",97,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,108.85 ",85,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,232.90 ",90,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,364.55 ",55,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,356.95 ",90,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,364.55 ",55,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,307.33 ",93,,,"$1,364.55 ","$2,406.57 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Cervical w/ + w/o Contrast,1169050,CDM,612,RC,72156,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Cervical w/ Contrast,1169052,CDM,612,RC,72142,HCPCS,outpatient,,,"$3,387.00 ","$2,540.25 ",,"$3,116.04 ",92,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,862.85 ","$3,285.39 ",other,,Not applicable. No negotiated rates per contract,"$2,912.82 ",86,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,709.60 ",80,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,217.65 ",95,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,217.65 ",95,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,540.25 ",75,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,878.95 ",85,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,048.30 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,878.95 ",85,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,048.30 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,217.65 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,149.91 ",93,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Cervical w/o Contrast,1169054,CDM,612,RC,72141,HCPCS,outpatient,,,"$3,298.00 ","$2,473.50 ",,"$3,034.16 ",92,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,813.90 ","$3,199.06 ",other,,Not applicable. No negotiated rates per contract,"$2,836.28 ",86,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,638.40 ",80,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,133.10 ",95,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,133.10 ",95,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,473.50 ",75,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,803.30 ",85,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,968.20 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,803.30 ",85,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,968.20 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,133.10 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,067.14 ",93,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Lumbar w/ + w/o Contrast,1169056,CDM,612,RC,72158,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Lumbar w/ Contrast,1169058,CDM,612,RC,72149,HCPCS,outpatient,,,"$3,764.00 ","$2,823.00 ",,"$3,462.88 ",92,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,070.20 ",55,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,070.20 ","$3,651.08 ",other,,Not applicable. No negotiated rates per contract,"$3,237.04 ",86,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,011.20 ",80,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,070.20 ",55,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,575.80 ",95,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,575.80 ",95,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,823.00 ",75,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,199.40 ",85,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,651.08 ",97,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,070.20 ",55,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,387.60 ",90,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,651.08 ",97,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,651.08 ",97,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,651.08 ",97,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,199.40 ",85,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,387.60 ",90,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,070.20 ",55,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,575.80 ",90,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,070.20 ",55,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,500.52 ",93,,,"$2,070.20 ","$3,651.08 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Lumbar w/o Contrast,1169060,CDM,612,RC,72148,HCPCS,outpatient,,,"$3,081.00 ","$2,310.75 ",,"$2,834.52 ",92,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,694.55 ",55,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,694.55 ","$2,988.57 ",other,,Not applicable. No negotiated rates per contract,"$2,649.66 ",86,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,464.80 ",80,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,694.55 ",55,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,926.95 ",95,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,926.95 ",95,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,310.75 ",75,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,618.85 ",85,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,988.57 ",97,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,694.55 ",55,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,772.90 ",90,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,988.57 ",97,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,988.57 ",97,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,988.57 ",97,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,618.85 ",85,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,772.90 ",90,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,694.55 ",55,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,926.95 ",90,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,694.55 ",55,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,865.33 ",93,,,"$1,694.55 ","$2,988.57 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Thoracic w/ + w/o Contrast,1169062,CDM,612,RC,72157,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Thoracic w/ Contrast,1169064,CDM,612,RC,72147,HCPCS,outpatient,,,"$3,387.00 ","$2,540.25 ",,"$3,116.04 ",92,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,862.85 ","$3,285.39 ",other,,Not applicable. No negotiated rates per contract,"$2,912.82 ",86,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,709.60 ",80,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,217.65 ",95,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,217.65 ",95,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,540.25 ",75,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,878.95 ",85,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,048.30 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,285.39 ",97,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,878.95 ",85,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,048.30 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,217.65 ",90,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,862.85 ",55,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,149.91 ",93,,,"$1,862.85 ","$3,285.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Spine Thoracic w/o Contrast,1169066,CDM,612,RC,72146,HCPCS,outpatient,,,"$3,298.00 ","$2,473.50 ",,"$3,034.16 ",92,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,813.90 ","$3,199.06 ",other,,Not applicable. No negotiated rates per contract,"$2,836.28 ",86,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,638.40 ",80,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,133.10 ",95,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,133.10 ",95,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,473.50 ",75,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,803.30 ",85,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,968.20 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,199.06 ",97,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,803.30 ",85,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,968.20 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,133.10 ",90,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.90 ",55,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,067.14 ",93,,,"$1,813.90 ","$3,199.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI TMJ,1169068,CDM,614,RC,70336,HCPCS,outpatient,,,"$2,623.00 ","$1,967.25 ",,"$2,413.16 ",92,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,442.65 ",55,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,442.65 ","$2,544.31 ",other,,Not applicable. No negotiated rates per contract,"$2,255.78 ",86,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,098.40 ",80,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,442.65 ",55,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,491.85 ",95,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,491.85 ",95,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.25 ",75,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,229.55 ",85,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,544.31 ",97,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.65 ",55,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,360.70 ",90,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,544.31 ",97,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,544.31 ",97,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,544.31 ",97,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,229.55 ",85,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,360.70 ",90,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.65 ",55,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,491.85 ",90,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.65 ",55,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,439.39 ",93,,,"$1,442.65 ","$2,544.31 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/ + w/o Contrast Left,8211755,CDM,614,RC,73223,HCPCS,outpatient,,,"$3,075.00 ","$2,306.25 ",,"$2,829.00 ",92,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,691.25 ","$2,982.75 ",other,,Not applicable. No negotiated rates per contract,"$2,644.50 ",86,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,460.00 ",80,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,921.25 ",95,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,921.25 ",95,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,306.25 ",75,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,613.75 ",85,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,767.50 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,613.75 ",85,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,767.50 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,921.25 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,859.75 ",93,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/ + w/o Contrast Right,8211758,CDM,614,RC,73223,HCPCS,outpatient,,,"$3,075.00 ","$2,306.25 ",,"$2,829.00 ",92,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,691.25 ","$2,982.75 ",other,,Not applicable. No negotiated rates per contract,"$2,644.50 ",86,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,460.00 ",80,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,921.25 ",95,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,921.25 ",95,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,306.25 ",75,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,613.75 ",85,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,767.50 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,982.75 ",97,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,613.75 ",85,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,767.50 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,921.25 ",90,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,691.25 ",55,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,859.75 ",93,,,"$1,691.25 ","$2,982.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/ Contrast Left,8211761,CDM,614,RC,73222,HCPCS,outpatient,,,"$3,625.00 ","$2,718.75 ",,"$3,335.00 ",92,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,993.75 ","$3,516.25 ",other,,Not applicable. No negotiated rates per contract,"$3,117.50 ",86,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,900.00 ",80,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,718.75 ",75,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,371.25 ",93,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/ Contrast Right,8211764,CDM,614,RC,73222,HCPCS,outpatient,,,"$3,625.00 ","$2,718.75 ",,"$3,335.00 ",92,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,993.75 ","$3,516.25 ",other,,Not applicable. No negotiated rates per contract,"$3,117.50 ",86,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,900.00 ",80,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,443.75 ",95,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,718.75 ",75,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,516.25 ",97,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,081.25 ",85,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,262.50 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,443.75 ",90,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,993.75 ",55,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,371.25 ",93,,,"$1,993.75 ","$3,516.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/o Contrast Left,8211767,CDM,614,RC,73221,HCPCS,outpatient,,,"$3,349.00 ","$2,511.75 ",,"$3,081.08 ",92,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,841.95 ","$3,248.53 ",other,,Not applicable. No negotiated rates per contract,"$2,880.14 ",86,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,679.20 ",80,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,511.75 ",75,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,114.57 ",93,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI UE Joint w/o Contrast Right,8211770,CDM,614,RC,73221,HCPCS,outpatient,,,"$3,349.00 ","$2,511.75 ",,"$3,081.08 ",92,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,841.95 ","$3,248.53 ",other,,Not applicable. No negotiated rates per contract,"$2,880.14 ",86,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,679.20 ",80,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,181.55 ",95,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,511.75 ",75,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,248.53 ",97,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,846.65 ",85,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,014.10 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,181.55 ",90,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,841.95 ",55,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,114.57 ",93,,,"$1,841.95 ","$3,248.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/ + w/o Cnt Left,8211166,CDM,614,RC,73220,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/ + w/o Cnt Right,8211169,CDM,614,RC,73220,HCPCS,outpatient,,,"$3,794.00 ","$2,845.50 ",,"$3,490.48 ",92,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,086.70 ","$3,680.18 ",other,,Not applicable. No negotiated rates per contract,"$3,262.84 ",86,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,035.20 ",80,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,604.30 ",95,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,845.50 ",75,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,680.18 ",97,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,224.90 ",85,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,414.60 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,604.30 ",90,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,086.70 ",55,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,528.42 ",93,,,"$2,086.70 ","$3,680.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/ Contrast Left,8211172,CDM,614,RC,73219,HCPCS,outpatient,,,"$3,488.00 ","$2,616.00 ",,"$3,208.96 ",92,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,918.40 ","$3,383.36 ",other,,Not applicable. No negotiated rates per contract,"$2,999.68 ",86,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,790.40 ",80,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,313.60 ",95,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,313.60 ",95,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,616.00 ",75,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,964.80 ",85,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,139.20 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,964.80 ",85,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,139.20 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,313.60 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,243.84 ",93,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/ Contrast Right,8211175,CDM,614,RC,73219,HCPCS,outpatient,,,"$3,488.00 ","$2,616.00 ",,"$3,208.96 ",92,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,918.40 ","$3,383.36 ",other,,Not applicable. No negotiated rates per contract,"$2,999.68 ",86,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,790.40 ",80,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,313.60 ",95,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,313.60 ",95,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,616.00 ",75,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,964.80 ",85,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,139.20 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,383.36 ",97,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,964.80 ",85,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,139.20 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,313.60 ",90,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,918.40 ",55,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,243.84 ",93,,,"$1,918.40 ","$3,383.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/o Contrast Left,8207933,CDM,614,RC,73218,HCPCS,outpatient,,,"$3,136.00 ","$2,352.00 ",,"$2,885.12 ",92,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,724.80 ","$3,041.92 ",other,,Not applicable. No negotiated rates per contract,"$2,696.96 ",86,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,508.80 ",80,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,979.20 ",95,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,979.20 ",95,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,352.00 ",75,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,665.60 ",85,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,822.40 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,665.60 ",85,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,822.40 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,979.20 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,916.48 ",93,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MRI Upper Extremity w/o Contrast Right,8207936,CDM,614,RC,73218,HCPCS,outpatient,,,"$3,136.00 ","$2,352.00 ",,"$2,885.12 ",92,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,724.80 ","$3,041.92 ",other,,Not applicable. No negotiated rates per contract,"$2,696.96 ",86,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,508.80 ",80,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,979.20 ",95,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,979.20 ",95,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,352.00 ",75,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,665.60 ",85,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,822.40 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,041.92 ",97,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,665.60 ",85,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,822.40 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,979.20 ",90,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,724.80 ",55,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,916.48 ",93,,,"$1,724.80 ","$3,041.92 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Bone Imaging Limited,1169176,CDM,341,RC,78300,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Bone Imaging Multiple Areas,1169178,CDM,341,RC,78305,HCPCS,outpatient,,,"$1,896.00 ","$1,422.00 ",,"$1,744.32 ",92,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,042.80 ",55,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.80 ","$1,839.12 ",other,,Not applicable. No negotiated rates per contract,"$1,630.56 ",86,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.80 ",80,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.80 ",55,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,801.20 ",95,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,801.20 ",95,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,422.00 ",75,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,611.60 ",85,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,839.12 ",97,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.80 ",55,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,706.40 ",90,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,839.12 ",97,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,839.12 ",97,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,839.12 ",97,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.60 ",85,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,706.40 ",90,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.80 ",55,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,801.20 ",90,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.80 ",55,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,763.28 ",93,,,"$1,042.80 ","$1,839.12 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Bone Imaging Whole Body,1169180,CDM,341,RC,78306,HCPCS,outpatient,,,"$2,100.00 ","$1,575.00 ",,"$1,932.00 ",92,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,155.00 ",55,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,155.00 ","$2,037.00 ",other,,Not applicable. No negotiated rates per contract,"$1,806.00 ",86,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,680.00 ",80,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,155.00 ",55,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,995.00 ",95,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,995.00 ",95,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,575.00 ",75,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,785.00 ",85,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,037.00 ",97,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,155.00 ",55,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,890.00 ",90,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,037.00 ",97,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,037.00 ",97,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,037.00 ",97,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,785.00 ",85,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,890.00 ",90,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.00 ",55,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,995.00 ",90,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.00 ",55,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,953.00 ",93,,,"$1,155.00 ","$2,037.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Bone Spect,1169188,CDM,341,RC,78803,HCPCS,outpatient,,,"$1,546.00 ","$1,159.50 ",,"$1,422.32 ",92,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.30 ,"$1,499.62 ",other,,Not applicable. No negotiated rates per contract,"$1,329.56 ",86,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,236.80 ",80,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,159.50 ",75,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.78 ",93,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Bone Three Phase Study,1169190,CDM,341,RC,78315,HCPCS,outpatient,,,"$2,247.00 ","$1,685.25 ",,"$2,067.24 ",92,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,235.85 ",55,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,235.85 ","$2,179.59 ",other,,Not applicable. No negotiated rates per contract,"$1,932.42 ",86,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,797.60 ",80,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,235.85 ",55,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,134.65 ",95,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,134.65 ",95,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,685.25 ",75,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,909.95 ",85,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,179.59 ",97,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,235.85 ",55,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,022.30 ",90,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,179.59 ",97,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,179.59 ",97,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,179.59 ",97,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,909.95 ",85,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,022.30 ",90,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,235.85 ",55,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,134.65 ",90,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,235.85 ",55,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,089.71 ",93,,,"$1,235.85 ","$2,179.59 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Cardiac MUGA,1169208,CDM,341,RC,78472,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Gastric Emptying Study,1169236,CDM,341,RC,78264,HCPCS,outpatient,,,"$2,459.00 ","$1,844.25 ",,"$2,262.28 ",92,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,352.45 ",55,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,352.45 ","$2,385.23 ",other,,Not applicable. No negotiated rates per contract,"$2,114.74 ",86,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,967.20 ",80,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,352.45 ",55,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,336.05 ",95,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,336.05 ",95,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,844.25 ",75,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,090.15 ",85,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,385.23 ",97,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,352.45 ",55,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,213.10 ",90,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,385.23 ",97,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,385.23 ",97,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,385.23 ",97,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,090.15 ",85,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,213.10 ",90,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,352.45 ",55,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,336.05 ",90,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,352.45 ",55,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,286.87 ",93,,,"$1,352.45 ","$2,385.23 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Gastrointestinal Blood Loss Imaging,1169242,CDM,341,RC,78278,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Hepatobiliary Imaging,2425954,CDM,341,RC,78226,HCPCS,outpatient,,,"$1,391.00 ","$1,043.25 ",,"$1,279.72 ",92,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$765.05 ,"$1,349.27 ",other,,Not applicable. No negotiated rates per contract,"$1,196.26 ",86,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,112.80 ",80,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,321.45 ",95,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,321.45 ",95,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,043.25 ",75,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,182.35 ",85,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,251.90 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,182.35 ",85,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,251.90 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,321.45 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,293.63 ",93,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Hepatobiliary Imaging w/ Drug,2425957,CDM,341,RC,78227,HCPCS,outpatient,,,"$1,917.00 ","$1,437.75 ",,"$1,763.64 ",92,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,054.35 ",55,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,054.35 ","$1,859.49 ",other,,Not applicable. No negotiated rates per contract,"$1,648.62 ",86,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,533.60 ",80,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,054.35 ",55,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,821.15 ",95,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,821.15 ",95,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,437.75 ",75,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,629.45 ",85,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,859.49 ",97,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,054.35 ",55,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,725.30 ",90,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,859.49 ",97,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,859.49 ",97,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,859.49 ",97,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,629.45 ",85,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,725.30 ",90,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.35 ",55,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,821.15 ",90,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,054.35 ",55,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,782.81 ",93,,,"$1,054.35 ","$1,859.49 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Intestine Imaging Meckels,1169254,CDM,341,RC,78290,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Kidney Imaging Single w/ Pharm,1169262,CDM,341,RC,78708,HCPCS,outpatient,,,"$1,546.00 ","$1,159.50 ",,"$1,422.32 ",92,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.30 ,"$1,499.62 ",other,,Not applicable. No negotiated rates per contract,"$1,329.56 ",86,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,236.80 ",80,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,159.50 ",75,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.78 ",93,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Kidney Morphology w/ Flow/Function,8741665,CDM,341,RC,78707,HCPCS,outpatient,,,"$1,546.00 ","$1,159.50 ",,"$1,422.32 ",92,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.30 ,"$1,499.62 ",other,,Not applicable. No negotiated rates per contract,"$1,329.56 ",86,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,236.80 ",80,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,159.50 ",75,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.78 ",93,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Liver/Spleen Imaging w/ Vascular Flow,1169288,CDM,341,RC,78216,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Liver/Spleen Static,8206505,CDM,341,RC,78215,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Lung Perfusion Differential Imaging,2425960,CDM,341,RC,78597,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Lung Perfusion Imaging,1169328,CDM,341,RC,78580,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Lung Vent/Perf Differential Imaging,2425963,CDM,341,RC,78598,HCPCS,outpatient,,,"$1,546.00 ","$1,159.50 ",,"$1,422.32 ",92,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.30 ,"$1,499.62 ",other,,Not applicable. No negotiated rates per contract,"$1,329.56 ",86,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,236.80 ",80,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,159.50 ",75,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.78 ",93,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Lung Vent/Perf Imaging,2425966,CDM,341,RC,78582,HCPCS,outpatient,,,"$1,546.00 ","$1,159.50 ",,"$1,422.32 ",92,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.30 ,"$1,499.62 ",other,,Not applicable. No negotiated rates per contract,"$1,329.56 ",86,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,236.80 ",80,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,468.70 ",95,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,159.50 ",75,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.62 ",97,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.10 ",85,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,391.40 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,468.70 ",90,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.30 ,55,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.78 ",93,,,$850.30 ,"$1,499.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Lung Ventilation Imaging,2425969,CDM,341,RC,78579,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Myocardial Planar Rest and Stress,2425972,CDM,341,RC,78454,HCPCS,outpatient,,,"$4,102.00 ","$3,076.50 ",,"$3,773.84 ",92,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,256.10 ","$3,978.94 ",other,,Not applicable. No negotiated rates per contract,"$3,527.72 ",86,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,281.60 ",80,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,076.50 ",75,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,814.86 ",93,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Myocardial Planar Single Study,2425978,CDM,341,RC,78453,HCPCS,outpatient,,,"$4,102.00 ","$3,076.50 ",,"$3,773.84 ",92,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,256.10 ","$3,978.94 ",other,,Not applicable. No negotiated rates per contract,"$3,527.72 ",86,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,281.60 ",80,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,076.50 ",75,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,814.86 ",93,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Myocardial SPECT Rest and Stress,2425975,CDM,341,RC,78452,HCPCS,outpatient,,,"$4,102.00 ","$3,076.50 ",,"$3,773.84 ",92,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,256.10 ","$3,978.94 ",other,,Not applicable. No negotiated rates per contract,"$3,527.72 ",86,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,281.60 ",80,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,076.50 ",75,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,814.86 ",93,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Myocardial SPECT Single Study,2425981,CDM,341,RC,78451,HCPCS,outpatient,,,"$4,102.00 ","$3,076.50 ",,"$3,773.84 ",92,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,256.10 ","$3,978.94 ",other,,Not applicable. No negotiated rates per contract,"$3,527.72 ",86,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,281.60 ",80,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,896.90 ",95,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,076.50 ",75,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,978.94 ",97,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,486.70 ",85,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,691.80 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,896.90 ",90,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.10 ",55,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,814.86 ",93,,,"$2,256.10 ","$3,978.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Parathyroid Imaging,1169316,CDM,341,RC,78070,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Parathyroid Imaging w/ Spect,2425984,CDM,341,RC,78071,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Testicular Imaging w/ Vascular Flow,8223958,CDM,341,RC,78761,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Thyroid Imaging,2426008,CDM,341,RC,78013,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Thyroid Uptake Single or Multi,3630554,CDM,341,RC,78014,HCPCS,outpatient,,,"$2,120.00 ","$1,590.00 ",,"$1,950.40 ",92,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,166.00 ",55,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,166.00 ","$2,056.40 ",other,,Not applicable. No negotiated rates per contract,"$1,823.20 ",86,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,696.00 ",80,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,166.00 ",55,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,014.00 ",95,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,014.00 ",95,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,590.00 ",75,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,802.00 ",85,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,056.40 ",97,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,166.00 ",55,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,908.00 ",90,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,056.40 ",97,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,056.40 ",97,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,056.40 ",97,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,802.00 ",85,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,908.00 ",90,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.00 ",55,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,014.00 ",90,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.00 ",55,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,971.60 ",93,,,"$1,166.00 ","$2,056.40 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NM Ureteral Reflux Study,1169426,CDM,341,RC,78740,HCPCS,outpatient,,,"$1,194.00 ",$895.50 ,,"$1,098.48 ",92,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$656.70 ,"$1,158.18 ",other,,Not applicable. No negotiated rates per contract,"$1,026.84 ",86,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$955.20 ,80,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,134.30 ",95,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$895.50 ,75,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,158.18 ",97,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,014.90 ",85,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,074.60 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,134.30 ",90,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$656.70 ,55,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.42 ",93,,,$656.70 ,"$1,158.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US ABI Complete Bilateral,8196596,CDM,921,RC,93923,HCPCS,outpatient,,,$712.00 ,$534.00 ,,$655.04 ,92,,,$391.60 ,$690.64 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$391.60 ,55,,,$391.60 ,$690.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$391.60 ,$690.64 ,other,,Not applicable. No negotiated rates per contract,$612.32 ,86,,,$391.60 ,$690.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$569.60 ,80,,,$391.60 ,$690.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$391.60 ,55,,,$391.60 ,$690.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$676.40 ,95,,,$391.60 ,$690.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$676.40 ,95,,,$391.60 ,$690.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$534.00 ,75,,,$391.60 ,$690.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$605.20 ,85,,,$391.60 ,$690.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$690.64 ,97,,,$391.60 ,$690.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.60 ,55,,,$391.60 ,$690.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$640.80 ,90,,,$391.60 ,$690.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$690.64 ,97,,,$391.60 ,$690.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$690.64 ,97,,,$391.60 ,$690.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$690.64 ,97,,,$391.60 ,$690.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$605.20 ,85,,,$391.60 ,$690.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$640.80 ,90,,,$391.60 ,$690.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.60 ,55,,,$391.60 ,$690.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$676.40 ,90,,,$391.60 ,$690.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.60 ,55,,,$391.60 ,$690.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$662.16 ,93,,,$391.60 ,$690.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Abdomen Complete,1169567,CDM,402,RC,76700,HCPCS,outpatient,,,"$1,013.00 ",$759.75 ,,$931.96 ,92,,,$557.15 ,$982.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$557.15 ,$982.61 ,other,,Not applicable. No negotiated rates per contract,$871.18 ,86,,,$557.15 ,$982.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$810.40 ,80,,,$557.15 ,$982.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$962.35 ,95,,,$557.15 ,$982.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$759.75 ,75,,,$557.15 ,$982.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.61 ,97,,,$557.15 ,$982.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$861.05 ,85,,,$557.15 ,$982.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$911.70 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.35 ,90,,,$557.15 ,$982.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.15 ,55,,,$557.15 ,$982.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.09 ,93,,,$557.15 ,$982.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Abdomen Limited,1169569,CDM,402,RC,76705,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Ankle Brachial Index,8111055,CDM,921,RC,93922,HCPCS,outpatient,,,$699.00 ,$524.25 ,,$643.08 ,92,,,$384.45 ,$678.03 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$384.45 ,$678.03 ,other,,Not applicable. No negotiated rates per contract,$601.14 ,86,,,$384.45 ,$678.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$559.20 ,80,,,$384.45 ,$678.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.05 ,95,,,$384.45 ,$678.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$664.05 ,95,,,$384.45 ,$678.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$524.25 ,75,,,$384.45 ,$678.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$594.15 ,85,,,$384.45 ,$678.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.10 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.03 ,97,,,$384.45 ,$678.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$594.15 ,85,,,$384.45 ,$678.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$629.10 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.05 ,90,,,$384.45 ,$678.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.45 ,55,,,$384.45 ,$678.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$650.07 ,93,,,$384.45 ,$678.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Aorta,8211181,CDM,402,RC,76706,HCPCS,outpatient,,,$373.00 ,$279.75 ,,$343.16 ,92,,,$205.15 ,$361.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.15 ,$361.81 ,other,,Not applicable. No negotiated rates per contract,$320.78 ,86,,,$205.15 ,$361.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$298.40 ,80,,,$205.15 ,$361.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.75 ,75,,,$205.15 ,$361.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.89 ,93,,,$205.15 ,$361.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Aorta Complete,8110948,CDM,402,RC,76775,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Biopsy Left,8100274,CDM,402,RC,76942,HCPCS,outpatient,,,$745.00 ,$558.75 ,,$685.40 ,92,,,$409.75 ,$722.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$409.75 ,$722.65 ,other,,Not applicable. No negotiated rates per contract,$640.70 ,86,,,$409.75 ,$722.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.00 ,80,,,$409.75 ,$722.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$558.75 ,75,,,$409.75 ,$722.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.85 ,93,,,$409.75 ,$722.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Biopsy Right,8100277,CDM,402,RC,76942,HCPCS,outpatient,,,$756.00 ,$567.00 ,,$695.52 ,92,,,$415.80 ,$733.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$415.80 ,55,,,$415.80 ,$733.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$415.80 ,$733.32 ,other,,Not applicable. No negotiated rates per contract,$650.16 ,86,,,$415.80 ,$733.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$604.80 ,80,,,$415.80 ,$733.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$415.80 ,55,,,$415.80 ,$733.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$718.20 ,95,,,$415.80 ,$733.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$718.20 ,95,,,$415.80 ,$733.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$567.00 ,75,,,$415.80 ,$733.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$642.60 ,85,,,$415.80 ,$733.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$733.32 ,97,,,$415.80 ,$733.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$415.80 ,55,,,$415.80 ,$733.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.40 ,90,,,$415.80 ,$733.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$733.32 ,97,,,$415.80 ,$733.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.32 ,97,,,$415.80 ,$733.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.32 ,97,,,$415.80 ,$733.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$642.60 ,85,,,$415.80 ,$733.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$680.40 ,90,,,$415.80 ,$733.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$415.80 ,55,,,$415.80 ,$733.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$718.20 ,90,,,$415.80 ,$733.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$415.80 ,55,,,$415.80 ,$733.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.08 ,93,,,$415.80 ,$733.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Complete Bilat,8111061,CDM,402,RC,76641,HCPCS,outpatient,,,$966.00 ,$724.50 ,,$888.72 ,92,,,$531.30 ,$937.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$531.30 ,$937.02 ,other,,Not applicable. No negotiated rates per contract,$830.76 ,86,,,$531.30 ,$937.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$772.80 ,80,,,$531.30 ,$937.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$724.50 ,75,,,$531.30 ,$937.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.38 ,93,,,$531.30 ,$937.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Complete Left.,8033264,CDM,402,RC,76641,HCPCS,outpatient,,,$966.00 ,$724.50 ,,$888.72 ,92,,,$531.30 ,$937.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$531.30 ,$937.02 ,other,,Not applicable. No negotiated rates per contract,$830.76 ,86,,,$531.30 ,$937.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$772.80 ,80,,,$531.30 ,$937.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$724.50 ,75,,,$531.30 ,$937.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.38 ,93,,,$531.30 ,$937.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Complete Right,4645477,CDM,402,RC,76641,HCPCS,outpatient,,,$966.00 ,$724.50 ,,$888.72 ,92,,,$531.30 ,$937.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$531.30 ,$937.02 ,other,,Not applicable. No negotiated rates per contract,$830.76 ,86,,,$531.30 ,$937.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$772.80 ,80,,,$531.30 ,$937.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$917.70 ,95,,,$531.30 ,$937.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$724.50 ,75,,,$531.30 ,$937.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$937.02 ,97,,,$531.30 ,$937.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$821.10 ,85,,,$531.30 ,$937.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$869.40 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$917.70 ,90,,,$531.30 ,$937.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$531.30 ,55,,,$531.30 ,$937.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.38 ,93,,,$531.30 ,$937.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Limited Bilat,8111067,CDM,402,RC,76642,HCPCS,outpatient,,,$724.00 ,$543.00 ,,$666.08 ,92,,,$398.20 ,$702.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$398.20 ,$702.28 ,other,,Not applicable. No negotiated rates per contract,$622.64 ,86,,,$398.20 ,$702.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$579.20 ,80,,,$398.20 ,$702.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.00 ,75,,,$398.20 ,$702.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.32 ,93,,,$398.20 ,$702.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Limited Left,4645480,CDM,402,RC,76642,HCPCS,outpatient,,,$724.00 ,$543.00 ,,$666.08 ,92,,,$398.20 ,$702.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$398.20 ,$702.28 ,other,,Not applicable. No negotiated rates per contract,$622.64 ,86,,,$398.20 ,$702.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$579.20 ,80,,,$398.20 ,$702.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.00 ,75,,,$398.20 ,$702.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.32 ,93,,,$398.20 ,$702.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Limited Right,4645483,CDM,402,RC,76642,HCPCS,outpatient,,,$724.00 ,$543.00 ,,$666.08 ,92,,,$398.20 ,$702.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$398.20 ,$702.28 ,other,,Not applicable. No negotiated rates per contract,$622.64 ,86,,,$398.20 ,$702.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$579.20 ,80,,,$398.20 ,$702.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$687.80 ,95,,,$398.20 ,$702.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.00 ,75,,,$398.20 ,$702.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$702.28 ,97,,,$398.20 ,$702.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$615.40 ,85,,,$398.20 ,$702.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$651.60 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.80 ,90,,,$398.20 ,$702.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$398.20 ,55,,,$398.20 ,$702.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.32 ,93,,,$398.20 ,$702.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Tissue Specimen Surgical Left,2425323,CDM,320,RC,76098,HCPCS,outpatient,,,"$1,487.00 ","$1,115.25 ",,"$1,368.04 ",92,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$817.85 ,"$1,442.39 ",other,,Not applicable. No negotiated rates per contract,"$1,278.82 ",86,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,189.60 ",80,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,412.65 ",95,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,412.65 ",95,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,115.25 ",75,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,263.95 ",85,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,338.30 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,263.95 ",85,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,338.30 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,412.65 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,382.91 ",93,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Breast Tissue Specimen Surgical Right,2425326,CDM,320,RC,76098,HCPCS,outpatient,,,"$1,487.00 ","$1,115.25 ",,"$1,368.04 ",92,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$817.85 ,"$1,442.39 ",other,,Not applicable. No negotiated rates per contract,"$1,278.82 ",86,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,189.60 ",80,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,412.65 ",95,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,412.65 ",95,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,115.25 ",75,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,263.95 ",85,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,338.30 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.39 ",97,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,263.95 ",85,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,338.30 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,412.65 ",90,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$817.85 ,55,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,382.91 ",93,,,$817.85 ,"$1,442.39 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Carotid Duplex Bilateral,1169631,CDM,921,RC,93880,HCPCS,outpatient,,,"$1,170.00 ",$877.50 ,,"$1,076.40 ",92,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$643.50 ,55,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$643.50 ,"$1,134.90 ",other,,Not applicable. No negotiated rates per contract,"$1,006.20 ",86,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$936.00 ,80,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$643.50 ,55,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,111.50 ",95,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,111.50 ",95,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$877.50 ,75,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$994.50 ,85,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,134.90 ",97,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$643.50 ,55,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,053.00 ",90,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.90 ",97,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,134.90 ",97,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,134.90 ",97,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$994.50 ,85,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,053.00 ",90,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$643.50 ,55,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,111.50 ",90,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$643.50 ,55,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,088.10 ",93,,,$643.50 ,"$1,134.90 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Chest,1169635,CDM,402,RC,76604,HCPCS,outpatient,,,$540.00 ,$405.00 ,,$496.80 ,92,,,$297.00 ,$523.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$297.00 ,55,,,$297.00 ,$523.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$297.00 ,$523.80 ,other,,Not applicable. No negotiated rates per contract,$464.40 ,86,,,$297.00 ,$523.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$432.00 ,80,,,$297.00 ,$523.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$297.00 ,55,,,$297.00 ,$523.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$513.00 ,95,,,$297.00 ,$523.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$513.00 ,95,,,$297.00 ,$523.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$405.00 ,75,,,$297.00 ,$523.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$459.00 ,85,,,$297.00 ,$523.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$523.80 ,97,,,$297.00 ,$523.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$297.00 ,55,,,$297.00 ,$523.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$486.00 ,90,,,$297.00 ,$523.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$523.80 ,97,,,$297.00 ,$523.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$523.80 ,97,,,$297.00 ,$523.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$523.80 ,97,,,$297.00 ,$523.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$459.00 ,85,,,$297.00 ,$523.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$486.00 ,90,,,$297.00 ,$523.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$297.00 ,55,,,$297.00 ,$523.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$513.00 ,90,,,$297.00 ,$523.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$297.00 ,55,,,$297.00 ,$523.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$502.20 ,93,,,$297.00 ,$523.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Echo Bubble Study,8106667,CDM,483,RC,93306,HCPCS,outpatient,,,"$3,774.00 ","$2,830.50 ",,"$3,472.08 ",92,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,075.70 ","$3,660.78 ",other,,Not applicable. No negotiated rates per contract,"$3,245.64 ",86,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,019.20 ",80,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,830.50 ",75,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,509.82 ",93,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Echo Bubble Study EO,8763610,CDM,483,RC,93306,HCPCS,outpatient,,,"$3,774.00 ","$2,830.50 ",,"$3,472.08 ",92,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,075.70 ","$3,660.78 ",other,,Not applicable. No negotiated rates per contract,"$3,245.64 ",86,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,019.20 ",80,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,830.50 ",75,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,509.82 ",93,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Echocardiogram Complete,8111085,CDM,483,RC,93306,HCPCS,outpatient,,,"$3,774.00 ","$2,830.50 ",,"$3,472.08 ",92,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,075.70 ","$3,660.78 ",other,,Not applicable. No negotiated rates per contract,"$3,245.64 ",86,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,019.20 ",80,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,830.50 ",75,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,509.82 ",93,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Echocardiogram Complete w/ Color EO,8255420,CDM,483,RC,93306,HCPCS,outpatient,,,"$3,774.00 ","$2,830.50 ",,"$3,472.08 ",92,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,075.70 ","$3,660.78 ",other,,Not applicable. No negotiated rates per contract,"$3,245.64 ",86,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,019.20 ",80,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,585.30 ",95,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,830.50 ",75,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,660.78 ",97,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,207.90 ",85,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,396.60 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,585.30 ",90,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,075.70 ",55,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,509.82 ",93,,,"$2,075.70 ","$3,660.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Echocardiogram Limited,8111088,CDM,483,RC,93308,HCPCS,outpatient,,,"$1,160.00 ",$870.00 ,,"$1,067.20 ",92,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$638.00 ,"$1,125.20 ",other,,Not applicable. No negotiated rates per contract,$997.60 ,86,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$928.00 ,80,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,102.00 ",95,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,102.00 ",95,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$870.00 ,75,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$986.00 ,85,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,044.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$986.00 ,85,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,044.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,102.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,078.80 ",93,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Echocardiogram Limited EO,8523001,CDM,483,RC,93308,HCPCS,outpatient,,,"$1,160.00 ",$870.00 ,,"$1,067.20 ",92,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$638.00 ,"$1,125.20 ",other,,Not applicable. No negotiated rates per contract,$997.60 ,86,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$928.00 ,80,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,102.00 ",95,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,102.00 ",95,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$870.00 ,75,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$986.00 ,85,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,044.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,125.20 ",97,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$986.00 ,85,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,044.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,102.00 ",90,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$638.00 ,55,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,078.80 ",93,,,$638.00 ,"$1,125.20 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Extremity Nonvascular Complete Left,2425332,CDM,402,RC,76881,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Extremity Nonvascular Complete Right,2425335,CDM,402,RC,76881,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Extremity Nonvascular Limited Left,2425338,CDM,402,RC,76882,HCPCS,outpatient,,,$774.00 ,$580.50 ,,$712.08 ,92,,,$425.70 ,$750.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$425.70 ,$750.78 ,other,,Not applicable. No negotiated rates per contract,$665.64 ,86,,,$425.70 ,$750.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$619.20 ,80,,,$425.70 ,$750.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$735.30 ,95,,,$425.70 ,$750.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$735.30 ,95,,,$425.70 ,$750.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$580.50 ,75,,,$425.70 ,$750.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$657.90 ,85,,,$425.70 ,$750.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$696.60 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$657.90 ,85,,,$425.70 ,$750.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$696.60 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$735.30 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$719.82 ,93,,,$425.70 ,$750.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Extremity Nonvascular Limited Right,2425341,CDM,402,RC,76882,HCPCS,outpatient,,,$774.00 ,$580.50 ,,$712.08 ,92,,,$425.70 ,$750.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$425.70 ,$750.78 ,other,,Not applicable. No negotiated rates per contract,$665.64 ,86,,,$425.70 ,$750.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$619.20 ,80,,,$425.70 ,$750.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$735.30 ,95,,,$425.70 ,$750.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$735.30 ,95,,,$425.70 ,$750.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$580.50 ,75,,,$425.70 ,$750.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$657.90 ,85,,,$425.70 ,$750.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$696.60 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$750.78 ,97,,,$425.70 ,$750.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$657.90 ,85,,,$425.70 ,$750.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$696.60 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$735.30 ,90,,,$425.70 ,$750.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$425.70 ,55,,,$425.70 ,$750.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$719.82 ,93,,,$425.70 ,$750.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Fetal Biophysical Profile w/o N-Str,1169689,CDM,402,RC,76818,HCPCS,outpatient,,,$836.00 ,$627.00 ,,$769.12 ,92,,,$459.80 ,$810.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$459.80 ,$810.92 ,other,,Not applicable. No negotiated rates per contract,$718.96 ,86,,,$459.80 ,$810.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$668.80 ,80,,,$459.80 ,$810.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$794.20 ,95,,,$459.80 ,$810.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$794.20 ,95,,,$459.80 ,$810.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$627.00 ,75,,,$459.80 ,$810.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$710.60 ,85,,,$459.80 ,$810.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$752.40 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.60 ,85,,,$459.80 ,$810.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$752.40 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$794.20 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$777.48 ,93,,,$459.80 ,$810.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Fine Needle Asp w/ Guide Each Add Les,9042561,CDM,402,RC,10006,HCPCS,outpatient,,,$202.00 ,$151.50 ,,$185.84 ,92,,,$111.10 ,$195.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$111.10 ,$195.94 ,other,,Not applicable. No negotiated rates per contract,$173.72 ,86,,,$111.10 ,$195.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$161.60 ,80,,,$111.10 ,$195.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$151.50 ,75,,,$111.10 ,$195.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.86 ,93,,,$111.10 ,$195.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Fine Needle Aspiration Thyroid Gland,2425344,CDM,402,RC,10005,HCPCS,outpatient,,,$461.00 ,$345.75 ,,$424.12 ,92,,,$253.55 ,$447.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$253.55 ,$447.17 ,other,,Not applicable. No negotiated rates per contract,$396.46 ,86,,,$253.55 ,$447.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$368.80 ,80,,,$253.55 ,$447.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.95 ,95,,,$253.55 ,$447.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$437.95 ,95,,,$253.55 ,$447.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$345.75 ,75,,,$253.55 ,$447.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$391.85 ,85,,,$253.55 ,$447.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$414.90 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.85 ,85,,,$253.55 ,$447.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$414.90 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.95 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.73 ,93,,,$253.55 ,$447.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Fine Needle Aspiration w/ Guidance,2425347,CDM,402,RC,76942,HCPCS,outpatient,,,$745.00 ,$558.75 ,,$685.40 ,92,,,$409.75 ,$722.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$409.75 ,$722.65 ,other,,Not applicable. No negotiated rates per contract,$640.70 ,86,,,$409.75 ,$722.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.00 ,80,,,$409.75 ,$722.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$558.75 ,75,,,$409.75 ,$722.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.85 ,93,,,$409.75 ,$722.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Guided Breast Biopsy Left.,8033282,CDM,402,RC,76942,HCPCS,outpatient,,,$745.00 ,$558.75 ,,$685.40 ,92,,,$409.75 ,$722.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$409.75 ,$722.65 ,other,,Not applicable. No negotiated rates per contract,$640.70 ,86,,,$409.75 ,$722.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.00 ,80,,,$409.75 ,$722.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$707.75 ,95,,,$409.75 ,$722.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$558.75 ,75,,,$409.75 ,$722.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.65 ,97,,,$409.75 ,$722.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$633.25 ,85,,,$409.75 ,$722.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$670.50 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.75 ,90,,,$409.75 ,$722.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$409.75 ,55,,,$409.75 ,$722.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.85 ,93,,,$409.75 ,$722.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Guided Drain Placement,8211779,CDM,402,RC,75989,HCPCS,outpatient,,,$402.00 ,$301.50 ,,$369.84 ,92,,,$221.10 ,$389.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$221.10 ,55,,,$221.10 ,$389.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$221.10 ,$389.94 ,other,,Not applicable. No negotiated rates per contract,$345.72 ,86,,,$221.10 ,$389.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$321.60 ,80,,,$221.10 ,$389.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$221.10 ,55,,,$221.10 ,$389.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.90 ,95,,,$221.10 ,$389.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$381.90 ,95,,,$221.10 ,$389.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$301.50 ,75,,,$221.10 ,$389.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$341.70 ,85,,,$221.10 ,$389.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$389.94 ,97,,,$221.10 ,$389.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.10 ,55,,,$221.10 ,$389.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$361.80 ,90,,,$221.10 ,$389.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$389.94 ,97,,,$221.10 ,$389.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$389.94 ,97,,,$221.10 ,$389.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$389.94 ,97,,,$221.10 ,$389.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.70 ,85,,,$221.10 ,$389.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.80 ,90,,,$221.10 ,$389.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.10 ,55,,,$221.10 ,$389.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.90 ,90,,,$221.10 ,$389.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.10 ,55,,,$221.10 ,$389.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.86 ,93,,,$221.10 ,$389.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Head/Neck Soft Tissue,1169729,CDM,402,RC,76536,HCPCS,outpatient,,,$958.00 ,$718.50 ,,$881.36 ,92,,,$526.90 ,$929.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$526.90 ,$929.26 ,other,,Not applicable. No negotiated rates per contract,$823.88 ,86,,,$526.90 ,$929.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$766.40 ,80,,,$526.90 ,$929.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$910.10 ,95,,,$526.90 ,$929.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$910.10 ,95,,,$526.90 ,$929.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$718.50 ,75,,,$526.90 ,$929.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$814.30 ,85,,,$526.90 ,$929.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$862.20 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$814.30 ,85,,,$526.90 ,$929.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$862.20 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$910.10 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$890.94 ,93,,,$526.90 ,$929.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Hips Infant Dynamic,1169731,CDM,402,RC,76885,HCPCS,outpatient,,,$776.00 ,$582.00 ,,$713.92 ,92,,,$426.80 ,$752.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$426.80 ,55,,,$426.80 ,$752.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$426.80 ,$752.72 ,other,,Not applicable. No negotiated rates per contract,$667.36 ,86,,,$426.80 ,$752.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$620.80 ,80,,,$426.80 ,$752.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$426.80 ,55,,,$426.80 ,$752.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$737.20 ,95,,,$426.80 ,$752.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$737.20 ,95,,,$426.80 ,$752.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$582.00 ,75,,,$426.80 ,$752.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$659.60 ,85,,,$426.80 ,$752.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$752.72 ,97,,,$426.80 ,$752.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$426.80 ,55,,,$426.80 ,$752.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$698.40 ,90,,,$426.80 ,$752.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$752.72 ,97,,,$426.80 ,$752.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$752.72 ,97,,,$426.80 ,$752.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$752.72 ,97,,,$426.80 ,$752.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$659.60 ,85,,,$426.80 ,$752.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$698.40 ,90,,,$426.80 ,$752.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$426.80 ,55,,,$426.80 ,$752.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$737.20 ,90,,,$426.80 ,$752.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$426.80 ,55,,,$426.80 ,$752.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.68 ,93,,,$426.80 ,$752.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Arterial Duplex Bilateral,1169759,CDM,921,RC,93925,HCPCS,outpatient,,,$958.00 ,$718.50 ,,$881.36 ,92,,,$526.90 ,$929.26 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$526.90 ,$929.26 ,other,,Not applicable. No negotiated rates per contract,$823.88 ,86,,,$526.90 ,$929.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$766.40 ,80,,,$526.90 ,$929.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$910.10 ,95,,,$526.90 ,$929.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$910.10 ,95,,,$526.90 ,$929.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$718.50 ,75,,,$526.90 ,$929.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$814.30 ,85,,,$526.90 ,$929.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$862.20 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$929.26 ,97,,,$526.90 ,$929.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$814.30 ,85,,,$526.90 ,$929.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$862.20 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$910.10 ,90,,,$526.90 ,$929.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$526.90 ,55,,,$526.90 ,$929.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$890.94 ,93,,,$526.90 ,$929.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Arterial Duplex Left,1169761,CDM,921,RC,93926,HCPCS,outpatient,,,$739.00 ,$554.25 ,,$679.88 ,92,,,$406.45 ,$716.83 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$406.45 ,$716.83 ,other,,Not applicable. No negotiated rates per contract,$635.54 ,86,,,$406.45 ,$716.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$591.20 ,80,,,$406.45 ,$716.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$702.05 ,95,,,$406.45 ,$716.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$702.05 ,95,,,$406.45 ,$716.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$554.25 ,75,,,$406.45 ,$716.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$628.15 ,85,,,$406.45 ,$716.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$665.10 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$628.15 ,85,,,$406.45 ,$716.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$665.10 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$702.05 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.27 ,93,,,$406.45 ,$716.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Arterial Duplex Right,1169763,CDM,921,RC,93926,HCPCS,outpatient,,,$739.00 ,$554.25 ,,$679.88 ,92,,,$406.45 ,$716.83 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$406.45 ,$716.83 ,other,,Not applicable. No negotiated rates per contract,$635.54 ,86,,,$406.45 ,$716.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$591.20 ,80,,,$406.45 ,$716.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$702.05 ,95,,,$406.45 ,$716.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$702.05 ,95,,,$406.45 ,$716.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$554.25 ,75,,,$406.45 ,$716.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$628.15 ,85,,,$406.45 ,$716.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$665.10 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$716.83 ,97,,,$406.45 ,$716.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$628.15 ,85,,,$406.45 ,$716.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$665.10 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$702.05 ,90,,,$406.45 ,$716.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.45 ,55,,,$406.45 ,$716.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$687.27 ,93,,,$406.45 ,$716.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Venous Duplex Bilateral,1169769,CDM,921,RC,93970,HCPCS,outpatient,,,"$1,895.00 ","$1,421.25 ",,"$1,743.40 ",92,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.25 ","$1,838.15 ",other,,Not applicable. No negotiated rates per contract,"$1,629.70 ",86,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.00 ",80,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.25 ",95,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,800.25 ",95,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,421.25 ",75,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,610.75 ",85,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.50 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,610.75 ",85,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,705.50 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.25 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.35 ",93,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Venous Duplex Left,1169771,CDM,921,RC,93971,HCPCS,outpatient,,,"$1,025.00 ",$768.75 ,,$943.00 ,92,,,$563.75 ,$994.25 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$563.75 ,$994.25 ,other,,Not applicable. No negotiated rates per contract,$881.50 ,86,,,$563.75 ,$994.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$820.00 ,80,,,$563.75 ,$994.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$973.75 ,95,,,$563.75 ,$994.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$973.75 ,95,,,$563.75 ,$994.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$768.75 ,75,,,$563.75 ,$994.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$871.25 ,85,,,$563.75 ,$994.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$922.50 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$871.25 ,85,,,$563.75 ,$994.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$922.50 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$973.75 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$953.25 ,93,,,$563.75 ,$994.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Lower Ext Venous Duplex Right,1169773,CDM,921,RC,93971,HCPCS,outpatient,,,"$1,025.00 ",$768.75 ,,$943.00 ,92,,,$563.75 ,$994.25 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$563.75 ,$994.25 ,other,,Not applicable. No negotiated rates per contract,$881.50 ,86,,,$563.75 ,$994.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$820.00 ,80,,,$563.75 ,$994.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$973.75 ,95,,,$563.75 ,$994.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$973.75 ,95,,,$563.75 ,$994.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$768.75 ,75,,,$563.75 ,$994.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$871.25 ,85,,,$563.75 ,$994.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$922.50 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$994.25 ,97,,,$563.75 ,$994.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$871.25 ,85,,,$563.75 ,$994.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$922.50 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$973.75 ,90,,,$563.75 ,$994.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$563.75 ,55,,,$563.75 ,$994.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$953.25 ,93,,,$563.75 ,$994.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US OB < 14 Weeks Single,8100928,CDM,402,RC,76801,HCPCS,outpatient,,,$812.00 ,$609.00 ,,$747.04 ,92,,,$446.60 ,$787.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$446.60 ,$787.64 ,other,,Not applicable. No negotiated rates per contract,$698.32 ,86,,,$446.60 ,$787.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$649.60 ,80,,,$446.60 ,$787.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$771.40 ,95,,,$446.60 ,$787.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$771.40 ,95,,,$446.60 ,$787.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$609.00 ,75,,,$446.60 ,$787.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$690.20 ,85,,,$446.60 ,$787.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.80 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$690.20 ,85,,,$446.60 ,$787.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$730.80 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$771.40 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$755.16 ,93,,,$446.60 ,$787.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US OB Follow Up,1169854,CDM,402,RC,76816,HCPCS,outpatient,,,"$1,254.00 ",$940.50 ,,"$1,153.68 ",92,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$689.70 ,"$1,216.38 ",other,,Not applicable. No negotiated rates per contract,"$1,078.44 ",86,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,003.20 ",80,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.30 ",95,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,191.30 ",95,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$940.50 ,75,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,065.90 ",85,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,128.60 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,065.90 ",85,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,128.60 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.30 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,166.22 ",93,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US OB Greater Than 14 Weeks,1169850,CDM,402,RC,76805,HCPCS,outpatient,,,"$1,254.00 ",$940.50 ,,"$1,153.68 ",92,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$689.70 ,"$1,216.38 ",other,,Not applicable. No negotiated rates per contract,"$1,078.44 ",86,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,003.20 ",80,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.30 ",95,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,191.30 ",95,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$940.50 ,75,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,065.90 ",85,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,128.60 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.38 ",97,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,065.90 ",85,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,128.60 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.30 ",90,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.70 ,55,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,166.22 ",93,,,$689.70 ,"$1,216.38 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US OB Greater Than 14 Weeks Multi,8100931,CDM,402,RC,76810,HCPCS,outpatient,,,$317.00 ,$237.75 ,,$291.64 ,92,,,$174.35 ,$307.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$174.35 ,55,,,$174.35 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.35 ,$307.49 ,other,,Not applicable. No negotiated rates per contract,$272.62 ,86,,,$174.35 ,$307.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$253.60 ,80,,,$174.35 ,$307.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$174.35 ,55,,,$174.35 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.15 ,95,,,$174.35 ,$307.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$301.15 ,95,,,$174.35 ,$307.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.75 ,75,,,$174.35 ,$307.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$269.45 ,85,,,$174.35 ,$307.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.49 ,97,,,$174.35 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.35 ,55,,,$174.35 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.30 ,90,,,$174.35 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.49 ,97,,,$174.35 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.49 ,97,,,$174.35 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.49 ,97,,,$174.35 ,$307.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.45 ,85,,,$174.35 ,$307.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$285.30 ,90,,,$174.35 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.35 ,55,,,$174.35 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.15 ,90,,,$174.35 ,$307.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.35 ,55,,,$174.35 ,$307.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$294.81 ,93,,,$174.35 ,$307.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US OB Limited,1169856,CDM,402,RC,76815,HCPCS,outpatient,,,$812.00 ,$609.00 ,,$747.04 ,92,,,$446.60 ,$787.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$446.60 ,$787.64 ,other,,Not applicable. No negotiated rates per contract,$698.32 ,86,,,$446.60 ,$787.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$649.60 ,80,,,$446.60 ,$787.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$771.40 ,95,,,$446.60 ,$787.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$771.40 ,95,,,$446.60 ,$787.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$609.00 ,75,,,$446.60 ,$787.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$690.20 ,85,,,$446.60 ,$787.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.80 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$787.64 ,97,,,$446.60 ,$787.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$690.20 ,85,,,$446.60 ,$787.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$730.80 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$771.40 ,90,,,$446.60 ,$787.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$446.60 ,55,,,$446.60 ,$787.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$755.16 ,93,,,$446.60 ,$787.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US OB Transvaginal,1169861,CDM,402,RC,76817,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Pelvic Complete,8102137,CDM,402,RC,76856,HCPCS,outpatient,,,"$1,061.00 ",$795.75 ,,$976.12 ,92,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$583.55 ,"$1,029.17 ",other,,Not applicable. No negotiated rates per contract,$912.46 ,86,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$848.80 ,80,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,007.95 ",95,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,007.95 ",95,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$795.75 ,75,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$901.85 ,85,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$954.90 ,90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$901.85 ,85,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$954.90 ,90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,007.95 ",90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$986.73 ,93,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Pelvic Ltd,8100934,CDM,402,RC,76857,HCPCS,outpatient,,,$901.00 ,$675.75 ,,$828.92 ,92,,,$495.55 ,$873.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.55 ,$873.97 ,other,,Not applicable. No negotiated rates per contract,$774.86 ,86,,,$495.55 ,$873.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.80 ,80,,,$495.55 ,$873.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.95 ,95,,,$495.55 ,$873.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.75 ,75,,,$495.55 ,$873.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.97 ,97,,,$495.55 ,$873.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.85 ,85,,,$495.55 ,$873.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.90 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.95 ,90,,,$495.55 ,$873.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.55 ,55,,,$495.55 ,$873.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.93 ,93,,,$495.55 ,$873.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Renal Artery Duplex Bilateral,4246822,CDM,921,RC,93975,HCPCS,outpatient,,,$791.00 ,$593.25 ,,$727.72 ,92,,,$435.05 ,$767.27 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$435.05 ,55,,,$435.05 ,$767.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$435.05 ,$767.27 ,other,,Not applicable. No negotiated rates per contract,$680.26 ,86,,,$435.05 ,$767.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$632.80 ,80,,,$435.05 ,$767.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$435.05 ,55,,,$435.05 ,$767.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$751.45 ,95,,,$435.05 ,$767.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$751.45 ,95,,,$435.05 ,$767.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$593.25 ,75,,,$435.05 ,$767.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$672.35 ,85,,,$435.05 ,$767.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$767.27 ,97,,,$435.05 ,$767.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$435.05 ,55,,,$435.05 ,$767.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$711.90 ,90,,,$435.05 ,$767.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$767.27 ,97,,,$435.05 ,$767.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$767.27 ,97,,,$435.05 ,$767.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$767.27 ,97,,,$435.05 ,$767.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$672.35 ,85,,,$435.05 ,$767.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$711.90 ,90,,,$435.05 ,$767.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$435.05 ,55,,,$435.05 ,$767.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$751.45 ,90,,,$435.05 ,$767.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$435.05 ,55,,,$435.05 ,$767.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$735.63 ,93,,,$435.05 ,$767.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Retroperitoneal Complete,1169867,CDM,402,RC,76770,HCPCS,outpatient,,,$968.00 ,$726.00 ,,$890.56 ,92,,,$532.40 ,$938.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$532.40 ,55,,,$532.40 ,$938.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$532.40 ,$938.96 ,other,,Not applicable. No negotiated rates per contract,$832.48 ,86,,,$532.40 ,$938.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$774.40 ,80,,,$532.40 ,$938.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$532.40 ,55,,,$532.40 ,$938.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$919.60 ,95,,,$532.40 ,$938.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$919.60 ,95,,,$532.40 ,$938.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$726.00 ,75,,,$532.40 ,$938.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$822.80 ,85,,,$532.40 ,$938.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$938.96 ,97,,,$532.40 ,$938.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$532.40 ,55,,,$532.40 ,$938.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$871.20 ,90,,,$532.40 ,$938.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$938.96 ,97,,,$532.40 ,$938.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$938.96 ,97,,,$532.40 ,$938.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$938.96 ,97,,,$532.40 ,$938.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$822.80 ,85,,,$532.40 ,$938.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$871.20 ,90,,,$532.40 ,$938.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$532.40 ,55,,,$532.40 ,$938.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$919.60 ,90,,,$532.40 ,$938.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$532.40 ,55,,,$532.40 ,$938.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$900.24 ,93,,,$532.40 ,$938.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Scrotum (Contents),8100937,CDM,402,RC,76870,HCPCS,outpatient,,,"$1,061.00 ",$795.75 ,,$976.12 ,92,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$583.55 ,"$1,029.17 ",other,,Not applicable. No negotiated rates per contract,$912.46 ,86,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$848.80 ,80,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,007.95 ",95,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,007.95 ",95,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$795.75 ,75,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$901.85 ,85,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$954.90 ,90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,029.17 ",97,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$901.85 ,85,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$954.90 ,90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,007.95 ",90,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$583.55 ,55,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$986.73 ,93,,,$583.55 ,"$1,029.17 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Transvaginal Non-OB,1169889,CDM,402,RC,76830,HCPCS,outpatient,,,"$1,127.00 ",$845.25 ,,"$1,036.84 ",92,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$619.85 ,55,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$619.85 ,"$1,093.19 ",other,,Not applicable. No negotiated rates per contract,$969.22 ,86,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$901.60 ,80,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$619.85 ,55,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,070.65 ",95,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,070.65 ",95,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$845.25 ,75,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$957.95 ,85,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,093.19 ",97,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$619.85 ,55,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,014.30 ",90,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,093.19 ",97,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,093.19 ",97,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,093.19 ",97,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$957.95 ,85,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,014.30 ",90,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$619.85 ,55,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,070.65 ",90,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$619.85 ,55,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,048.11 ",93,,,$619.85 ,"$1,093.19 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Unlisted Procedure,8367319,CDM,402,RC,76999,HCPCS,outpatient,,,$299.00 ,$224.25 ,,$275.08 ,92,,,$164.45 ,$290.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$164.45 ,$290.03 ,other,,Not applicable. No negotiated rates per contract,$257.14 ,86,,,$164.45 ,$290.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$239.20 ,80,,,$164.45 ,$290.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,95,,,$164.45 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.05 ,95,,,$164.45 ,$290.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.25 ,75,,,$164.45 ,$290.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$254.15 ,85,,,$164.45 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.10 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.03 ,97,,,$164.45 ,$290.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.15 ,85,,,$164.45 ,$290.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.10 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.05 ,90,,,$164.45 ,$290.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.45 ,55,,,$164.45 ,$290.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.07 ,93,,,$164.45 ,$290.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Arterial Duplex Bilateral,1169895,CDM,921,RC,93930,HCPCS,outpatient,,,"$1,405.00 ","$1,053.75 ",,"$1,292.60 ",92,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$772.75 ,55,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$772.75 ,"$1,362.85 ",other,,Not applicable. No negotiated rates per contract,"$1,208.30 ",86,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,124.00 ",80,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$772.75 ,55,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,334.75 ",95,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,334.75 ",95,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,053.75 ",75,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,194.25 ",85,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,362.85 ",97,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$772.75 ,55,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,264.50 ",90,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,362.85 ",97,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,362.85 ",97,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,362.85 ",97,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,194.25 ",85,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,264.50 ",90,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$772.75 ,55,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,334.75 ",90,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$772.75 ,55,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,306.65 ",93,,,$772.75 ,"$1,362.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Arterial Duplex Left,1169897,CDM,921,RC,93931,HCPCS,outpatient,,,$918.00 ,$688.50 ,,$844.56 ,92,,,$504.90 ,$890.46 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$504.90 ,$890.46 ,other,,Not applicable. No negotiated rates per contract,$789.48 ,86,,,$504.90 ,$890.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$734.40 ,80,,,$504.90 ,$890.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$872.10 ,95,,,$504.90 ,$890.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$872.10 ,95,,,$504.90 ,$890.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$688.50 ,75,,,$504.90 ,$890.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$780.30 ,85,,,$504.90 ,$890.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$826.20 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$780.30 ,85,,,$504.90 ,$890.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$826.20 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$872.10 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$853.74 ,93,,,$504.90 ,$890.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Arterial Duplex Right,1169899,CDM,921,RC,93931,HCPCS,outpatient,,,$918.00 ,$688.50 ,,$844.56 ,92,,,$504.90 ,$890.46 ,percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$504.90 ,$890.46 ,other,,Not applicable. No negotiated rates per contract,$789.48 ,86,,,$504.90 ,$890.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$734.40 ,80,,,$504.90 ,$890.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$872.10 ,95,,,$504.90 ,$890.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$872.10 ,95,,,$504.90 ,$890.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$688.50 ,75,,,$504.90 ,$890.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$780.30 ,85,,,$504.90 ,$890.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$826.20 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$890.46 ,97,,,$504.90 ,$890.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$780.30 ,85,,,$504.90 ,$890.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$826.20 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$872.10 ,90,,,$504.90 ,$890.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.90 ,55,,,$504.90 ,$890.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$853.74 ,93,,,$504.90 ,$890.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Venous Duplex Bilateral,1169901,CDM,921,RC,93970,HCPCS,outpatient,,,"$1,895.00 ","$1,421.25 ",,"$1,743.40 ",92,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.25 ","$1,838.15 ",other,,Not applicable. No negotiated rates per contract,"$1,629.70 ",86,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.00 ",80,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.25 ",95,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,800.25 ",95,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,421.25 ",75,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,610.75 ",85,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.50 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.15 ",97,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,610.75 ",85,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,705.50 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.25 ",90,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.25 ",55,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.35 ",93,,,"$1,042.25 ","$1,838.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Venous Duplex Left,1169903,CDM,921,RC,93971,HCPCS,outpatient,,,"$1,092.00 ",$819.00 ,,"$1,004.64 ",92,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$600.60 ,"$1,059.24 ",other,,Not applicable. No negotiated rates per contract,$939.12 ,86,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$873.60 ,80,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,037.40 ",95,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,037.40 ",95,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$819.00 ,75,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$928.20 ,85,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$982.80 ,90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$928.20 ,85,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$982.80 ,90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,037.40 ",90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,015.56 ",93,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,93% of total billed charges for outpatient setting
US Upper Ext Venous Duplex Right,1169905,CDM,921,RC,93971,HCPCS,outpatient,,,"$1,092.00 ",$819.00 ,,"$1,004.64 ",92,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,92% of billed charges for Vascular Diagnostic Studies rate,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$600.60 ,"$1,059.24 ",other,,Not applicable. No negotiated rates per contract,$939.12 ,86,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$873.60 ,80,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,037.40 ",95,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,037.40 ",95,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$819.00 ,75,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$928.20 ,85,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$982.80 ,90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,059.24 ",97,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$928.20 ,85,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$982.80 ,90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,037.40 ",90,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$600.60 ,55,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,015.56 ",93,,,$600.60 ,"$1,059.24 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR AC Joints Bilateral,1169922,CDM,320,RC,73050,HCPCS,outpatient,,,$404.00 ,$303.00 ,,$371.68 ,92,,,$222.20 ,$391.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.20 ,55,,,$222.20 ,$391.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.20 ,$391.88 ,other,,Not applicable. No negotiated rates per contract,$347.44 ,86,,,$222.20 ,$391.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$323.20 ,80,,,$222.20 ,$391.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.20 ,55,,,$222.20 ,$391.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.80 ,95,,,$222.20 ,$391.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$383.80 ,95,,,$222.20 ,$391.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.00 ,75,,,$222.20 ,$391.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$343.40 ,85,,,$222.20 ,$391.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.88 ,97,,,$222.20 ,$391.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.20 ,55,,,$222.20 ,$391.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.60 ,90,,,$222.20 ,$391.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.88 ,97,,,$222.20 ,$391.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.88 ,97,,,$222.20 ,$391.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.88 ,97,,,$222.20 ,$391.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$343.40 ,85,,,$222.20 ,$391.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$363.60 ,90,,,$222.20 ,$391.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.20 ,55,,,$222.20 ,$391.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.80 ,90,,,$222.20 ,$391.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.20 ,55,,,$222.20 ,$391.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.72 ,93,,,$222.20 ,$391.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Abdomen 1 View,8111091,CDM,320,RC,74018,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$189.75 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.75 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$189.75 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$189.75 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$189.75 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$189.75 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Abdomen 2 Views,8111094,CDM,320,RC,74019,HCPCS,outpatient,,,$401.00 ,$300.75 ,,$368.92 ,92,,,$220.55 ,$388.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.55 ,$388.97 ,other,,Not applicable. No negotiated rates per contract,$344.86 ,86,,,$220.55 ,$388.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.80 ,80,,,$220.55 ,$388.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.75 ,75,,,$220.55 ,$388.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.93 ,93,,,$220.55 ,$388.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Abdomen 3+ Views,8111097,CDM,320,RC,74021,HCPCS,outpatient,,,$514.00 ,$385.50 ,,$472.88 ,92,,,$282.70 ,$498.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$282.70 ,$498.58 ,other,,Not applicable. No negotiated rates per contract,$442.04 ,86,,,$282.70 ,$498.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$411.20 ,80,,,$282.70 ,$498.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.50 ,75,,,$282.70 ,$498.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.02 ,93,,,$282.70 ,$498.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Abdomen Series + Chest 1 View,1169932,CDM,320,RC,74022,HCPCS,outpatient,,,$514.00 ,$385.50 ,,$472.88 ,92,,,$282.70 ,$498.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$282.70 ,$498.58 ,other,,Not applicable. No negotiated rates per contract,$442.04 ,86,,,$282.70 ,$498.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$411.20 ,80,,,$282.70 ,$498.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$488.30 ,95,,,$282.70 ,$498.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$385.50 ,75,,,$282.70 ,$498.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$498.58 ,97,,,$282.70 ,$498.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$436.90 ,85,,,$282.70 ,$498.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.60 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.30 ,90,,,$282.70 ,$498.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.70 ,55,,,$282.70 ,$498.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.02 ,93,,,$282.70 ,$498.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ankle 2 Views Left,1169936,CDM,320,RC,73600,HCPCS,outpatient,,,$401.00 ,$300.75 ,,$368.92 ,92,,,$220.55 ,$388.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.55 ,$388.97 ,other,,Not applicable. No negotiated rates per contract,$344.86 ,86,,,$220.55 ,$388.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.80 ,80,,,$220.55 ,$388.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.75 ,75,,,$220.55 ,$388.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.93 ,93,,,$220.55 ,$388.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ankle 2 Views Right,1169938,CDM,320,RC,73600,HCPCS,outpatient,,,$401.00 ,$300.75 ,,$368.92 ,92,,,$220.55 ,$388.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.55 ,$388.97 ,other,,Not applicable. No negotiated rates per contract,$344.86 ,86,,,$220.55 ,$388.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.80 ,80,,,$220.55 ,$388.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.75 ,75,,,$220.55 ,$388.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.93 ,93,,,$220.55 ,$388.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ankle Complete 3+ Views Left,1169942,CDM,320,RC,73610,HCPCS,outpatient,,,$435.00 ,$326.25 ,,$400.20 ,92,,,$239.25 ,$421.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.25 ,$421.95 ,other,,Not applicable. No negotiated rates per contract,$374.10 ,86,,,$239.25 ,$421.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.00 ,80,,,$239.25 ,$421.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.25 ,75,,,$239.25 ,$421.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.55 ,93,,,$239.25 ,$421.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ankle Complete 3+ Views Right,1169944,CDM,320,RC,73610,HCPCS,outpatient,,,$435.00 ,$326.25 ,,$400.20 ,92,,,$239.25 ,$421.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.25 ,$421.95 ,other,,Not applicable. No negotiated rates per contract,$374.10 ,86,,,$239.25 ,$421.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.00 ,80,,,$239.25 ,$421.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.25 ,75,,,$239.25 ,$421.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.55 ,93,,,$239.25 ,$421.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Ankle SI Left,2425392,CDM,320,RC,73615,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Ankle SI Right,2425395,CDM,320,RC,73615,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Elbow Left,8127585,CDM,320,RC,73085,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Elbow Right,8127588,CDM,320,RC,73085,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Hip Left,8127591,CDM,320,RC,73525,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Hip Right,8127594,CDM,320,RC,73525,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Knee Left,8127597,CDM,320,RC,73580,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Knee Right,8127600,CDM,320,RC,73580,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Shoulder Left,8127603,CDM,320,RC,73040,HCPCS,outpatient,,,"$1,556.00 ","$1,167.00 ",,"$1,431.52 ",92,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$855.80 ,"$1,509.32 ",other,,Not applicable. No negotiated rates per contract,"$1,338.16 ",86,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,244.80 ",80,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,167.00 ",75,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,447.08 ",93,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Shoulder Right,8127606,CDM,320,RC,73040,HCPCS,outpatient,,,"$1,556.00 ","$1,167.00 ",,"$1,431.52 ",92,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$855.80 ,"$1,509.32 ",other,,Not applicable. No negotiated rates per contract,"$1,338.16 ",86,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,244.80 ",80,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,478.20 ",95,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,167.00 ",75,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,509.32 ",97,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,322.60 ",85,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,400.40 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,478.20 ",90,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$855.80 ,55,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,447.08 ",93,,,$855.80 ,"$1,509.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Wrist Left,8127609,CDM,320,RC,73115,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Arthrogram Wrist Right,8127612,CDM,320,RC,73115,HCPCS,outpatient,,,"$1,531.00 ","$1,148.25 ",,"$1,408.52 ",92,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$842.05 ,"$1,485.07 ",other,,Not applicable. No negotiated rates per contract,"$1,316.66 ",86,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,224.80 ",80,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,454.45 ",95,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,148.25 ",75,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,485.07 ",97,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,301.35 ",85,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,377.90 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,454.45 ",90,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$842.05 ,55,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,423.83 ",93,,,$842.05 ,"$1,485.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Bone Age Studies,1170014,CDM,320,RC,77072,HCPCS,outpatient,,,$384.00 ,$288.00 ,,$353.28 ,92,,,$211.20 ,$372.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$211.20 ,55,,,$211.20 ,$372.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$211.20 ,$372.48 ,other,,Not applicable. No negotiated rates per contract,$330.24 ,86,,,$211.20 ,$372.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$307.20 ,80,,,$211.20 ,$372.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$211.20 ,55,,,$211.20 ,$372.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.80 ,95,,,$211.20 ,$372.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$364.80 ,95,,,$211.20 ,$372.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$288.00 ,75,,,$211.20 ,$372.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$326.40 ,85,,,$211.20 ,$372.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.48 ,97,,,$211.20 ,$372.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.20 ,55,,,$211.20 ,$372.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.60 ,90,,,$211.20 ,$372.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$372.48 ,97,,,$211.20 ,$372.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$372.48 ,97,,,$211.20 ,$372.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$372.48 ,97,,,$211.20 ,$372.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.40 ,85,,,$211.20 ,$372.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$345.60 ,90,,,$211.20 ,$372.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$211.20 ,55,,,$211.20 ,$372.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.80 ,90,,,$211.20 ,$372.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$211.20 ,55,,,$211.20 ,$372.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.12 ,93,,,$211.20 ,$372.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Bone Age Studies Infant,8102140,CDM,320,RC,77076,HCPCS,outpatient,,,$395.00 ,$296.25 ,,$363.40 ,92,,,$217.25 ,$383.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$217.25 ,$383.15 ,other,,Not applicable. No negotiated rates per contract,$339.70 ,86,,,$217.25 ,$383.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$316.00 ,80,,,$217.25 ,$383.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.25 ,95,,,$217.25 ,$383.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$375.25 ,95,,,$217.25 ,$383.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.25 ,75,,,$217.25 ,$383.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$335.75 ,85,,,$217.25 ,$383.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.50 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.75 ,85,,,$217.25 ,$383.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$355.50 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.25 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$367.35 ,93,,,$217.25 ,$383.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Calcaneus Left,1170032,CDM,320,RC,73650,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$189.75 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.75 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$189.75 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$189.75 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$189.75 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$189.75 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Calcaneus Right,1170034,CDM,320,RC,73650,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$189.75 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.75 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$189.75 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$189.75 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$189.75 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$189.75 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Chest 1 View,8102143,CDM,320,RC,71045,HCPCS,outpatient,,,$316.00 ,$237.00 ,,$290.72 ,92,,,$173.80 ,$306.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$173.80 ,55,,,$173.80 ,$306.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$173.80 ,$306.52 ,other,,Not applicable. No negotiated rates per contract,$271.76 ,86,,,$173.80 ,$306.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$252.80 ,80,,,$173.80 ,$306.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$173.80 ,55,,,$173.80 ,$306.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.20 ,95,,,$173.80 ,$306.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.20 ,95,,,$173.80 ,$306.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.00 ,75,,,$173.80 ,$306.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$268.60 ,85,,,$173.80 ,$306.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.52 ,97,,,$173.80 ,$306.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.80 ,55,,,$173.80 ,$306.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.40 ,90,,,$173.80 ,$306.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.52 ,97,,,$173.80 ,$306.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.52 ,97,,,$173.80 ,$306.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.52 ,97,,,$173.80 ,$306.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.60 ,85,,,$173.80 ,$306.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.40 ,90,,,$173.80 ,$306.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.80 ,55,,,$173.80 ,$306.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.20 ,90,,,$173.80 ,$306.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.80 ,55,,,$173.80 ,$306.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.88 ,93,,,$173.80 ,$306.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Chest 2 Views,689607,CDM,320,RC,71046,HCPCS,outpatient,,,$471.00 ,$353.25 ,,$433.32 ,92,,,$259.05 ,$456.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$259.05 ,55,,,$259.05 ,$456.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$259.05 ,$456.87 ,other,,Not applicable. No negotiated rates per contract,$405.06 ,86,,,$259.05 ,$456.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$376.80 ,80,,,$259.05 ,$456.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$259.05 ,55,,,$259.05 ,$456.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.45 ,95,,,$259.05 ,$456.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$447.45 ,95,,,$259.05 ,$456.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.25 ,75,,,$259.05 ,$456.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$400.35 ,85,,,$259.05 ,$456.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$456.87 ,97,,,$259.05 ,$456.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.05 ,55,,,$259.05 ,$456.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$423.90 ,90,,,$259.05 ,$456.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$456.87 ,97,,,$259.05 ,$456.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$456.87 ,97,,,$259.05 ,$456.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$456.87 ,97,,,$259.05 ,$456.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$400.35 ,85,,,$259.05 ,$456.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$423.90 ,90,,,$259.05 ,$456.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.05 ,55,,,$259.05 ,$456.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.45 ,90,,,$259.05 ,$456.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.05 ,55,,,$259.05 ,$456.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.03 ,93,,,$259.05 ,$456.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Chest 3 Views,8111100,CDM,320,RC,71047,HCPCS,outpatient,,,$476.00 ,$357.00 ,,$437.92 ,92,,,$261.80 ,$461.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.80 ,$461.72 ,other,,Not applicable. No negotiated rates per contract,$409.36 ,86,,,$261.80 ,$461.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$380.80 ,80,,,$261.80 ,$461.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.20 ,95,,,$261.80 ,$461.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.20 ,95,,,$261.80 ,$461.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.00 ,75,,,$261.80 ,$461.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$404.60 ,85,,,$261.80 ,$461.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.40 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.72 ,97,,,$261.80 ,$461.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.60 ,85,,,$261.80 ,$461.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$428.40 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.20 ,90,,,$261.80 ,$461.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.80 ,55,,,$261.80 ,$461.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.68 ,93,,,$261.80 ,$461.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Chest 4+ Views,1170053,CDM,320,RC,71048,HCPCS,outpatient,,,$562.00 ,$421.50 ,,$517.04 ,92,,,$309.10 ,$545.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.10 ,55,,,$309.10 ,$545.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$309.10 ,$545.14 ,other,,Not applicable. No negotiated rates per contract,$483.32 ,86,,,$309.10 ,$545.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$449.60 ,80,,,$309.10 ,$545.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.10 ,55,,,$309.10 ,$545.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$533.90 ,95,,,$309.10 ,$545.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$533.90 ,95,,,$309.10 ,$545.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$421.50 ,75,,,$309.10 ,$545.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$477.70 ,85,,,$309.10 ,$545.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$545.14 ,97,,,$309.10 ,$545.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.10 ,55,,,$309.10 ,$545.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$505.80 ,90,,,$309.10 ,$545.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.14 ,97,,,$309.10 ,$545.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.14 ,97,,,$309.10 ,$545.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.14 ,97,,,$309.10 ,$545.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.70 ,85,,,$309.10 ,$545.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$505.80 ,90,,,$309.10 ,$545.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.10 ,55,,,$309.10 ,$545.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$533.90 ,90,,,$309.10 ,$545.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.10 ,55,,,$309.10 ,$545.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$522.66 ,93,,,$309.10 ,$545.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Chest Decubitus,1170049,CDM,320,RC,71035,HCPCS,outpatient,,,$410.00 ,$307.50 ,,$377.20 ,92,,,$225.50 ,$397.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$225.50 ,55,,,$225.50 ,$397.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$225.50 ,$397.70 ,other,,Not applicable. No negotiated rates per contract,$352.60 ,86,,,$225.50 ,$397.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$328.00 ,80,,,$225.50 ,$397.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$225.50 ,55,,,$225.50 ,$397.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.50 ,95,,,$225.50 ,$397.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$389.50 ,95,,,$225.50 ,$397.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$307.50 ,75,,,$225.50 ,$397.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$348.50 ,85,,,$225.50 ,$397.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$397.70 ,97,,,$225.50 ,$397.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.50 ,55,,,$225.50 ,$397.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$369.00 ,90,,,$225.50 ,$397.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$397.70 ,97,,,$225.50 ,$397.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.70 ,97,,,$225.50 ,$397.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.70 ,97,,,$225.50 ,$397.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$348.50 ,85,,,$225.50 ,$397.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$369.00 ,90,,,$225.50 ,$397.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.50 ,55,,,$225.50 ,$397.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.50 ,90,,,$225.50 ,$397.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.50 ,55,,,$225.50 ,$397.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.30 ,93,,,$225.50 ,$397.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Clavicle Left,1170075,CDM,320,RC,73000,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$189.75 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.75 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$189.75 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$189.75 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$189.75 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$189.75 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Clavicle Right,1170077,CDM,320,RC,73000,HCPCS,outpatient,,,$345.00 ,$258.75 ,,$317.40 ,92,,,$189.75 ,$334.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.75 ,$334.65 ,other,,Not applicable. No negotiated rates per contract,$296.70 ,86,,,$189.75 ,$334.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.00 ,80,,,$189.75 ,$334.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,95,,,$189.75 ,$334.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.75 ,75,,,$189.75 ,$334.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.65 ,97,,,$189.75 ,$334.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$293.25 ,85,,,$189.75 ,$334.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.50 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.75 ,90,,,$189.75 ,$334.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.75 ,55,,,$189.75 ,$334.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.85 ,93,,,$189.75 ,$334.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Elbow 2 Views Left,1170121,CDM,320,RC,73070,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Elbow 2 Views Right,1170123,CDM,320,RC,73070,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Elbow Complete 3+ Views Left,1170127,CDM,320,RC,73080,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Elbow Complete 3+ Views Right,1170129,CDM,320,RC,73080,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Esophagus,1170137,CDM,320,RC,74220,HCPCS,outpatient,,,$837.00 ,$627.75 ,,$770.04 ,92,,,$460.35 ,$811.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$460.35 ,55,,,$460.35 ,$811.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$460.35 ,$811.89 ,other,,Not applicable. No negotiated rates per contract,$719.82 ,86,,,$460.35 ,$811.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$669.60 ,80,,,$460.35 ,$811.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$460.35 ,55,,,$460.35 ,$811.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$795.15 ,95,,,$460.35 ,$811.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$795.15 ,95,,,$460.35 ,$811.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$627.75 ,75,,,$460.35 ,$811.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$711.45 ,85,,,$460.35 ,$811.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$811.89 ,97,,,$460.35 ,$811.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.35 ,55,,,$460.35 ,$811.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$753.30 ,90,,,$460.35 ,$811.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$811.89 ,97,,,$460.35 ,$811.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$811.89 ,97,,,$460.35 ,$811.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$811.89 ,97,,,$460.35 ,$811.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$711.45 ,85,,,$460.35 ,$811.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$753.30 ,90,,,$460.35 ,$811.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.35 ,55,,,$460.35 ,$811.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$795.15 ,90,,,$460.35 ,$811.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.35 ,55,,,$460.35 ,$811.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$778.41 ,93,,,$460.35 ,$811.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv1 Left,2425473,CDM,761,RC,64493,HCPCS,outpatient,,,"$2,534.00 ","$1,900.50 ",,"$2,331.28 ",92,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,393.70 ","$2,457.98 ",other,,Not applicable. No negotiated rates per contract,"$2,179.24 ",86,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,027.20 ",80,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,900.50 ",75,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,356.62 ",93,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv1 Right,2425476,CDM,761,RC,64493,HCPCS,outpatient,,,"$2,534.00 ","$1,900.50 ",,"$2,331.28 ",92,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,393.70 ","$2,457.98 ",other,,Not applicable. No negotiated rates per contract,"$2,179.24 ",86,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,027.20 ",80,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,900.50 ",75,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,356.62 ",93,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv2 Left,2425479,CDM,761,RC,64494,HCPCS,outpatient,,,$178.00 ,$133.50 ,,$163.76 ,92,,,$97.90 ,$172.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.90 ,$172.66 ,other,,Not applicable. No negotiated rates per contract,$153.08 ,86,,,$97.90 ,$172.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.40 ,80,,,$97.90 ,$172.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.50 ,75,,,$97.90 ,$172.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.54 ,93,,,$97.90 ,$172.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv2 Right,2425482,CDM,761,RC,64494,HCPCS,outpatient,,,$178.00 ,$133.50 ,,$163.76 ,92,,,$97.90 ,$172.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.90 ,$172.66 ,other,,Not applicable. No negotiated rates per contract,$153.08 ,86,,,$97.90 ,$172.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.40 ,80,,,$97.90 ,$172.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.50 ,75,,,$97.90 ,$172.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.54 ,93,,,$97.90 ,$172.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv3+ Left,2425485,CDM,761,RC,64495,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$99.00 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$99.00 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$154.80 ,86,,,$99.00 ,$174.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$144.00 ,80,,,$99.00 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$99.00 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$99.00 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv3+ Right,2425488,CDM,761,RC,64495,HCPCS,outpatient,,,$180.00 ,$135.00 ,,$165.60 ,92,,,$99.00 ,$174.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$99.00 ,$174.60 ,other,,Not applicable. No negotiated rates per contract,$154.80 ,86,,,$99.00 ,$174.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$144.00 ,80,,,$99.00 ,$174.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$171.00 ,95,,,$99.00 ,$174.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.00 ,75,,,$99.00 ,$174.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.60 ,97,,,$99.00 ,$174.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.00 ,85,,,$99.00 ,$174.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$162.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.00 ,90,,,$99.00 ,$174.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.00 ,55,,,$99.00 ,$174.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,93,,,$99.00 ,$174.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv1 Bilat,8207978,CDM,761,RC,64493,HCPCS,outpatient,,,"$2,534.00 ","$1,900.50 ",,"$2,331.28 ",92,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,393.70 ","$2,457.98 ",other,,Not applicable. No negotiated rates per contract,"$2,179.24 ",86,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,027.20 ",80,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,407.30 ",95,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,900.50 ",75,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,457.98 ",97,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,153.90 ",85,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,280.60 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,407.30 ",90,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,393.70 ",55,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,356.62 ",93,,,"$1,393.70 ","$2,457.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv2 Bilat,8207981,CDM,761,RC,64494,HCPCS,outpatient,,,$178.00 ,$133.50 ,,$163.76 ,92,,,$97.90 ,$172.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.90 ,$172.66 ,other,,Not applicable. No negotiated rates per contract,$153.08 ,86,,,$97.90 ,$172.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.40 ,80,,,$97.90 ,$172.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.10 ,95,,,$97.90 ,$172.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.50 ,75,,,$97.90 ,$172.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.66 ,97,,,$97.90 ,$172.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.30 ,85,,,$97.90 ,$172.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.20 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.10 ,90,,,$97.90 ,$172.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.90 ,55,,,$97.90 ,$172.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.54 ,93,,,$97.90 ,$172.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facet Injection Lumb/Sacr Lv3+ Bilat,8207984,CDM,761,RC,64495,HCPCS,outpatient,,,$359.00 ,$269.25 ,,$330.28 ,92,,,$197.45 ,$348.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$197.45 ,55,,,$197.45 ,$348.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$197.45 ,$348.23 ,other,,Not applicable. No negotiated rates per contract,$308.74 ,86,,,$197.45 ,$348.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$287.20 ,80,,,$197.45 ,$348.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$197.45 ,55,,,$197.45 ,$348.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.05 ,95,,,$197.45 ,$348.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$341.05 ,95,,,$197.45 ,$348.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.25 ,75,,,$197.45 ,$348.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$305.15 ,85,,,$197.45 ,$348.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$348.23 ,97,,,$197.45 ,$348.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.45 ,55,,,$197.45 ,$348.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.10 ,90,,,$197.45 ,$348.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$348.23 ,97,,,$197.45 ,$348.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$348.23 ,97,,,$197.45 ,$348.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$348.23 ,97,,,$197.45 ,$348.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$305.15 ,85,,,$197.45 ,$348.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$323.10 ,90,,,$197.45 ,$348.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.45 ,55,,,$197.45 ,$348.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.05 ,90,,,$197.45 ,$348.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.45 ,55,,,$197.45 ,$348.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$333.87 ,93,,,$197.45 ,$348.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facial Bones 3+ Views,1170141,CDM,320,RC,70150,HCPCS,outpatient,,,$430.00 ,$322.50 ,,$395.60 ,92,,,$236.50 ,$417.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$236.50 ,$417.10 ,other,,Not applicable. No negotiated rates per contract,$369.80 ,86,,,$236.50 ,$417.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$344.00 ,80,,,$236.50 ,$417.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.50 ,95,,,$236.50 ,$417.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$408.50 ,95,,,$236.50 ,$417.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$322.50 ,75,,,$236.50 ,$417.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$365.50 ,85,,,$236.50 ,$417.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.00 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.50 ,85,,,$236.50 ,$417.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.00 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.50 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.90 ,93,,,$236.50 ,$417.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Facial Bones < 3 Views,1170139,CDM,320,RC,70140,HCPCS,outpatient,,,$374.00 ,$280.50 ,,$344.08 ,92,,,$205.70 ,$362.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.70 ,$362.78 ,other,,Not applicable. No negotiated rates per contract,$321.64 ,86,,,$205.70 ,$362.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$299.20 ,80,,,$205.70 ,$362.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,95,,,$205.70 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$355.30 ,95,,,$205.70 ,$362.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$280.50 ,75,,,$205.70 ,$362.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.90 ,85,,,$205.70 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$336.60 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$362.78 ,97,,,$205.70 ,$362.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.90 ,85,,,$205.70 ,$362.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$336.60 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.30 ,90,,,$205.70 ,$362.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.70 ,55,,,$205.70 ,$362.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.82 ,93,,,$205.70 ,$362.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Femur 1 View Left,7520564,CDM,320,RC,73551,HCPCS,outpatient,,,$329.00 ,$246.75 ,,$302.68 ,92,,,$180.95 ,$319.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$180.95 ,$319.13 ,other,,Not applicable. No negotiated rates per contract,$282.94 ,86,,,$180.95 ,$319.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$263.20 ,80,,,$180.95 ,$319.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.55 ,95,,,$180.95 ,$319.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.55 ,95,,,$180.95 ,$319.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.75 ,75,,,$180.95 ,$319.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$279.65 ,85,,,$180.95 ,$319.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.10 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.65 ,85,,,$180.95 ,$319.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$296.10 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.55 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$305.97 ,93,,,$180.95 ,$319.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Femur 1 View Right,7520567,CDM,320,RC,73551,HCPCS,outpatient,,,$329.00 ,$246.75 ,,$302.68 ,92,,,$180.95 ,$319.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$180.95 ,$319.13 ,other,,Not applicable. No negotiated rates per contract,$282.94 ,86,,,$180.95 ,$319.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$263.20 ,80,,,$180.95 ,$319.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.55 ,95,,,$180.95 ,$319.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.55 ,95,,,$180.95 ,$319.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.75 ,75,,,$180.95 ,$319.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$279.65 ,85,,,$180.95 ,$319.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.10 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.13 ,97,,,$180.95 ,$319.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.65 ,85,,,$180.95 ,$319.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$296.10 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.55 ,90,,,$180.95 ,$319.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.95 ,55,,,$180.95 ,$319.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$305.97 ,93,,,$180.95 ,$319.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Femur 2 Views Left,7520570,CDM,320,RC,73552,HCPCS,outpatient,,,$454.00 ,$340.50 ,,$417.68 ,92,,,$249.70 ,$440.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$249.70 ,$440.38 ,other,,Not applicable. No negotiated rates per contract,$390.44 ,86,,,$249.70 ,$440.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$363.20 ,80,,,$249.70 ,$440.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,95,,,$249.70 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.30 ,95,,,$249.70 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$340.50 ,75,,,$249.70 ,$440.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$385.90 ,85,,,$249.70 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.60 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.90 ,85,,,$249.70 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$408.60 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$422.22 ,93,,,$249.70 ,$440.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Femur 2 Views Right,7520573,CDM,320,RC,73552,HCPCS,outpatient,,,$454.00 ,$340.50 ,,$417.68 ,92,,,$249.70 ,$440.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$249.70 ,$440.38 ,other,,Not applicable. No negotiated rates per contract,$390.44 ,86,,,$249.70 ,$440.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$363.20 ,80,,,$249.70 ,$440.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,95,,,$249.70 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.30 ,95,,,$249.70 ,$440.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$340.50 ,75,,,$249.70 ,$440.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$385.90 ,85,,,$249.70 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.60 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$440.38 ,97,,,$249.70 ,$440.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.90 ,85,,,$249.70 ,$440.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$408.60 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.30 ,90,,,$249.70 ,$440.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.70 ,55,,,$249.70 ,$440.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$422.22 ,93,,,$249.70 ,$440.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Finger(s) 2+ Views Left,8111106,CDM,320,RC,73140,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Finger(s) 2+ Views Right,8111108,CDM,320,RC,73140,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Fluoro Guidance Needle Loc Spine,1170173,CDM,761,RC,62323,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Fluoro Guidance Needle Placement,1170175,CDM,320,RC,77002,HCPCS,outpatient,,,$912.00 ,$684.00 ,,$839.04 ,92,,,$501.60 ,$884.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$501.60 ,55,,,$501.60 ,$884.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$501.60 ,$884.64 ,other,,Not applicable. No negotiated rates per contract,$784.32 ,86,,,$501.60 ,$884.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$729.60 ,80,,,$501.60 ,$884.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$501.60 ,55,,,$501.60 ,$884.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$866.40 ,95,,,$501.60 ,$884.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$866.40 ,95,,,$501.60 ,$884.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$684.00 ,75,,,$501.60 ,$884.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$775.20 ,85,,,$501.60 ,$884.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.64 ,97,,,$501.60 ,$884.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$501.60 ,55,,,$501.60 ,$884.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$820.80 ,90,,,$501.60 ,$884.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$884.64 ,97,,,$501.60 ,$884.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$884.64 ,97,,,$501.60 ,$884.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$884.64 ,97,,,$501.60 ,$884.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$775.20 ,85,,,$501.60 ,$884.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$820.80 ,90,,,$501.60 ,$884.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$501.60 ,55,,,$501.60 ,$884.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$866.40 ,90,,,$501.60 ,$884.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$501.60 ,55,,,$501.60 ,$884.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$848.16 ,93,,,$501.60 ,$884.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Fluoro Guidance Needle Loc Spine EO,8585363,CDM,320,RC,77003,HCPCS,outpatient,,,"$1,031.00 ",$773.25 ,,$948.52 ,92,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$567.05 ,"$1,000.07 ",other,,Not applicable. No negotiated rates per contract,$886.66 ,86,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$824.80 ,80,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$979.45 ,95,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$979.45 ,95,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$773.25 ,75,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$876.35 ,85,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$927.90 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.35 ,85,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$927.90 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$979.45 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$958.83 ,93,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Fluoroscopy Under 1 Hour EO,8111113,CDM,320,RC,76000,HCPCS,outpatient,,,$836.00 ,$627.00 ,,$769.12 ,92,,,$459.80 ,$810.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$459.80 ,$810.92 ,other,,Not applicable. No negotiated rates per contract,$718.96 ,86,,,$459.80 ,$810.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$668.80 ,80,,,$459.80 ,$810.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$794.20 ,95,,,$459.80 ,$810.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$794.20 ,95,,,$459.80 ,$810.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$627.00 ,75,,,$459.80 ,$810.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$710.60 ,85,,,$459.80 ,$810.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$752.40 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$810.92 ,97,,,$459.80 ,$810.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.60 ,85,,,$459.80 ,$810.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$752.40 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$794.20 ,90,,,$459.80 ,$810.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$459.80 ,55,,,$459.80 ,$810.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$777.48 ,93,,,$459.80 ,$810.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Foot 2 Views Left,1170185,CDM,320,RC,73620,HCPCS,outpatient,,,$325.00 ,$243.75 ,,$299.00 ,92,,,$178.75 ,$315.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$178.75 ,$315.25 ,other,,Not applicable. No negotiated rates per contract,$279.50 ,86,,,$178.75 ,$315.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$260.00 ,80,,,$178.75 ,$315.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.75 ,75,,,$178.75 ,$315.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.25 ,93,,,$178.75 ,$315.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Foot 2 Views Right,1170187,CDM,320,RC,73620,HCPCS,outpatient,,,$325.00 ,$243.75 ,,$299.00 ,92,,,$178.75 ,$315.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$178.75 ,$315.25 ,other,,Not applicable. No negotiated rates per contract,$279.50 ,86,,,$178.75 ,$315.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$260.00 ,80,,,$178.75 ,$315.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.75 ,75,,,$178.75 ,$315.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.25 ,93,,,$178.75 ,$315.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Foot Complete 3+ Views Left,1170191,CDM,320,RC,73630,HCPCS,outpatient,,,$435.00 ,$326.25 ,,$400.20 ,92,,,$239.25 ,$421.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.25 ,$421.95 ,other,,Not applicable. No negotiated rates per contract,$374.10 ,86,,,$239.25 ,$421.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.00 ,80,,,$239.25 ,$421.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.25 ,75,,,$239.25 ,$421.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.55 ,93,,,$239.25 ,$421.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Foot Complete 3+ Views Right,1170193,CDM,320,RC,73630,HCPCS,outpatient,,,$435.00 ,$326.25 ,,$400.20 ,92,,,$239.25 ,$421.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.25 ,$421.95 ,other,,Not applicable. No negotiated rates per contract,$374.10 ,86,,,$239.25 ,$421.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.00 ,80,,,$239.25 ,$421.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.25 ,75,,,$239.25 ,$421.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.55 ,93,,,$239.25 ,$421.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Forearm 2 Views Left,1170197,CDM,320,RC,73090,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Forearm 2 Views Right,1170199,CDM,320,RC,73090,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Foreign Body Localization Eye,1170203,CDM,320,RC,70030,HCPCS,outpatient,,,$234.00 ,$175.50 ,,$215.28 ,92,,,$128.70 ,$226.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.70 ,$226.98 ,other,,Not applicable. No negotiated rates per contract,$201.24 ,86,,,$128.70 ,$226.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$187.20 ,80,,,$128.70 ,$226.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,95,,,$128.70 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.30 ,95,,,$128.70 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.50 ,75,,,$128.70 ,$226.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.90 ,85,,,$128.70 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.60 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.90 ,85,,,$128.70 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.60 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$217.62 ,93,,,$128.70 ,$226.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hand 2 Views Left,1170215,CDM,320,RC,73120,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hand 2 Views Right,1170217,CDM,320,RC,73120,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hand Complete 3+ Views Left,1170221,CDM,320,RC,73130,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hand Complete 3+ Views Right,1170223,CDM,320,RC,73130,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hip 1 View Left,1170225,CDM,320,RC,73501,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hip 1 View Right,1170227,CDM,320,RC,73501,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hip 2-3 Views w/AP Pelvis Left,7520588,CDM,320,RC,73502,HCPCS,outpatient,,,$494.00 ,$370.50 ,,$454.48 ,92,,,$271.70 ,$479.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$271.70 ,$479.18 ,other,,Not applicable. No negotiated rates per contract,$424.84 ,86,,,$271.70 ,$479.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$395.20 ,80,,,$271.70 ,$479.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.30 ,95,,,$271.70 ,$479.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$469.30 ,95,,,$271.70 ,$479.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$370.50 ,75,,,$271.70 ,$479.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$419.90 ,85,,,$271.70 ,$479.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.60 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.90 ,85,,,$271.70 ,$479.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$444.60 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.30 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.42 ,93,,,$271.70 ,$479.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hip 2-3 Views w/AP Pelvis Right,7520591,CDM,320,RC,73502,HCPCS,outpatient,,,$494.00 ,$370.50 ,,$454.48 ,92,,,$271.70 ,$479.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$271.70 ,$479.18 ,other,,Not applicable. No negotiated rates per contract,$424.84 ,86,,,$271.70 ,$479.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$395.20 ,80,,,$271.70 ,$479.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.30 ,95,,,$271.70 ,$479.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$469.30 ,95,,,$271.70 ,$479.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$370.50 ,75,,,$271.70 ,$479.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$419.90 ,85,,,$271.70 ,$479.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.60 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.18 ,97,,,$271.70 ,$479.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.90 ,85,,,$271.70 ,$479.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$444.60 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.30 ,90,,,$271.70 ,$479.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.70 ,55,,,$271.70 ,$479.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.42 ,93,,,$271.70 ,$479.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Hips 2 Views Bilat,7520606,CDM,320,RC,73521,HCPCS,outpatient,,,$559.00 ,$419.25 ,,$514.28 ,92,,,$307.45 ,$542.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$307.45 ,$542.23 ,other,,Not applicable. No negotiated rates per contract,$480.74 ,86,,,$307.45 ,$542.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$447.20 ,80,,,$307.45 ,$542.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$531.05 ,95,,,$307.45 ,$542.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$531.05 ,95,,,$307.45 ,$542.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$419.25 ,75,,,$307.45 ,$542.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$475.15 ,85,,,$307.45 ,$542.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$503.10 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$475.15 ,85,,,$307.45 ,$542.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$503.10 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$531.05 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.87 ,93,,,$307.45 ,$542.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Humerus Left,1170245,CDM,320,RC,73060,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Humerus Right,1170247,CDM,320,RC,73060,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee 1 View Standing AP Bilateral,1170291,CDM,320,RC,73565,HCPCS,outpatient,,,$376.00 ,$282.00 ,,$345.92 ,92,,,$206.80 ,$364.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$206.80 ,55,,,$206.80 ,$364.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$206.80 ,$364.72 ,other,,Not applicable. No negotiated rates per contract,$323.36 ,86,,,$206.80 ,$364.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$300.80 ,80,,,$206.80 ,$364.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$206.80 ,55,,,$206.80 ,$364.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.20 ,95,,,$206.80 ,$364.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.20 ,95,,,$206.80 ,$364.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.00 ,75,,,$206.80 ,$364.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$319.60 ,85,,,$206.80 ,$364.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.72 ,97,,,$206.80 ,$364.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.80 ,55,,,$206.80 ,$364.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.40 ,90,,,$206.80 ,$364.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$364.72 ,97,,,$206.80 ,$364.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.72 ,97,,,$206.80 ,$364.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$364.72 ,97,,,$206.80 ,$364.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.60 ,85,,,$206.80 ,$364.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$338.40 ,90,,,$206.80 ,$364.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.80 ,55,,,$206.80 ,$364.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.20 ,90,,,$206.80 ,$364.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.80 ,55,,,$206.80 ,$364.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$349.68 ,93,,,$206.80 ,$364.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee 1 or 2 Views Left,1170263,CDM,320,RC,73560,HCPCS,outpatient,,,$475.00 ,$356.25 ,,$437.00 ,92,,,$261.25 ,$460.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.25 ,$460.75 ,other,,Not applicable. No negotiated rates per contract,$408.50 ,86,,,$261.25 ,$460.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$380.00 ,80,,,$261.25 ,$460.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.25 ,95,,,$261.25 ,$460.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$451.25 ,95,,,$261.25 ,$460.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.25 ,75,,,$261.25 ,$460.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$403.75 ,85,,,$261.25 ,$460.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$427.50 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.75 ,85,,,$261.25 ,$460.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$427.50 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.25 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.75 ,93,,,$261.25 ,$460.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee 1 or 2 Views Right,1170265,CDM,320,RC,73560,HCPCS,outpatient,,,$475.00 ,$356.25 ,,$437.00 ,92,,,$261.25 ,$460.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.25 ,$460.75 ,other,,Not applicable. No negotiated rates per contract,$408.50 ,86,,,$261.25 ,$460.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$380.00 ,80,,,$261.25 ,$460.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.25 ,95,,,$261.25 ,$460.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$451.25 ,95,,,$261.25 ,$460.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.25 ,75,,,$261.25 ,$460.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$403.75 ,85,,,$261.25 ,$460.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$427.50 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.75 ,97,,,$261.25 ,$460.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.75 ,85,,,$261.25 ,$460.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$427.50 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.25 ,90,,,$261.25 ,$460.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.25 ,55,,,$261.25 ,$460.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.75 ,93,,,$261.25 ,$460.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee 3 Views Left,1170269,CDM,320,RC,73562,HCPCS,outpatient,,,$495.00 ,$371.25 ,,$455.40 ,92,,,$272.25 ,$480.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$272.25 ,$480.15 ,other,,Not applicable. No negotiated rates per contract,$425.70 ,86,,,$272.25 ,$480.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$396.00 ,80,,,$272.25 ,$480.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.25 ,75,,,$272.25 ,$480.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.35 ,93,,,$272.25 ,$480.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee 3 Views Right,1170271,CDM,320,RC,73562,HCPCS,outpatient,,,$495.00 ,$371.25 ,,$455.40 ,92,,,$272.25 ,$480.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$272.25 ,$480.15 ,other,,Not applicable. No negotiated rates per contract,$425.70 ,86,,,$272.25 ,$480.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$396.00 ,80,,,$272.25 ,$480.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$470.25 ,95,,,$272.25 ,$480.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.25 ,75,,,$272.25 ,$480.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.15 ,97,,,$272.25 ,$480.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$420.75 ,85,,,$272.25 ,$480.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.50 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.25 ,90,,,$272.25 ,$480.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.25 ,55,,,$272.25 ,$480.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.35 ,93,,,$272.25 ,$480.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee Complete 4+ Views Left,1170287,CDM,320,RC,73564,HCPCS,outpatient,,,$555.00 ,$416.25 ,,$510.60 ,92,,,$305.25 ,$538.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$305.25 ,$538.35 ,other,,Not applicable. No negotiated rates per contract,$477.30 ,86,,,$305.25 ,$538.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$444.00 ,80,,,$305.25 ,$538.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$416.25 ,75,,,$305.25 ,$538.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$516.15 ,93,,,$305.25 ,$538.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Knee Complete 4+ Views Right,1170289,CDM,320,RC,73564,HCPCS,outpatient,,,$555.00 ,$416.25 ,,$510.60 ,92,,,$305.25 ,$538.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$305.25 ,$538.35 ,other,,Not applicable. No negotiated rates per contract,$477.30 ,86,,,$305.25 ,$538.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$444.00 ,80,,,$305.25 ,$538.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$416.25 ,75,,,$305.25 ,$538.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$516.15 ,93,,,$305.25 ,$538.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Lower Extremity Infant (0-1yr) Left,1170297,CDM,320,RC,73592,HCPCS,outpatient,,,$291.00 ,$218.25 ,,$267.72 ,92,,,$160.05 ,$282.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$160.05 ,$282.27 ,other,,Not applicable. No negotiated rates per contract,$250.26 ,86,,,$160.05 ,$282.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$232.80 ,80,,,$160.05 ,$282.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,95,,,$160.05 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$276.45 ,95,,,$160.05 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$218.25 ,75,,,$160.05 ,$282.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$247.35 ,85,,,$160.05 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.90 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,85,,,$160.05 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.90 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.63 ,93,,,$160.05 ,$282.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Lower Extremity Infant (0-1yr) Right,1170299,CDM,320,RC,73592,HCPCS,outpatient,,,$291.00 ,$218.25 ,,$267.72 ,92,,,$160.05 ,$282.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$160.05 ,$282.27 ,other,,Not applicable. No negotiated rates per contract,$250.26 ,86,,,$160.05 ,$282.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$232.80 ,80,,,$160.05 ,$282.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,95,,,$160.05 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$276.45 ,95,,,$160.05 ,$282.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$218.25 ,75,,,$160.05 ,$282.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$247.35 ,85,,,$160.05 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.90 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.27 ,97,,,$160.05 ,$282.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,85,,,$160.05 ,$282.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.90 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.45 ,90,,,$160.05 ,$282.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.05 ,55,,,$160.05 ,$282.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.63 ,93,,,$160.05 ,$282.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Mandible Complete 4+ Views,1170301,CDM,320,RC,70110,HCPCS,outpatient,,,$421.00 ,$315.75 ,,$387.32 ,92,,,$231.55 ,$408.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$231.55 ,55,,,$231.55 ,$408.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$231.55 ,$408.37 ,other,,Not applicable. No negotiated rates per contract,$362.06 ,86,,,$231.55 ,$408.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$336.80 ,80,,,$231.55 ,$408.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$231.55 ,55,,,$231.55 ,$408.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.95 ,95,,,$231.55 ,$408.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$399.95 ,95,,,$231.55 ,$408.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.75 ,75,,,$231.55 ,$408.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$357.85 ,85,,,$231.55 ,$408.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$408.37 ,97,,,$231.55 ,$408.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.55 ,55,,,$231.55 ,$408.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.90 ,90,,,$231.55 ,$408.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$408.37 ,97,,,$231.55 ,$408.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$408.37 ,97,,,$231.55 ,$408.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$408.37 ,97,,,$231.55 ,$408.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$357.85 ,85,,,$231.55 ,$408.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$378.90 ,90,,,$231.55 ,$408.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.55 ,55,,,$231.55 ,$408.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.95 ,90,,,$231.55 ,$408.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.55 ,55,,,$231.55 ,$408.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.53 ,93,,,$231.55 ,$408.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Mandible Less Than 4 Views,1170303,CDM,320,RC,70100,HCPCS,outpatient,,,$255.00 ,$191.25 ,,$234.60 ,92,,,$140.25 ,$247.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$140.25 ,$247.35 ,other,,Not applicable. No negotiated rates per contract,$219.30 ,86,,,$140.25 ,$247.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$204.00 ,80,,,$140.25 ,$247.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.25 ,95,,,$140.25 ,$247.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$242.25 ,95,,,$140.25 ,$247.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$191.25 ,75,,,$140.25 ,$247.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$216.75 ,85,,,$140.25 ,$247.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$229.50 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.75 ,85,,,$140.25 ,$247.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$229.50 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.25 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.15 ,93,,,$140.25 ,$247.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Myelogram Injection,2425581,CDM,320,RC,77003,HCPCS,outpatient,,,"$1,031.00 ",$773.25 ,,$948.52 ,92,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$567.05 ,"$1,000.07 ",other,,Not applicable. No negotiated rates per contract,$886.66 ,86,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$824.80 ,80,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$979.45 ,95,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$979.45 ,95,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$773.25 ,75,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$876.35 ,85,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$927.90 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,000.07 ",97,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.35 ,85,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$927.90 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$979.45 ,90,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$567.05 ,55,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$958.83 ,93,,,$567.05 ,"$1,000.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Myelogram Lumbosacral Spine,1170321,CDM,320,RC,72265,HCPCS,outpatient,,,"$2,326.00 ","$1,744.50 ",,"$2,139.92 ",92,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,279.30 ",55,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,279.30 ","$2,256.22 ",other,,Not applicable. No negotiated rates per contract,"$2,000.36 ",86,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,860.80 ",80,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,279.30 ",55,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,209.70 ",95,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,209.70 ",95,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,744.50 ",75,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,977.10 ",85,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,256.22 ",97,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,279.30 ",55,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,093.40 ",90,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,256.22 ",97,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.22 ",97,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,256.22 ",97,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,977.10 ",85,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,093.40 ",90,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,279.30 ",55,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,209.70 ",90,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,279.30 ",55,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,163.18 ",93,,,"$1,279.30 ","$2,256.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Nasal Bones 3+ Views,1170329,CDM,320,RC,70160,HCPCS,outpatient,,,$394.00 ,$295.50 ,,$362.48 ,92,,,$216.70 ,$382.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.70 ,$382.18 ,other,,Not applicable. No negotiated rates per contract,$338.84 ,86,,,$216.70 ,$382.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$315.20 ,80,,,$216.70 ,$382.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.30 ,95,,,$216.70 ,$382.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$374.30 ,95,,,$216.70 ,$382.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$295.50 ,75,,,$216.70 ,$382.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.90 ,85,,,$216.70 ,$382.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.60 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.18 ,97,,,$216.70 ,$382.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.90 ,85,,,$216.70 ,$382.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.60 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.30 ,90,,,$216.70 ,$382.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.70 ,55,,,$216.70 ,$382.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$366.42 ,93,,,$216.70 ,$382.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Neck Soft Tissue,1170331,CDM,320,RC,70360,HCPCS,outpatient,,,$298.00 ,$223.50 ,,$274.16 ,92,,,$163.90 ,$289.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.90 ,$289.06 ,other,,Not applicable. No negotiated rates per contract,$256.28 ,86,,,$163.90 ,$289.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$238.40 ,80,,,$163.90 ,$289.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.10 ,95,,,$163.90 ,$289.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$223.50 ,75,,,$163.90 ,$289.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.06 ,97,,,$163.90 ,$289.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.30 ,85,,,$163.90 ,$289.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$268.20 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.10 ,90,,,$163.90 ,$289.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.90 ,55,,,$163.90 ,$289.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.14 ,93,,,$163.90 ,$289.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Orbits Complete,1170339,CDM,320,RC,70200,HCPCS,outpatient,,,$430.00 ,$322.50 ,,$395.60 ,92,,,$236.50 ,$417.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$236.50 ,$417.10 ,other,,Not applicable. No negotiated rates per contract,$369.80 ,86,,,$236.50 ,$417.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$344.00 ,80,,,$236.50 ,$417.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.50 ,95,,,$236.50 ,$417.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$408.50 ,95,,,$236.50 ,$417.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$322.50 ,75,,,$236.50 ,$417.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$365.50 ,85,,,$236.50 ,$417.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.00 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.10 ,97,,,$236.50 ,$417.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.50 ,85,,,$236.50 ,$417.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.00 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$408.50 ,90,,,$236.50 ,$417.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.50 ,55,,,$236.50 ,$417.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.90 ,93,,,$236.50 ,$417.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Osseous Survey Complete,1170018,CDM,320,RC,77075,HCPCS,outpatient,,,"$1,049.00 ",$786.75 ,,$965.08 ,92,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$576.95 ,"$1,017.53 ",other,,Not applicable. No negotiated rates per contract,$902.14 ,86,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$839.20 ,80,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$996.55 ,95,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$996.55 ,95,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$786.75 ,75,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$891.65 ,85,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$944.10 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,017.53 ",97,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$891.65 ,85,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$944.10 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$996.55 ,90,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.95 ,55,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$975.57 ,93,,,$576.95 ,"$1,017.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Osseous Survey Limited,1170022,CDM,320,RC,77074,HCPCS,outpatient,,,$547.00 ,$410.25 ,,$503.24 ,92,,,$300.85 ,$530.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$300.85 ,55,,,$300.85 ,$530.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$300.85 ,$530.59 ,other,,Not applicable. No negotiated rates per contract,$470.42 ,86,,,$300.85 ,$530.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$437.60 ,80,,,$300.85 ,$530.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$300.85 ,55,,,$300.85 ,$530.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.65 ,95,,,$300.85 ,$530.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$519.65 ,95,,,$300.85 ,$530.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.25 ,75,,,$300.85 ,$530.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$464.95 ,85,,,$300.85 ,$530.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$530.59 ,97,,,$300.85 ,$530.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.85 ,55,,,$300.85 ,$530.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$492.30 ,90,,,$300.85 ,$530.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$530.59 ,97,,,$300.85 ,$530.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.59 ,97,,,$300.85 ,$530.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.59 ,97,,,$300.85 ,$530.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.95 ,85,,,$300.85 ,$530.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$492.30 ,90,,,$300.85 ,$530.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.85 ,55,,,$300.85 ,$530.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.65 ,90,,,$300.85 ,$530.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.85 ,55,,,$300.85 ,$530.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.71 ,93,,,$300.85 ,$530.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Pelvis 1 or 2 Views,1170351,CDM,320,RC,72170,HCPCS,outpatient,,,$482.00 ,$361.50 ,,$443.44 ,92,,,$265.10 ,$467.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$265.10 ,55,,,$265.10 ,$467.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$265.10 ,$467.54 ,other,,Not applicable. No negotiated rates per contract,$414.52 ,86,,,$265.10 ,$467.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$385.60 ,80,,,$265.10 ,$467.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$265.10 ,55,,,$265.10 ,$467.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.90 ,95,,,$265.10 ,$467.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$457.90 ,95,,,$265.10 ,$467.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$361.50 ,75,,,$265.10 ,$467.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$409.70 ,85,,,$265.10 ,$467.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$467.54 ,97,,,$265.10 ,$467.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.10 ,55,,,$265.10 ,$467.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.80 ,90,,,$265.10 ,$467.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.54 ,97,,,$265.10 ,$467.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.54 ,97,,,$265.10 ,$467.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.54 ,97,,,$265.10 ,$467.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.70 ,85,,,$265.10 ,$467.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$433.80 ,90,,,$265.10 ,$467.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.10 ,55,,,$265.10 ,$467.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.90 ,90,,,$265.10 ,$467.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.10 ,55,,,$265.10 ,$467.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.26 ,93,,,$265.10 ,$467.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Pelvis Complete 3+ Views,1170353,CDM,320,RC,72190,HCPCS,outpatient,,,$543.00 ,$407.25 ,,$499.56 ,92,,,$298.65 ,$526.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$298.65 ,55,,,$298.65 ,$526.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$298.65 ,$526.71 ,other,,Not applicable. No negotiated rates per contract,$466.98 ,86,,,$298.65 ,$526.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$434.40 ,80,,,$298.65 ,$526.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$298.65 ,55,,,$298.65 ,$526.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$515.85 ,95,,,$298.65 ,$526.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.85 ,95,,,$298.65 ,$526.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$407.25 ,75,,,$298.65 ,$526.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$461.55 ,85,,,$298.65 ,$526.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$526.71 ,97,,,$298.65 ,$526.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$298.65 ,55,,,$298.65 ,$526.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$488.70 ,90,,,$298.65 ,$526.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$526.71 ,97,,,$298.65 ,$526.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$526.71 ,97,,,$298.65 ,$526.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$526.71 ,97,,,$298.65 ,$526.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.55 ,85,,,$298.65 ,$526.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$488.70 ,90,,,$298.65 ,$526.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$298.65 ,55,,,$298.65 ,$526.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$515.85 ,90,,,$298.65 ,$526.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$298.65 ,55,,,$298.65 ,$526.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.99 ,93,,,$298.65 ,$526.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs 2 Views Left,1170371,CDM,320,RC,71100,HCPCS,outpatient,,,$405.00 ,$303.75 ,,$372.60 ,92,,,$222.75 ,$392.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.75 ,$392.85 ,other,,Not applicable. No negotiated rates per contract,$348.30 ,86,,,$222.75 ,$392.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.00 ,80,,,$222.75 ,$392.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.75 ,75,,,$222.75 ,$392.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.65 ,93,,,$222.75 ,$392.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs 2 Views Right,1170373,CDM,320,RC,71100,HCPCS,outpatient,,,$405.00 ,$303.75 ,,$372.60 ,92,,,$222.75 ,$392.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.75 ,$392.85 ,other,,Not applicable. No negotiated rates per contract,$348.30 ,86,,,$222.75 ,$392.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.00 ,80,,,$222.75 ,$392.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.75 ,75,,,$222.75 ,$392.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.65 ,93,,,$222.75 ,$392.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs 3 Views Bilateral,1170375,CDM,320,RC,71110,HCPCS,outpatient,,,$580.00 ,$435.00 ,,$533.60 ,92,,,$319.00 ,$562.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$319.00 ,55,,,$319.00 ,$562.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$319.00 ,$562.60 ,other,,Not applicable. No negotiated rates per contract,$498.80 ,86,,,$319.00 ,$562.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$464.00 ,80,,,$319.00 ,$562.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$319.00 ,55,,,$319.00 ,$562.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$551.00 ,95,,,$319.00 ,$562.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$551.00 ,95,,,$319.00 ,$562.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$435.00 ,75,,,$319.00 ,$562.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$493.00 ,85,,,$319.00 ,$562.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$562.60 ,97,,,$319.00 ,$562.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.00 ,55,,,$319.00 ,$562.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$522.00 ,90,,,$319.00 ,$562.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$562.60 ,97,,,$319.00 ,$562.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$562.60 ,97,,,$319.00 ,$562.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$562.60 ,97,,,$319.00 ,$562.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$493.00 ,85,,,$319.00 ,$562.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$522.00 ,90,,,$319.00 ,$562.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.00 ,55,,,$319.00 ,$562.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$551.00 ,90,,,$319.00 ,$562.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.00 ,55,,,$319.00 ,$562.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$539.40 ,93,,,$319.00 ,$562.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs w/ PA Chest Bilateral,1170377,CDM,320,RC,71111,HCPCS,outpatient,,,$595.00 ,$446.25 ,,$547.40 ,92,,,$327.25 ,$577.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$327.25 ,55,,,$327.25 ,$577.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$327.25 ,$577.15 ,other,,Not applicable. No negotiated rates per contract,$511.70 ,86,,,$327.25 ,$577.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$476.00 ,80,,,$327.25 ,$577.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$327.25 ,55,,,$327.25 ,$577.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$565.25 ,95,,,$327.25 ,$577.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$565.25 ,95,,,$327.25 ,$577.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$446.25 ,75,,,$327.25 ,$577.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$505.75 ,85,,,$327.25 ,$577.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$577.15 ,97,,,$327.25 ,$577.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$327.25 ,55,,,$327.25 ,$577.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.50 ,90,,,$327.25 ,$577.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$577.15 ,97,,,$327.25 ,$577.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$577.15 ,97,,,$327.25 ,$577.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$577.15 ,97,,,$327.25 ,$577.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$505.75 ,85,,,$327.25 ,$577.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$535.50 ,90,,,$327.25 ,$577.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$327.25 ,55,,,$327.25 ,$577.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$565.25 ,90,,,$327.25 ,$577.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$327.25 ,55,,,$327.25 ,$577.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$553.35 ,93,,,$327.25 ,$577.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs w/ PA Chest Left,1170379,CDM,320,RC,71101,HCPCS,outpatient,,,$621.00 ,$465.75 ,,$571.32 ,92,,,$341.55 ,$602.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$341.55 ,$602.37 ,other,,Not applicable. No negotiated rates per contract,$534.06 ,86,,,$341.55 ,$602.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$496.80 ,80,,,$341.55 ,$602.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$589.95 ,95,,,$341.55 ,$602.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.95 ,95,,,$341.55 ,$602.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$465.75 ,75,,,$341.55 ,$602.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$527.85 ,85,,,$341.55 ,$602.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$558.90 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$527.85 ,85,,,$341.55 ,$602.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$558.90 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$589.95 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$577.53 ,93,,,$341.55 ,$602.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Ribs w/ PA Chest Right,1170381,CDM,320,RC,71101,HCPCS,outpatient,,,$621.00 ,$465.75 ,,$571.32 ,92,,,$341.55 ,$602.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$341.55 ,$602.37 ,other,,Not applicable. No negotiated rates per contract,$534.06 ,86,,,$341.55 ,$602.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$496.80 ,80,,,$341.55 ,$602.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$589.95 ,95,,,$341.55 ,$602.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.95 ,95,,,$341.55 ,$602.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$465.75 ,75,,,$341.55 ,$602.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$527.85 ,85,,,$341.55 ,$602.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$558.90 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$602.37 ,97,,,$341.55 ,$602.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$527.85 ,85,,,$341.55 ,$602.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$558.90 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$589.95 ,90,,,$341.55 ,$602.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$341.55 ,55,,,$341.55 ,$602.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$577.53 ,93,,,$341.55 ,$602.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sacroiliac Joints 1 or 2 Views,1170385,CDM,320,RC,72200,HCPCS,outpatient,,,$393.00 ,$294.75 ,,$361.56 ,92,,,$216.15 ,$381.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.15 ,55,,,$216.15 ,$381.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.15 ,$381.21 ,other,,Not applicable. No negotiated rates per contract,$337.98 ,86,,,$216.15 ,$381.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$314.40 ,80,,,$216.15 ,$381.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.15 ,55,,,$216.15 ,$381.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.35 ,95,,,$216.15 ,$381.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.35 ,95,,,$216.15 ,$381.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$294.75 ,75,,,$216.15 ,$381.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.05 ,85,,,$216.15 ,$381.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$381.21 ,97,,,$216.15 ,$381.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.15 ,55,,,$216.15 ,$381.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.70 ,90,,,$216.15 ,$381.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.21 ,97,,,$216.15 ,$381.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.21 ,97,,,$216.15 ,$381.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.21 ,97,,,$216.15 ,$381.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.05 ,85,,,$216.15 ,$381.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$353.70 ,90,,,$216.15 ,$381.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.15 ,55,,,$216.15 ,$381.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.35 ,90,,,$216.15 ,$381.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.15 ,55,,,$216.15 ,$381.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.49 ,93,,,$216.15 ,$381.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sacroiliac Joints 3+ Views,1170387,CDM,320,RC,72202,HCPCS,outpatient,,,$447.00 ,$335.25 ,,$411.24 ,92,,,$245.85 ,$433.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$245.85 ,55,,,$245.85 ,$433.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$245.85 ,$433.59 ,other,,Not applicable. No negotiated rates per contract,$384.42 ,86,,,$245.85 ,$433.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$357.60 ,80,,,$245.85 ,$433.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$245.85 ,55,,,$245.85 ,$433.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.65 ,95,,,$245.85 ,$433.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$424.65 ,95,,,$245.85 ,$433.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$335.25 ,75,,,$245.85 ,$433.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$379.95 ,85,,,$245.85 ,$433.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$433.59 ,97,,,$245.85 ,$433.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.85 ,55,,,$245.85 ,$433.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$402.30 ,90,,,$245.85 ,$433.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.59 ,97,,,$245.85 ,$433.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.59 ,97,,,$245.85 ,$433.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.59 ,97,,,$245.85 ,$433.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.95 ,85,,,$245.85 ,$433.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$402.30 ,90,,,$245.85 ,$433.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.85 ,55,,,$245.85 ,$433.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.65 ,90,,,$245.85 ,$433.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.85 ,55,,,$245.85 ,$433.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.71 ,93,,,$245.85 ,$433.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sacrum/Coccyx 2+ Views,1170391,CDM,320,RC,72220,HCPCS,outpatient,,,$528.00 ,$396.00 ,,$485.76 ,92,,,$290.40 ,$512.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$290.40 ,55,,,$290.40 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$290.40 ,$512.16 ,other,,Not applicable. No negotiated rates per contract,$454.08 ,86,,,$290.40 ,$512.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$422.40 ,80,,,$290.40 ,$512.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$290.40 ,55,,,$290.40 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.60 ,95,,,$290.40 ,$512.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.60 ,95,,,$290.40 ,$512.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$396.00 ,75,,,$290.40 ,$512.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$448.80 ,85,,,$290.40 ,$512.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$512.16 ,97,,,$290.40 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.40 ,55,,,$290.40 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$475.20 ,90,,,$290.40 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$512.16 ,97,,,$290.40 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$512.16 ,97,,,$290.40 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$512.16 ,97,,,$290.40 ,$512.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$448.80 ,85,,,$290.40 ,$512.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$475.20 ,90,,,$290.40 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.40 ,55,,,$290.40 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.60 ,90,,,$290.40 ,$512.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.40 ,55,,,$290.40 ,$512.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$491.04 ,93,,,$290.40 ,$512.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Scapula Complete Bilateral,8207987,CDM,320,RC,73010,HCPCS,outpatient,,,$360.00 ,$270.00 ,,$331.20 ,92,,,$198.00 ,$349.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$198.00 ,$349.20 ,other,,Not applicable. No negotiated rates per contract,$309.60 ,86,,,$198.00 ,$349.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$288.00 ,80,,,$198.00 ,$349.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.00 ,75,,,$198.00 ,$349.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,93,,,$198.00 ,$349.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Scapula Left,1170401,CDM,320,RC,73010,HCPCS,outpatient,,,$360.00 ,$270.00 ,,$331.20 ,92,,,$198.00 ,$349.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$198.00 ,$349.20 ,other,,Not applicable. No negotiated rates per contract,$309.60 ,86,,,$198.00 ,$349.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$288.00 ,80,,,$198.00 ,$349.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.00 ,75,,,$198.00 ,$349.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,93,,,$198.00 ,$349.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Scapula Right,1170403,CDM,320,RC,73010,HCPCS,outpatient,,,$360.00 ,$270.00 ,,$331.20 ,92,,,$198.00 ,$349.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$198.00 ,$349.20 ,other,,Not applicable. No negotiated rates per contract,$309.60 ,86,,,$198.00 ,$349.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$288.00 ,80,,,$198.00 ,$349.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.00 ,75,,,$198.00 ,$349.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,93,,,$198.00 ,$349.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Shoulder 1 View Left,1170409,CDM,320,RC,73020,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$149.05 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.05 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$233.06 ,86,,,$149.05 ,$262.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.80 ,80,,,$149.05 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$149.05 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$149.05 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Shoulder 1 View Right,1170411,CDM,320,RC,73020,HCPCS,outpatient,,,$271.00 ,$203.25 ,,$249.32 ,92,,,$149.05 ,$262.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.05 ,$262.87 ,other,,Not applicable. No negotiated rates per contract,$233.06 ,86,,,$149.05 ,$262.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.80 ,80,,,$149.05 ,$262.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.45 ,95,,,$149.05 ,$262.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.25 ,75,,,$149.05 ,$262.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.87 ,97,,,$149.05 ,$262.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.35 ,85,,,$149.05 ,$262.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.90 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.45 ,90,,,$149.05 ,$262.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.05 ,55,,,$149.05 ,$262.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.03 ,93,,,$149.05 ,$262.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Shoulder Complete 2+ Views Left,1170415,CDM,320,RC,73030,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Shoulder Complete 2+ Views Right,1170417,CDM,320,RC,73030,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sinuses Paranasal < 3 Views,1170432,CDM,320,RC,70210,HCPCS,outpatient,,,$273.00 ,$204.75 ,,$251.16 ,92,,,$150.15 ,$264.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$150.15 ,55,,,$150.15 ,$264.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$150.15 ,$264.81 ,other,,Not applicable. No negotiated rates per contract,$234.78 ,86,,,$150.15 ,$264.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$218.40 ,80,,,$150.15 ,$264.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$150.15 ,55,,,$150.15 ,$264.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.35 ,95,,,$150.15 ,$264.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$259.35 ,95,,,$150.15 ,$264.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.75 ,75,,,$150.15 ,$264.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$232.05 ,85,,,$150.15 ,$264.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$264.81 ,97,,,$150.15 ,$264.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.15 ,55,,,$150.15 ,$264.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.70 ,90,,,$150.15 ,$264.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$264.81 ,97,,,$150.15 ,$264.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$264.81 ,97,,,$150.15 ,$264.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$264.81 ,97,,,$150.15 ,$264.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.05 ,85,,,$150.15 ,$264.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$245.70 ,90,,,$150.15 ,$264.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.15 ,55,,,$150.15 ,$264.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.35 ,90,,,$150.15 ,$264.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.15 ,55,,,$150.15 ,$264.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$253.89 ,93,,,$150.15 ,$264.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sinuses Paranasal Complete,1170434,CDM,320,RC,70220,HCPCS,outpatient,,,$405.00 ,$303.75 ,,$372.60 ,92,,,$222.75 ,$392.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.75 ,$392.85 ,other,,Not applicable. No negotiated rates per contract,$348.30 ,86,,,$222.75 ,$392.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.00 ,80,,,$222.75 ,$392.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.75 ,75,,,$222.75 ,$392.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.65 ,93,,,$222.75 ,$392.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Skull < 4 Views,1170436,CDM,320,RC,70250,HCPCS,outpatient,,,$507.00 ,$380.25 ,,$466.44 ,92,,,$278.85 ,$491.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$278.85 ,$491.79 ,other,,Not applicable. No negotiated rates per contract,$436.02 ,86,,,$278.85 ,$491.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$405.60 ,80,,,$278.85 ,$491.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$481.65 ,95,,,$278.85 ,$491.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.25 ,75,,,$278.85 ,$491.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$491.79 ,97,,,$278.85 ,$491.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$430.95 ,85,,,$278.85 ,$491.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$456.30 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.65 ,90,,,$278.85 ,$491.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.85 ,55,,,$278.85 ,$491.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.51 ,93,,,$278.85 ,$491.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Skull > 4 views,1170438,CDM,320,RC,70260,HCPCS,outpatient,,,$551.00 ,$413.25 ,,$506.92 ,92,,,$303.05 ,$534.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$303.05 ,55,,,$303.05 ,$534.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$303.05 ,$534.47 ,other,,Not applicable. No negotiated rates per contract,$473.86 ,86,,,$303.05 ,$534.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$440.80 ,80,,,$303.05 ,$534.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$303.05 ,55,,,$303.05 ,$534.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.45 ,95,,,$303.05 ,$534.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$523.45 ,95,,,$303.05 ,$534.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,75,,,$303.05 ,$534.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$468.35 ,85,,,$303.05 ,$534.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$534.47 ,97,,,$303.05 ,$534.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.05 ,55,,,$303.05 ,$534.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$495.90 ,90,,,$303.05 ,$534.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$534.47 ,97,,,$303.05 ,$534.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$534.47 ,97,,,$303.05 ,$534.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$534.47 ,97,,,$303.05 ,$534.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$468.35 ,85,,,$303.05 ,$534.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$495.90 ,90,,,$303.05 ,$534.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$303.05 ,55,,,$303.05 ,$534.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.45 ,90,,,$303.05 ,$534.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$303.05 ,55,,,$303.05 ,$534.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$512.43 ,93,,,$303.05 ,$534.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Small Bowel w/ Multiple Series,1170442,CDM,320,RC,74250,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Cervical 1 View,1170446,CDM,320,RC,72020,HCPCS,outpatient,,,$290.00 ,$217.50 ,,$266.80 ,92,,,$159.50 ,$281.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.50 ,$281.30 ,other,,Not applicable. No negotiated rates per contract,$249.40 ,86,,,$159.50 ,$281.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$232.00 ,80,,,$159.50 ,$281.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.50 ,75,,,$159.50 ,$281.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.70 ,93,,,$159.50 ,$281.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Cervical 2 or 3 Views,1170452,CDM,320,RC,72040,HCPCS,outpatient,,,$437.00 ,$327.75 ,,$402.04 ,92,,,$240.35 ,$423.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$240.35 ,55,,,$240.35 ,$423.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$240.35 ,$423.89 ,other,,Not applicable. No negotiated rates per contract,$375.82 ,86,,,$240.35 ,$423.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$349.60 ,80,,,$240.35 ,$423.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$240.35 ,55,,,$240.35 ,$423.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.15 ,95,,,$240.35 ,$423.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$415.15 ,95,,,$240.35 ,$423.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$327.75 ,75,,,$240.35 ,$423.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$371.45 ,85,,,$240.35 ,$423.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$423.89 ,97,,,$240.35 ,$423.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.35 ,55,,,$240.35 ,$423.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.30 ,90,,,$240.35 ,$423.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$423.89 ,97,,,$240.35 ,$423.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$423.89 ,97,,,$240.35 ,$423.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$423.89 ,97,,,$240.35 ,$423.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.45 ,85,,,$240.35 ,$423.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.30 ,90,,,$240.35 ,$423.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$240.35 ,55,,,$240.35 ,$423.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.15 ,90,,,$240.35 ,$423.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$240.35 ,55,,,$240.35 ,$423.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$406.41 ,93,,,$240.35 ,$423.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Cervical 4 or 5 Views,1170454,CDM,320,RC,72050,HCPCS,outpatient,,,$746.00 ,$559.50 ,,$686.32 ,92,,,$410.30 ,$723.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$410.30 ,55,,,$410.30 ,$723.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$410.30 ,$723.62 ,other,,Not applicable. No negotiated rates per contract,$641.56 ,86,,,$410.30 ,$723.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.80 ,80,,,$410.30 ,$723.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$410.30 ,55,,,$410.30 ,$723.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.70 ,95,,,$410.30 ,$723.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.70 ,95,,,$410.30 ,$723.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$559.50 ,75,,,$410.30 ,$723.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$634.10 ,85,,,$410.30 ,$723.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$723.62 ,97,,,$410.30 ,$723.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$410.30 ,55,,,$410.30 ,$723.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$671.40 ,90,,,$410.30 ,$723.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$723.62 ,97,,,$410.30 ,$723.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$723.62 ,97,,,$410.30 ,$723.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$723.62 ,97,,,$410.30 ,$723.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$634.10 ,85,,,$410.30 ,$723.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$671.40 ,90,,,$410.30 ,$723.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$410.30 ,55,,,$410.30 ,$723.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.70 ,90,,,$410.30 ,$723.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$410.30 ,55,,,$410.30 ,$723.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$693.78 ,93,,,$410.30 ,$723.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Cervical 6+ Views,1170461,CDM,320,RC,72052,HCPCS,outpatient,,,$769.00 ,$576.75 ,,$707.48 ,92,,,$422.95 ,$745.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$422.95 ,$745.93 ,other,,Not applicable. No negotiated rates per contract,$661.34 ,86,,,$422.95 ,$745.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$615.20 ,80,,,$422.95 ,$745.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.55 ,95,,,$422.95 ,$745.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$730.55 ,95,,,$422.95 ,$745.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$576.75 ,75,,,$422.95 ,$745.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$653.65 ,85,,,$422.95 ,$745.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$692.10 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$745.93 ,97,,,$422.95 ,$745.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$653.65 ,85,,,$422.95 ,$745.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$692.10 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.55 ,90,,,$422.95 ,$745.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$422.95 ,55,,,$422.95 ,$745.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$715.17 ,93,,,$422.95 ,$745.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Lumbosacral 2 or 3 Views,1170470,CDM,320,RC,72100,HCPCS,outpatient,,,$559.00 ,$419.25 ,,$514.28 ,92,,,$307.45 ,$542.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$307.45 ,$542.23 ,other,,Not applicable. No negotiated rates per contract,$480.74 ,86,,,$307.45 ,$542.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$447.20 ,80,,,$307.45 ,$542.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$531.05 ,95,,,$307.45 ,$542.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$531.05 ,95,,,$307.45 ,$542.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$419.25 ,75,,,$307.45 ,$542.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$475.15 ,85,,,$307.45 ,$542.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$503.10 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$542.23 ,97,,,$307.45 ,$542.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$475.15 ,85,,,$307.45 ,$542.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$503.10 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$531.05 ,90,,,$307.45 ,$542.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.45 ,55,,,$307.45 ,$542.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.87 ,93,,,$307.45 ,$542.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Lumbosacral 4+ Views,1170476,CDM,320,RC,72110,HCPCS,outpatient,,,$838.00 ,$628.50 ,,$770.96 ,92,,,$460.90 ,$812.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$460.90 ,55,,,$460.90 ,$812.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$460.90 ,$812.86 ,other,,Not applicable. No negotiated rates per contract,$720.68 ,86,,,$460.90 ,$812.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$670.40 ,80,,,$460.90 ,$812.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$460.90 ,55,,,$460.90 ,$812.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$796.10 ,95,,,$460.90 ,$812.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$796.10 ,95,,,$460.90 ,$812.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$628.50 ,75,,,$460.90 ,$812.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$712.30 ,85,,,$460.90 ,$812.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$812.86 ,97,,,$460.90 ,$812.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.90 ,55,,,$460.90 ,$812.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$754.20 ,90,,,$460.90 ,$812.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$812.86 ,97,,,$460.90 ,$812.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$812.86 ,97,,,$460.90 ,$812.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$812.86 ,97,,,$460.90 ,$812.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$712.30 ,85,,,$460.90 ,$812.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$754.20 ,90,,,$460.90 ,$812.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.90 ,55,,,$460.90 ,$812.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$796.10 ,90,,,$460.90 ,$812.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.90 ,55,,,$460.90 ,$812.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$779.34 ,93,,,$460.90 ,$812.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Thoracic 2 Views,1170484,CDM,320,RC,72070,HCPCS,outpatient,,,$504.00 ,$378.00 ,,$463.68 ,92,,,$277.20 ,$488.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$277.20 ,55,,,$277.20 ,$488.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$277.20 ,$488.88 ,other,,Not applicable. No negotiated rates per contract,$433.44 ,86,,,$277.20 ,$488.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$403.20 ,80,,,$277.20 ,$488.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$277.20 ,55,,,$277.20 ,$488.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.80 ,95,,,$277.20 ,$488.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$478.80 ,95,,,$277.20 ,$488.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.00 ,75,,,$277.20 ,$488.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$428.40 ,85,,,$277.20 ,$488.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$488.88 ,97,,,$277.20 ,$488.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.20 ,55,,,$277.20 ,$488.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.60 ,90,,,$277.20 ,$488.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$488.88 ,97,,,$277.20 ,$488.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$488.88 ,97,,,$277.20 ,$488.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$488.88 ,97,,,$277.20 ,$488.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$428.40 ,85,,,$277.20 ,$488.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$453.60 ,90,,,$277.20 ,$488.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.20 ,55,,,$277.20 ,$488.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$478.80 ,90,,,$277.20 ,$488.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.20 ,55,,,$277.20 ,$488.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$468.72 ,93,,,$277.20 ,$488.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Spine Thoracic 3 Views,1170486,CDM,320,RC,72072,HCPCS,outpatient,,,$555.00 ,$416.25 ,,$510.60 ,92,,,$305.25 ,$538.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$305.25 ,$538.35 ,other,,Not applicable. No negotiated rates per contract,$477.30 ,86,,,$305.25 ,$538.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$444.00 ,80,,,$305.25 ,$538.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$527.25 ,95,,,$305.25 ,$538.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$416.25 ,75,,,$305.25 ,$538.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$538.35 ,97,,,$305.25 ,$538.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$471.75 ,85,,,$305.25 ,$538.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$499.50 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$527.25 ,90,,,$305.25 ,$538.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$305.25 ,55,,,$305.25 ,$538.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$516.15 ,93,,,$305.25 ,$538.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sternoclavicular Joint(s),1170494,CDM,320,RC,71130,HCPCS,outpatient,,,$320.00 ,$240.00 ,,$294.40 ,92,,,$176.00 ,$310.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.00 ,$310.40 ,other,,Not applicable. No negotiated rates per contract,$275.20 ,86,,,$176.00 ,$310.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.00 ,80,,,$176.00 ,$310.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.00 ,75,,,$176.00 ,$310.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.60 ,93,,,$176.00 ,$310.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Sternum 2+ Views,1170496,CDM,320,RC,71120,HCPCS,outpatient,,,$366.00 ,$274.50 ,,$336.72 ,92,,,$201.30 ,$355.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$201.30 ,55,,,$201.30 ,$355.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$201.30 ,$355.02 ,other,,Not applicable. No negotiated rates per contract,$314.76 ,86,,,$201.30 ,$355.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$292.80 ,80,,,$201.30 ,$355.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$201.30 ,55,,,$201.30 ,$355.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.70 ,95,,,$201.30 ,$355.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$347.70 ,95,,,$201.30 ,$355.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$274.50 ,75,,,$201.30 ,$355.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$311.10 ,85,,,$201.30 ,$355.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$355.02 ,97,,,$201.30 ,$355.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.30 ,55,,,$201.30 ,$355.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$329.40 ,90,,,$201.30 ,$355.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$355.02 ,97,,,$201.30 ,$355.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$355.02 ,97,,,$201.30 ,$355.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$355.02 ,97,,,$201.30 ,$355.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.10 ,85,,,$201.30 ,$355.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$329.40 ,90,,,$201.30 ,$355.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.30 ,55,,,$201.30 ,$355.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.70 ,90,,,$201.30 ,$355.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.30 ,55,,,$201.30 ,$355.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$340.38 ,93,,,$201.30 ,$355.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR TMJ Open and Closed Bilateral,1170502,CDM,320,RC,70330,HCPCS,outpatient,,,$378.00 ,$283.50 ,,$347.76 ,92,,,$207.90 ,$366.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.90 ,$366.66 ,other,,Not applicable. No negotiated rates per contract,$325.08 ,86,,,$207.90 ,$366.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$302.40 ,80,,,$207.90 ,$366.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,95,,,$207.90 ,$366.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$359.10 ,95,,,$207.90 ,$366.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.50 ,75,,,$207.90 ,$366.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$321.30 ,85,,,$207.90 ,$366.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$340.20 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.66 ,97,,,$207.90 ,$366.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.30 ,85,,,$207.90 ,$366.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$340.20 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.10 ,90,,,$207.90 ,$366.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.90 ,55,,,$207.90 ,$366.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.54 ,93,,,$207.90 ,$366.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR TMJ Open and Closed Left,8100061,CDM,320,RC,70328,HCPCS,outpatient,,,$320.00 ,$240.00 ,,$294.40 ,92,,,$176.00 ,$310.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.00 ,$310.40 ,other,,Not applicable. No negotiated rates per contract,$275.20 ,86,,,$176.00 ,$310.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.00 ,80,,,$176.00 ,$310.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.00 ,75,,,$176.00 ,$310.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.60 ,93,,,$176.00 ,$310.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR TMJ Open and Closed Right,8100063,CDM,320,RC,70328,HCPCS,outpatient,,,$320.00 ,$240.00 ,,$294.40 ,92,,,$176.00 ,$310.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.00 ,$310.40 ,other,,Not applicable. No negotiated rates per contract,$275.20 ,86,,,$176.00 ,$310.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.00 ,80,,,$176.00 ,$310.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.00 ,75,,,$176.00 ,$310.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.60 ,93,,,$176.00 ,$310.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Tibia/Fibula Left,1170516,CDM,320,RC,73590,HCPCS,outpatient,,,$401.00 ,$300.75 ,,$368.92 ,92,,,$220.55 ,$388.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.55 ,$388.97 ,other,,Not applicable. No negotiated rates per contract,$344.86 ,86,,,$220.55 ,$388.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.80 ,80,,,$220.55 ,$388.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.75 ,75,,,$220.55 ,$388.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.93 ,93,,,$220.55 ,$388.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Tibia/Fibula Right,1170518,CDM,320,RC,73590,HCPCS,outpatient,,,$401.00 ,$300.75 ,,$368.92 ,92,,,$220.55 ,$388.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.55 ,$388.97 ,other,,Not applicable. No negotiated rates per contract,$344.86 ,86,,,$220.55 ,$388.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$320.80 ,80,,,$220.55 ,$388.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$380.95 ,95,,,$220.55 ,$388.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.75 ,75,,,$220.55 ,$388.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$388.97 ,97,,,$220.55 ,$388.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.85 ,85,,,$220.55 ,$388.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.90 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$380.95 ,90,,,$220.55 ,$388.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.55 ,55,,,$220.55 ,$388.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.93 ,93,,,$220.55 ,$388.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Toe(s) 2+ Views Left,1170520,CDM,320,RC,73660,HCPCS,outpatient,,,$318.00 ,$238.50 ,,$292.56 ,92,,,$174.90 ,$308.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.90 ,$308.46 ,other,,Not applicable. No negotiated rates per contract,$273.48 ,86,,,$174.90 ,$308.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.40 ,80,,,$174.90 ,$308.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,95,,,$174.90 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.10 ,95,,,$174.90 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.50 ,75,,,$174.90 ,$308.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.30 ,85,,,$174.90 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.20 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.30 ,85,,,$174.90 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.20 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.74 ,93,,,$174.90 ,$308.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Toe(s) 2+ Views Right,8111120,CDM,320,RC,73660,HCPCS,outpatient,,,$318.00 ,$238.50 ,,$292.56 ,92,,,$174.90 ,$308.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.90 ,$308.46 ,other,,Not applicable. No negotiated rates per contract,$273.48 ,86,,,$174.90 ,$308.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.40 ,80,,,$174.90 ,$308.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,95,,,$174.90 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.10 ,95,,,$174.90 ,$308.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.50 ,75,,,$174.90 ,$308.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.30 ,85,,,$174.90 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.20 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.46 ,97,,,$174.90 ,$308.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.30 ,85,,,$174.90 ,$308.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.20 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.10 ,90,,,$174.90 ,$308.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.90 ,55,,,$174.90 ,$308.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.74 ,93,,,$174.90 ,$308.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Transforaminal Inj L/S Spine 1L,8741668,CDM,761,RC,77003,HCPCS,outpatient,,,$395.00 ,$296.25 ,,$363.40 ,92,,,$217.25 ,$383.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$217.25 ,$383.15 ,other,,Not applicable. No negotiated rates per contract,$339.70 ,86,,,$217.25 ,$383.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$316.00 ,80,,,$217.25 ,$383.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.25 ,95,,,$217.25 ,$383.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$375.25 ,95,,,$217.25 ,$383.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.25 ,75,,,$217.25 ,$383.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$335.75 ,85,,,$217.25 ,$383.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.50 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.15 ,97,,,$217.25 ,$383.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.75 ,85,,,$217.25 ,$383.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$355.50 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.25 ,90,,,$217.25 ,$383.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.25 ,55,,,$217.25 ,$383.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$367.35 ,93,,,$217.25 ,$383.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Upper Extremity Infant (0-1yr) Left,1170558,CDM,320,RC,73092,HCPCS,outpatient,,,$383.00 ,$287.25 ,,$352.36 ,92,,,$210.65 ,$371.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$210.65 ,$371.51 ,other,,Not applicable. No negotiated rates per contract,$329.38 ,86,,,$210.65 ,$371.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$306.40 ,80,,,$210.65 ,$371.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$287.25 ,75,,,$210.65 ,$371.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.19 ,93,,,$210.65 ,$371.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Upper Extremity Infant (0-1yr) Right,1170560,CDM,320,RC,73092,HCPCS,outpatient,,,$383.00 ,$287.25 ,,$352.36 ,92,,,$210.65 ,$371.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$210.65 ,$371.51 ,other,,Not applicable. No negotiated rates per contract,$329.38 ,86,,,$210.65 ,$371.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$306.40 ,80,,,$210.65 ,$371.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.85 ,95,,,$210.65 ,$371.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$287.25 ,75,,,$210.65 ,$371.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.51 ,97,,,$210.65 ,$371.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$325.55 ,85,,,$210.65 ,$371.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$344.70 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.85 ,90,,,$210.65 ,$371.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.65 ,55,,,$210.65 ,$371.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.19 ,93,,,$210.65 ,$371.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Upper GI,1170562,CDM,320,RC,74246,HCPCS,outpatient,,,$863.00 ,$647.25 ,,$793.96 ,92,,,$474.65 ,$837.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$474.65 ,$837.11 ,other,,Not applicable. No negotiated rates per contract,$742.18 ,86,,,$474.65 ,$837.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$690.40 ,80,,,$474.65 ,$837.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.85 ,95,,,$474.65 ,$837.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$819.85 ,95,,,$474.65 ,$837.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$647.25 ,75,,,$474.65 ,$837.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$733.55 ,85,,,$474.65 ,$837.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$776.70 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.55 ,85,,,$474.65 ,$837.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$776.70 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.85 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$802.59 ,93,,,$474.65 ,$837.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Upper GI w/ Air Contrast,1170566,CDM,320,RC,74246,HCPCS,outpatient,,,$863.00 ,$647.25 ,,$793.96 ,92,,,$474.65 ,$837.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$474.65 ,$837.11 ,other,,Not applicable. No negotiated rates per contract,$742.18 ,86,,,$474.65 ,$837.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$690.40 ,80,,,$474.65 ,$837.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.85 ,95,,,$474.65 ,$837.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$819.85 ,95,,,$474.65 ,$837.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$647.25 ,75,,,$474.65 ,$837.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$733.55 ,85,,,$474.65 ,$837.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$776.70 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$837.11 ,97,,,$474.65 ,$837.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.55 ,85,,,$474.65 ,$837.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$776.70 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$819.85 ,90,,,$474.65 ,$837.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$474.65 ,55,,,$474.65 ,$837.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$802.59 ,93,,,$474.65 ,$837.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Upper GI w/ Air w/ Small Bowel,1170570,CDM,320,RC,74249,HCPCS,outpatient,,,"$1,351.00 ","$1,013.25 ",,"$1,242.92 ",92,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$743.05 ,"$1,310.47 ",other,,Not applicable. No negotiated rates per contract,"$1,161.86 ",86,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,080.80 ",80,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,283.45 ",95,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,283.45 ",95,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,013.25 ",75,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,148.35 ",85,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,215.90 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,310.47 ",97,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,148.35 ",85,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,215.90 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,283.45 ",90,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$743.05 ,55,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,256.43 ",93,,,$743.05 ,"$1,310.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Venogram Extremity Left,8211788,CDM,340,RC,78457,HCPCS,outpatient,,,"$4,303.00 ","$3,227.25 ",,"$3,958.76 ",92,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,366.65 ","$4,173.91 ",other,,Not applicable. No negotiated rates per contract,"$3,700.58 ",86,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,442.40 ",80,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,087.85 ",95,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,087.85 ",95,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,227.25 ",75,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,657.55 ",85,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,872.70 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,657.55 ",85,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,872.70 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,087.85 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,001.79 ",93,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Venogram Extremity Right,8211791,CDM,340,RC,78457,HCPCS,outpatient,,,"$4,303.00 ","$3,227.25 ",,"$3,958.76 ",92,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,366.65 ","$4,173.91 ",other,,Not applicable. No negotiated rates per contract,"$3,700.58 ",86,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,442.40 ",80,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,087.85 ",95,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,087.85 ",95,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,227.25 ",75,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,657.55 ",85,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,872.70 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,173.91 ",97,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,657.55 ",85,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,872.70 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,087.85 ",90,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,366.65 ",55,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,001.79 ",93,,,"$2,366.65 ","$4,173.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
XR Wrist 2 Views Left,1170606,CDM,320,RC,73100,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Wrist 2 Views Right,1170608,CDM,320,RC,73100,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Wrist Complete 3+ Views Left,1170612,CDM,320,RC,73110,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XR Wrist Complete 3+ Views Right,1170614,CDM,320,RC,73110,HCPCS,outpatient,,,$379.00 ,$284.25 ,,$348.68 ,92,,,$208.45 ,$367.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$208.45 ,$367.63 ,other,,Not applicable. No negotiated rates per contract,$325.94 ,86,,,$208.45 ,$367.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$303.20 ,80,,,$208.45 ,$367.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$360.05 ,95,,,$208.45 ,$367.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$284.25 ,75,,,$208.45 ,$367.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.63 ,97,,,$208.45 ,$367.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.15 ,85,,,$208.45 ,$367.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.10 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$360.05 ,90,,,$208.45 ,$367.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.45 ,55,,,$208.45 ,$367.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.47 ,93,,,$208.45 ,$367.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Ankle Arthrogram Inj,8728595,CDM,320,RC,27648,HCPCS,outpatient,,,$416.00 ,$312.00 ,,$382.72 ,92,,,$228.80 ,$403.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$228.80 ,$403.52 ,other,,Not applicable. No negotiated rates per contract,$357.76 ,86,,,$228.80 ,$403.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$332.80 ,80,,,$228.80 ,$403.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$395.20 ,95,,,$228.80 ,$403.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$395.20 ,95,,,$228.80 ,$403.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.00 ,75,,,$228.80 ,$403.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$353.60 ,85,,,$228.80 ,$403.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.40 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$353.60 ,85,,,$228.80 ,$403.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$374.40 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$395.20 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$386.88 ,93,,,$228.80 ,$403.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA CT Facet Injection Cerv/Thor Lv2,9663329,CDM,320,RC,64491,HCPCS,outpatient,,,$332.00 ,$249.00 ,,$305.44 ,92,,,$182.60 ,$322.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$182.60 ,$322.04 ,other,,Not applicable. No negotiated rates per contract,$285.52 ,86,,,$182.60 ,$322.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$265.60 ,80,,,$182.60 ,$322.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$249.00 ,75,,,$182.60 ,$322.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,93,,,$182.60 ,$322.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA CT Facet Injection Cerv/Thor Lv3+,9663331,CDM,320,RC,64492,HCPCS,outpatient,,,$332.00 ,$249.00 ,,$305.44 ,92,,,$182.60 ,$322.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$182.60 ,$322.04 ,other,,Not applicable. No negotiated rates per contract,$285.52 ,86,,,$182.60 ,$322.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$265.60 ,80,,,$182.60 ,$322.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$249.00 ,75,,,$182.60 ,$322.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,93,,,$182.60 ,$322.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA CT Facet Injection Lumb/Sacr Lv2,9663333,CDM,320,RC,64494,HCPCS,outpatient,,,$332.00 ,$249.00 ,,$305.44 ,92,,,$182.60 ,$322.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$182.60 ,$322.04 ,other,,Not applicable. No negotiated rates per contract,$285.52 ,86,,,$182.60 ,$322.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$265.60 ,80,,,$182.60 ,$322.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$249.00 ,75,,,$182.60 ,$322.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,93,,,$182.60 ,$322.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA CT Facet Injection Lumb/Sacr Lv3+,9663335,CDM,320,RC,64495,HCPCS,outpatient,,,$332.00 ,$249.00 ,,$305.44 ,92,,,$182.60 ,$322.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$182.60 ,$322.04 ,other,,Not applicable. No negotiated rates per contract,$285.52 ,86,,,$182.60 ,$322.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$265.60 ,80,,,$182.60 ,$322.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.40 ,95,,,$182.60 ,$322.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$249.00 ,75,,,$182.60 ,$322.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$322.04 ,97,,,$182.60 ,$322.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$282.20 ,85,,,$182.60 ,$322.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$298.80 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$315.40 ,90,,,$182.60 ,$322.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.60 ,55,,,$182.60 ,$322.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,93,,,$182.60 ,$322.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Elbow Arthrogram Inj,8728604,CDM,320,RC,24220,HCPCS,outpatient,,,$416.00 ,$312.00 ,,$382.72 ,92,,,$228.80 ,$403.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$228.80 ,$403.52 ,other,,Not applicable. No negotiated rates per contract,$357.76 ,86,,,$228.80 ,$403.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$332.80 ,80,,,$228.80 ,$403.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$395.20 ,95,,,$228.80 ,$403.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$395.20 ,95,,,$228.80 ,$403.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.00 ,75,,,$228.80 ,$403.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$353.60 ,85,,,$228.80 ,$403.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.40 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.52 ,97,,,$228.80 ,$403.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$353.60 ,85,,,$228.80 ,$403.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$374.40 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$395.20 ,90,,,$228.80 ,$403.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.80 ,55,,,$228.80 ,$403.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$386.88 ,93,,,$228.80 ,$403.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Hip Arthrogram Inj,8728593,CDM,320,RC,27093,HCPCS,outpatient,,,$241.00 ,$180.75 ,,$221.72 ,92,,,$132.55 ,$233.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.55 ,$233.77 ,other,,Not applicable. No negotiated rates per contract,$207.26 ,86,,,$132.55 ,$233.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.80 ,80,,,$132.55 ,$233.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,95,,,$132.55 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.95 ,95,,,$132.55 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.75 ,75,,,$132.55 ,$233.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.85 ,85,,,$132.55 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.90 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.85 ,85,,,$132.55 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.90 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.13 ,93,,,$132.55 ,$233.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Knee Arthrogram Inj,8728581,CDM,320,RC,27369,HCPCS,outpatient,,,$146.00 ,$109.50 ,,$134.32 ,92,,,$80.30 ,$141.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.30 ,$141.62 ,other,,Not applicable. No negotiated rates per contract,$125.56 ,86,,,$80.30 ,$141.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.80 ,80,,,$80.30 ,$141.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,95,,,$80.30 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.70 ,95,,,$80.30 ,$141.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.50 ,75,,,$80.30 ,$141.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.10 ,85,,,$80.30 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.40 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.62 ,97,,,$80.30 ,$141.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.10 ,85,,,$80.30 ,$141.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.40 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.70 ,90,,,$80.30 ,$141.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.30 ,55,,,$80.30 ,$141.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.78 ,93,,,$80.30 ,$141.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Lexiscan,8728579,CDM,250,RC,,HCPCS,outpatient,,,"$1,226.00 ",$919.50 ,,"$1,127.92 ",92,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$674.30 ,55,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$674.30 ,"$1,189.22 ",other,,Not applicable. No negotiated rates per contract,"$1,054.36 ",86,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$980.80 ,80,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$674.30 ,55,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,164.70 ",95,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,164.70 ",95,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$919.50 ,75,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,042.10 ",85,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,189.22 ",97,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$674.30 ,55,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,103.40 ",90,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,189.22 ",97,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,189.22 ",97,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,189.22 ",97,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.10 ",85,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,103.40 ",90,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$674.30 ,55,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,164.70 ",90,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$674.30 ,55,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,140.18 ",93,,,$674.30 ,"$1,189.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Lumbar Epidural  (ESI),8728587,CDM,761,RC,62282,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Lumbar Epidural Steroid Injection (ESI),9021884,CDM,320,RC,62282,HCPCS,outpatient,,,"$2,690.00 ","$2,017.50 ",,"$2,474.80 ",92,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,479.50 ","$2,609.30 ",other,,Not applicable. No negotiated rates per contract,"$2,313.40 ",86,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,152.00 ",80,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,555.50 ",95,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,555.50 ",95,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,017.50 ",75,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,286.50 ",85,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,421.00 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,286.50 ",85,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,421.00 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,555.50 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,501.70 ",93,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Major Joint Arthr/Asp/Inj,8728577,CDM,761,RC,20610,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$242.88 ,92,,,$145.20 ,$256.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$145.20 ,$256.08 ,other,,Not applicable. No negotiated rates per contract,$227.04 ,86,,,$145.20 ,$256.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$211.20 ,80,,,$145.20 ,$256.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.00 ,75,,,$145.20 ,$256.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.52 ,93,,,$145.20 ,$256.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Myelogram Inj,8728614,CDM,761,RC,62284,HCPCS,outpatient,,,"$1,065.00 ",$798.75 ,,$979.80 ,92,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$585.75 ,"$1,033.05 ",other,,Not applicable. No negotiated rates per contract,$915.90 ,86,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$852.00 ,80,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,011.75 ",95,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,011.75 ",95,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$798.75 ,75,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$905.25 ,85,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$958.50 ,90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,033.05 ",97,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$905.25 ,85,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$958.50 ,90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,011.75 ",90,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$585.75 ,55,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$990.45 ,93,,,$585.75 ,"$1,033.05 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Shoulder Arthrogram inj,8728601,CDM,320,RC,23350,HCPCS,outpatient,,,$451.00 ,$338.25 ,,$414.92 ,92,,,$248.05 ,$437.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$248.05 ,$437.47 ,other,,Not applicable. No negotiated rates per contract,$387.86 ,86,,,$248.05 ,$437.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$360.80 ,80,,,$248.05 ,$437.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.45 ,95,,,$248.05 ,$437.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$428.45 ,95,,,$248.05 ,$437.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$338.25 ,75,,,$248.05 ,$437.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$383.35 ,85,,,$248.05 ,$437.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$405.90 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.47 ,97,,,$248.05 ,$437.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.35 ,85,,,$248.05 ,$437.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$405.90 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.45 ,90,,,$248.05 ,$437.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.05 ,55,,,$248.05 ,$437.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$419.43 ,93,,,$248.05 ,$437.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Steroid Injection,8728589,CDM,761,RC,20610,HCPCS,outpatient,,,$264.00 ,$198.00 ,,$242.88 ,92,,,$145.20 ,$256.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$145.20 ,$256.08 ,other,,Not applicable. No negotiated rates per contract,$227.04 ,86,,,$145.20 ,$256.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$211.20 ,80,,,$145.20 ,$256.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.80 ,95,,,$145.20 ,$256.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.00 ,75,,,$145.20 ,$256.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.08 ,97,,,$145.20 ,$256.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.40 ,85,,,$145.20 ,$256.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$237.60 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.80 ,90,,,$145.20 ,$256.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.20 ,55,,,$145.20 ,$256.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$245.52 ,93,,,$145.20 ,$256.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Stress Test Room,8728623,CDM,482,RC,93017,HCPCS,outpatient,,,"$1,150.00 ",$862.50 ,,"$1,058.00 ",92,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$632.50 ,"$1,115.50 ",other,,Not applicable. No negotiated rates per contract,$989.00 ,86,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$920.00 ,80,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$862.50 ,75,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,069.50 ",93,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Thoracic Epidural (ESI),8728583,CDM,761,RC,62281,HCPCS,outpatient,,,$553.00 ,$414.75 ,,$508.76 ,92,,,$304.15 ,$536.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$304.15 ,55,,,$304.15 ,$536.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$304.15 ,$536.41 ,other,,Not applicable. No negotiated rates per contract,$475.58 ,86,,,$304.15 ,$536.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$442.40 ,80,,,$304.15 ,$536.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$304.15 ,55,,,$304.15 ,$536.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$525.35 ,95,,,$304.15 ,$536.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$525.35 ,95,,,$304.15 ,$536.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$414.75 ,75,,,$304.15 ,$536.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$470.05 ,85,,,$304.15 ,$536.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$536.41 ,97,,,$304.15 ,$536.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.15 ,55,,,$304.15 ,$536.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$497.70 ,90,,,$304.15 ,$536.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$536.41 ,97,,,$304.15 ,$536.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$536.41 ,97,,,$304.15 ,$536.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$536.41 ,97,,,$304.15 ,$536.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$470.05 ,85,,,$304.15 ,$536.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$497.70 ,90,,,$304.15 ,$536.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$304.15 ,55,,,$304.15 ,$536.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$525.35 ,90,,,$304.15 ,$536.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$304.15 ,55,,,$304.15 ,$536.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$514.29 ,93,,,$304.15 ,$536.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Transforaminal ESI Addl Lvl,8728608,CDM,761,RC,64484,HCPCS,outpatient,,,$184.00 ,$138.00 ,,$169.28 ,92,,,$101.20 ,$178.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.20 ,55,,,$101.20 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$101.20 ,$178.48 ,other,,Not applicable. No negotiated rates per contract,$158.24 ,86,,,$101.20 ,$178.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$147.20 ,80,,,$101.20 ,$178.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.20 ,55,,,$101.20 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,95,,,$101.20 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.80 ,95,,,$101.20 ,$178.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.00 ,75,,,$101.20 ,$178.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.40 ,85,,,$101.20 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.48 ,97,,,$101.20 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.20 ,55,,,$101.20 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.60 ,90,,,$101.20 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.48 ,97,,,$101.20 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$101.20 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.48 ,97,,,$101.20 ,$178.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.40 ,85,,,$101.20 ,$178.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.60 ,90,,,$101.20 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$101.20 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.80 ,90,,,$101.20 ,$178.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.20 ,55,,,$101.20 ,$178.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.12 ,93,,,$101.20 ,$178.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Transforaminal ESI First Level,8728620,CDM,761,RC,64483,HCPCS,outpatient,,,"$2,690.00 ","$2,017.50 ",,"$2,474.80 ",92,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,479.50 ","$2,609.30 ",other,,Not applicable. No negotiated rates per contract,"$2,313.40 ",86,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,152.00 ",80,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,555.50 ",95,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,555.50 ",95,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,017.50 ",75,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,286.50 ",85,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,421.00 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,609.30 ",97,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,286.50 ",85,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,421.00 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,555.50 ",90,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,479.50 ",55,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,501.70 ",93,,,"$1,479.50 ","$2,609.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA US Fine Ndl Asp w/Guide Ea Add Les,9663337,CDM,402,RC,10006,HCPCS,outpatient,,,$202.00 ,$151.50 ,,$185.84 ,92,,,$111.10 ,$195.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$111.10 ,$195.94 ,other,,Not applicable. No negotiated rates per contract,$173.72 ,86,,,$111.10 ,$195.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$161.60 ,80,,,$111.10 ,$195.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$191.90 ,95,,,$111.10 ,$195.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$151.50 ,75,,,$111.10 ,$195.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$195.94 ,97,,,$111.10 ,$195.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.70 ,85,,,$111.10 ,$195.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.80 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,90,,,$111.10 ,$195.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.10 ,55,,,$111.10 ,$195.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.86 ,93,,,$111.10 ,$195.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA US OB Each Add Gestation,8728612,CDM,402,RC,76802,HCPCS,outpatient,,,$220.00 ,$165.00 ,,$202.40 ,92,,,$121.00 ,$213.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.00 ,55,,,$121.00 ,$213.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.00 ,$213.40 ,other,,Not applicable. No negotiated rates per contract,$189.20 ,86,,,$121.00 ,$213.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.00 ,80,,,$121.00 ,$213.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.00 ,55,,,$121.00 ,$213.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.00 ,95,,,$121.00 ,$213.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.00 ,95,,,$121.00 ,$213.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.00 ,75,,,$121.00 ,$213.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.00 ,85,,,$121.00 ,$213.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$213.40 ,97,,,$121.00 ,$213.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.00 ,55,,,$121.00 ,$213.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.00 ,90,,,$121.00 ,$213.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$213.40 ,97,,,$121.00 ,$213.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$213.40 ,97,,,$121.00 ,$213.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$213.40 ,97,,,$121.00 ,$213.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.00 ,85,,,$121.00 ,$213.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.00 ,90,,,$121.00 ,$213.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.00 ,55,,,$121.00 ,$213.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.00 ,90,,,$121.00 ,$213.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.00 ,55,,,$121.00 ,$213.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.60 ,93,,,$121.00 ,$213.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA XR Arthrogram Wrist SI Left,9068016,CDM,320,RC,25246,HCPCS,outpatient,,,$259.00 ,$194.25 ,,$238.28 ,92,,,$142.45 ,$251.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.45 ,$251.23 ,other,,Not applicable. No negotiated rates per contract,$222.74 ,86,,,$142.45 ,$251.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.20 ,80,,,$142.45 ,$251.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.25 ,75,,,$142.45 ,$251.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.87 ,93,,,$142.45 ,$251.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA XR Arthrogram Wrist SI Right,9068018,CDM,320,RC,25246,HCPCS,outpatient,,,$259.00 ,$194.25 ,,$238.28 ,92,,,$142.45 ,$251.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.45 ,$251.23 ,other,,Not applicable. No negotiated rates per contract,$222.74 ,86,,,$142.45 ,$251.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.20 ,80,,,$142.45 ,$251.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.25 ,75,,,$142.45 ,$251.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.87 ,93,,,$142.45 ,$251.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA XR flouro greater than 1 hour,9067804,CDM,320,RC,76001,HCPCS,outpatient,,,"$1,239.00 ",$929.25 ,,"$1,139.88 ",92,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$681.45 ,55,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$681.45 ,"$1,201.83 ",other,,Not applicable. No negotiated rates per contract,"$1,065.54 ",86,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$991.20 ,80,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$681.45 ,55,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,177.05 ",95,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,177.05 ",95,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$929.25 ,75,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,053.15 ",85,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,201.83 ",97,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$681.45 ,55,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,115.10 ",90,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,201.83 ",97,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,201.83 ",97,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,201.83 ",97,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,053.15 ",85,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,115.10 ",90,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$681.45 ,55,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,177.05 ",90,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$681.45 ,55,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,152.27 ",93,,,$681.45 ,"$1,201.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
10005 Fine needle aspiration biopsy,8741040,CDM,402,RC,10005,HCPCS,outpatient,,,$461.00 ,$345.75 ,,$424.12 ,92,,,$253.55 ,$447.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$253.55 ,$447.17 ,other,,Not applicable. No negotiated rates per contract,$396.46 ,86,,,$253.55 ,$447.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$368.80 ,80,,,$253.55 ,$447.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.95 ,95,,,$253.55 ,$447.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$437.95 ,95,,,$253.55 ,$447.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$345.75 ,75,,,$253.55 ,$447.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$391.85 ,85,,,$253.55 ,$447.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$414.90 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.17 ,97,,,$253.55 ,$447.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.85 ,85,,,$253.55 ,$447.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$414.90 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.95 ,90,,,$253.55 ,$447.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.55 ,55,,,$253.55 ,$447.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.73 ,93,,,$253.55 ,$447.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
70553 MRI BRN BRN STEM C-/C+ ProFee,8102622,CDM,611,RC,70553,HCPCS,outpatient,,,"$6,668.00 ","$5,001.00 ",,"$6,134.56 ",92,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,667.40 ","$6,467.96 ",other,,Not applicable. No negotiated rates per contract,"$5,734.48 ",86,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,334.40 ",80,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,334.60 ",95,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,334.60 ",95,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,001.00 ",75,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,667.80 ",85,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,001.20 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,467.96 ",97,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,667.80 ",85,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,001.20 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,334.60 ",90,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,667.40 ",55,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,201.24 ",93,,,"$3,667.40 ","$6,467.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Fluoro Upper GI w/SBFT,9144100,CDM,320,RC,74249,HCPCS,outpatient,,,"$1,391.00 ","$1,043.25 ",,"$1,279.72 ",92,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$765.05 ,"$1,349.27 ",other,,Not applicable. No negotiated rates per contract,"$1,196.26 ",86,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,112.80 ",80,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,321.45 ",95,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,321.45 ",95,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,043.25 ",75,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,182.35 ",85,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,251.90 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,349.27 ",97,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,182.35 ",85,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,251.90 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,321.45 ",90,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$765.05 ,55,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,293.63 ",93,,,$765.05 ,"$1,349.27 ",percent of total billed charges,,93% of total billed charges for outpatient setting
94150 PEAK FLOW TEST CHARGE,8711500,CDM,460,RC,94150,HCPCS,outpatient,,,$189.00 ,$141.75 ,,$173.88 ,92,,,$103.95 ,$183.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$103.95 ,$183.33 ,other,,Not applicable. No negotiated rates per contract,$162.54 ,86,,,$103.95 ,$183.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.20 ,80,,,$103.95 ,$183.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.75 ,75,,,$103.95 ,$183.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.77 ,93,,,$103.95 ,$183.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
94669 ACAPELLA EACH USE CHARGE,8951322,CDM,410,RC,94669,HCPCS,outpatient,,,$320.00 ,$240.00 ,,$294.40 ,92,,,$176.00 ,$310.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.00 ,$310.40 ,other,,Not applicable. No negotiated rates per contract,$275.20 ,86,,,$176.00 ,$310.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.00 ,80,,,$176.00 ,$310.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.00 ,95,,,$176.00 ,$310.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.00 ,75,,,$176.00 ,$310.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.40 ,97,,,$176.00 ,$310.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.00 ,85,,,$176.00 ,$310.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.00 ,90,,,$176.00 ,$310.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.00 ,55,,,$176.00 ,$310.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.60 ,93,,,$176.00 ,$310.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OXYGEN - OP SHORT TERM,8730601,CDM,270,RC,,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.80 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OXYGEN DAILY CHARGE,8711494,CDM,270,RC,,HCPCS,outpatient,,,$373.00 ,$279.75 ,,$343.16 ,92,,,$205.15 ,$361.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.15 ,$361.81 ,other,,Not applicable. No negotiated rates per contract,$320.78 ,86,,,$205.15 ,$361.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$298.40 ,80,,,$205.15 ,$361.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.75 ,75,,,$205.15 ,$361.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.89 ,93,,,$205.15 ,$361.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OXYHOOD PER DAY,8730602,CDM,270,RC,,HCPCS,outpatient,,,$373.00 ,$279.75 ,,$343.16 ,92,,,$205.15 ,$361.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$205.15 ,$361.81 ,other,,Not applicable. No negotiated rates per contract,$320.78 ,86,,,$205.15 ,$361.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$298.40 ,80,,,$205.15 ,$361.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$354.35 ,95,,,$205.15 ,$361.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$279.75 ,75,,,$205.15 ,$361.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.81 ,97,,,$205.15 ,$361.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$317.05 ,85,,,$205.15 ,$361.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.70 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.35 ,90,,,$205.15 ,$361.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$205.15 ,55,,,$205.15 ,$361.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$346.89 ,93,,,$205.15 ,$361.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
95810 Sleep Study Charge,8728242,CDM,920,RC,95810,HCPCS,outpatient,,,"$3,185.00 ","$2,388.75 ",,"$2,930.20 ",92,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,751.75 ","$3,089.45 ",other,,Not applicable. No negotiated rates per contract,"$2,739.10 ",86,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,548.00 ",80,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,025.75 ",95,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,025.75 ",95,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,388.75 ",75,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,707.25 ",85,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,866.50 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,707.25 ",85,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,866.50 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,025.75 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,962.05 ",93,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,93% of total billed charges for outpatient setting
95811 SLEEP STUDY W/CPAP CHARGE,8712860,CDM,920,RC,95811,HCPCS,outpatient,,,"$3,185.00 ","$2,388.75 ",,"$2,930.20 ",92,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,751.75 ","$3,089.45 ",other,,Not applicable. No negotiated rates per contract,"$2,739.10 ",86,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,548.00 ",80,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,025.75 ",95,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,025.75 ",95,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,388.75 ",75,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,707.25 ",85,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,866.50 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,089.45 ",97,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,707.25 ",85,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,866.50 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,025.75 ",90,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,751.75 ",55,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,962.05 ",93,,,"$1,751.75 ","$3,089.45 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BD/CAREFUSION NEEDLE INSUFFLATION/NEEDLE  14G X 120MM,8782750,CDM,270,RC,,HCPCS,outpatient,,,$186.04 ,$139.53 ,,$171.16 ,92,,,$102.32 ,$180.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.32 ,55,,,$102.32 ,$180.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.32 ,$180.46 ,other,,Not applicable. No negotiated rates per contract,$159.99 ,86,,,$102.32 ,$180.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$148.83 ,80,,,$102.32 ,$180.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.32 ,55,,,$102.32 ,$180.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.74 ,95,,,$102.32 ,$180.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.74 ,95,,,$102.32 ,$180.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.53 ,75,,,$102.32 ,$180.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.13 ,85,,,$102.32 ,$180.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.46 ,97,,,$102.32 ,$180.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.32 ,55,,,$102.32 ,$180.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.44 ,90,,,$102.32 ,$180.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.46 ,97,,,$102.32 ,$180.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.46 ,97,,,$102.32 ,$180.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.46 ,97,,,$102.32 ,$180.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.13 ,85,,,$102.32 ,$180.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$167.44 ,90,,,$102.32 ,$180.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.32 ,55,,,$102.32 ,$180.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.74 ,90,,,$102.32 ,$180.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.32 ,55,,,$102.32 ,$180.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.02 ,93,,,$102.32 ,$180.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784798,CDM,270,RC,51174,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VOLUMAT LINE  PRIMARY INFUSION SET,8783135,CDM,270,RC,,HCPCS,outpatient,,,$44.06 ,$33.05 ,,$40.54 ,92,,,$24.23 ,$42.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.23 ,55,,,$24.23 ,$42.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.23 ,$42.74 ,other,,Not applicable. No negotiated rates per contract,$37.89 ,86,,,$24.23 ,$42.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.25 ,80,,,$24.23 ,$42.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.23 ,55,,,$24.23 ,$42.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.86 ,95,,,$24.23 ,$42.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.86 ,95,,,$24.23 ,$42.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.05 ,75,,,$24.23 ,$42.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.45 ,85,,,$24.23 ,$42.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.74 ,97,,,$24.23 ,$42.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.23 ,55,,,$24.23 ,$42.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.65 ,90,,,$24.23 ,$42.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.74 ,97,,,$24.23 ,$42.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.74 ,97,,,$24.23 ,$42.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.74 ,97,,,$24.23 ,$42.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.45 ,85,,,$24.23 ,$42.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.65 ,90,,,$24.23 ,$42.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.23 ,55,,,$24.23 ,$42.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.86 ,90,,,$24.23 ,$42.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.23 ,55,,,$24.23 ,$42.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.98 ,93,,,$24.23 ,$42.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX COLLAGEN COATED FIBERLOOP #2,8782098,CDM,270,RC,,HCPCS,outpatient,,,$484.38 ,$363.29 ,,$445.63 ,92,,,$266.41 ,$469.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.41 ,$469.85 ,other,,Not applicable. No negotiated rates per contract,$416.57 ,86,,,$266.41 ,$469.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.50 ,80,,,$266.41 ,$469.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.29 ,75,,,$266.41 ,$469.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.47 ,93,,,$266.41 ,$469.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BACTERIA FILTER FOR THE TRILOGY (VENTILATORS),8786258,CDM,270,RC,,HCPCS,outpatient,,,$40.00 ,$30.00 ,,$36.80 ,92,,,$22.00 ,$38.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.00 ,$38.80 ,other,,Not applicable. No negotiated rates per contract,$34.40 ,86,,,$22.00 ,$38.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.00 ,80,,,$22.00 ,$38.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.00 ,75,,,$22.00 ,$38.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.20 ,93,,,$22.00 ,$38.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BD SURGICAL CLIPPER BLADE,8785743,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE RECIPROCATING DOUBLE-SIDED,8960450,CDM,270,RC,,HCPCS,outpatient,,,$289.78 ,$217.34 ,,$266.60 ,92,,,$159.38 ,$281.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.38 ,$281.09 ,other,,Not applicable. No negotiated rates per contract,$249.21 ,86,,,$159.38 ,$281.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$231.82 ,80,,,$159.38 ,$281.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.29 ,95,,,$159.38 ,$281.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.29 ,95,,,$159.38 ,$281.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.34 ,75,,,$159.38 ,$281.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.31 ,85,,,$159.38 ,$281.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.80 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.31 ,85,,,$159.38 ,$281.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.80 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.29 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.50 ,93,,,$159.38 ,$281.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH foley 2-WAY SECURE  STATLOCK,8785570,CDM,270,RC,,HCPCS,outpatient,,,$33.60 ,$25.20 ,,$30.91 ,92,,,$18.48 ,$32.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.48 ,$32.59 ,other,,Not applicable. No negotiated rates per contract,$28.90 ,86,,,$18.48 ,$32.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.88 ,80,,,$18.48 ,$32.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.92 ,95,,,$18.48 ,$32.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.92 ,95,,,$18.48 ,$32.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.20 ,75,,,$18.48 ,$32.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.56 ,85,,,$18.48 ,$32.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.24 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.56 ,85,,,$18.48 ,$32.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.24 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.92 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.25 ,93,,,$18.48 ,$32.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CONTROL SYRINGE 20ML,9132870,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIGITAL  FINGER SPLINT,8787058,CDM,270,RC,51588,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DJO,9328587,CDM,270,RC,,HCPCS,outpatient,,,$478.00 ,$358.50 ,,$439.76 ,92,,,$262.90 ,$463.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$262.90 ,55,,,$262.90 ,$463.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$262.90 ,$463.66 ,other,,Not applicable. No negotiated rates per contract,$411.08 ,86,,,$262.90 ,$463.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$382.40 ,80,,,$262.90 ,$463.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$262.90 ,55,,,$262.90 ,$463.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$454.10 ,95,,,$262.90 ,$463.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$454.10 ,95,,,$262.90 ,$463.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$358.50 ,75,,,$262.90 ,$463.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$406.30 ,85,,,$262.90 ,$463.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$463.66 ,97,,,$262.90 ,$463.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.90 ,55,,,$262.90 ,$463.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$430.20 ,90,,,$262.90 ,$463.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$463.66 ,97,,,$262.90 ,$463.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.66 ,97,,,$262.90 ,$463.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.66 ,97,,,$262.90 ,$463.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.30 ,85,,,$262.90 ,$463.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$430.20 ,90,,,$262.90 ,$463.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.90 ,55,,,$262.90 ,$463.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$454.10 ,90,,,$262.90 ,$463.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.90 ,55,,,$262.90 ,$463.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.54 ,93,,,$262.90 ,$463.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING MEPILEX BOARDER AG 4X8,9055117,CDM,270,RC,,HCPCS,outpatient,,,$285.29 ,$213.97 ,,$262.47 ,92,,,$156.91 ,$276.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.91 ,55,,,$156.91 ,$276.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.91 ,$276.73 ,other,,Not applicable. No negotiated rates per contract,$245.35 ,86,,,$156.91 ,$276.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$228.23 ,80,,,$156.91 ,$276.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.91 ,55,,,$156.91 ,$276.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.03 ,95,,,$156.91 ,$276.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.03 ,95,,,$156.91 ,$276.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.97 ,75,,,$156.91 ,$276.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$242.50 ,85,,,$156.91 ,$276.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$276.73 ,97,,,$156.91 ,$276.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.91 ,55,,,$156.91 ,$276.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.76 ,90,,,$156.91 ,$276.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$276.73 ,97,,,$156.91 ,$276.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.73 ,97,,,$156.91 ,$276.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.73 ,97,,,$156.91 ,$276.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.50 ,85,,,$156.91 ,$276.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.76 ,90,,,$156.91 ,$276.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.91 ,55,,,$156.91 ,$276.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.03 ,90,,,$156.91 ,$276.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.91 ,55,,,$156.91 ,$276.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.32 ,93,,,$156.91 ,$276.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDO TRACH GUIDE ADULT 10FR.,8783042,CDM,270,RC,,HCPCS,outpatient,,,$42.82 ,$32.12 ,,$39.39 ,92,,,$23.55 ,$41.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.55 ,$41.54 ,other,,Not applicable. No negotiated rates per contract,$36.83 ,86,,,$23.55 ,$41.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.26 ,80,,,$23.55 ,$41.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.12 ,75,,,$23.55 ,$41.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.82 ,93,,,$23.55 ,$41.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA SPHERE FEMUR CEMENTED LEFT S4,10045530,CDM,278,RC,,HCPCS,both,,,"$11,550.00 ","$8,662.50 ",,"$10,626.00 ",92,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$6,352.50 ","$11,203.50 ",other,,Not applicable. No negotiated rates per contract,"$9,933.00 ",86,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$9,240.00 ",80,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$8,662.50 ",75,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,741.50 ",93,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045538,CDM,278,RC,,HCPCS,both,,,$656.25 ,$492.19 ,,$603.75 ,92,,,$360.94 ,$636.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$360.94 ,$636.56 ,other,,Not applicable. No negotiated rates per contract,$564.38 ,86,,,$360.94 ,$636.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$525.00 ,80,,,$360.94 ,$636.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$492.19 ,75,,,$360.94 ,$636.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.31 ,93,,,$360.94 ,$636.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10058769,CDM,278,RC,,HCPCS,both,,,"$11,550.00 ","$8,662.50 ",,"$10,626.00 ",92,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$6,352.50 ","$11,203.50 ",other,,Not applicable. No negotiated rates per contract,"$9,933.00 ",86,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$9,240.00 ",80,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$8,662.50 ",75,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,741.50 ",93,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT EVOLUTION MP KEELED TIBIAL BASE,9566940,CDM,278,RC,55223,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
OSTEOMED PILOT DRILL1.8MM J-LATCH,8784802,CDM,270,RC,,HCPCS,outpatient,,,$783.75 ,$587.81 ,,$721.05 ,92,,,$431.06 ,$760.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.06 ,$760.24 ,other,,Not applicable. No negotiated rates per contract,$674.03 ,86,,,$431.06 ,$760.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$627.00 ,80,,,$431.06 ,$760.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.81 ,75,,,$431.06 ,$760.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.89 ,93,,,$431.06 ,$760.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED SCREW,8784799,CDM,270,RC,,HCPCS,outpatient,,,$563.50 ,$422.63 ,,$518.42 ,92,,,$309.93 ,$546.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$309.93 ,$546.60 ,other,,Not applicable. No negotiated rates per contract,$484.61 ,86,,,$309.93 ,$546.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$450.80 ,80,,,$309.93 ,$546.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.33 ,95,,,$309.93 ,$546.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.33 ,95,,,$309.93 ,$546.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$422.63 ,75,,,$309.93 ,$546.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$478.98 ,85,,,$309.93 ,$546.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$507.15 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$478.98 ,85,,,$309.93 ,$546.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$507.15 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.33 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$524.06 ,93,,,$309.93 ,$546.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED SCREW,8784826,CDM,270,RC,,HCPCS,outpatient,,,$630.00 ,$472.50 ,,$579.60 ,92,,,$346.50 ,$611.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$346.50 ,$611.10 ,other,,Not applicable. No negotiated rates per contract,$541.80 ,86,,,$346.50 ,$611.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$504.00 ,80,,,$346.50 ,$611.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$598.50 ,95,,,$346.50 ,$611.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$598.50 ,95,,,$346.50 ,$611.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.50 ,75,,,$346.50 ,$611.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$535.50 ,85,,,$346.50 ,$611.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.00 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$535.50 ,85,,,$346.50 ,$611.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$567.00 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$598.50 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$585.90 ,93,,,$346.50 ,$611.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED SCREW,8784818,CDM,270,RC,,HCPCS,outpatient,,,$630.00 ,$472.50 ,,$579.60 ,92,,,$346.50 ,$611.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$346.50 ,$611.10 ,other,,Not applicable. No negotiated rates per contract,$541.80 ,86,,,$346.50 ,$611.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$504.00 ,80,,,$346.50 ,$611.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$598.50 ,95,,,$346.50 ,$611.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$598.50 ,95,,,$346.50 ,$611.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.50 ,75,,,$346.50 ,$611.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$535.50 ,85,,,$346.50 ,$611.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.00 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.10 ,97,,,$346.50 ,$611.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$535.50 ,85,,,$346.50 ,$611.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$567.00 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$598.50 ,90,,,$346.50 ,$611.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.50 ,55,,,$346.50 ,$611.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$585.90 ,93,,,$346.50 ,$611.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784823,CDM,270,RC,,HCPCS,outpatient,,,$783.75 ,$587.81 ,,$721.05 ,92,,,$431.06 ,$760.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.06 ,$760.24 ,other,,Not applicable. No negotiated rates per contract,$674.03 ,86,,,$431.06 ,$760.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$627.00 ,80,,,$431.06 ,$760.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.81 ,75,,,$431.06 ,$760.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.89 ,93,,,$431.06 ,$760.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784811,CDM,270,RC,52612,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PHILIPS SENSOR ADULT REUSABLE SP02 (ER),8786251,CDM,270,RC,,HCPCS,outpatient,,,$931.71 ,$698.78 ,,$857.17 ,92,,,$512.44 ,$903.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$512.44 ,55,,,$512.44 ,$903.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$512.44 ,$903.76 ,other,,Not applicable. No negotiated rates per contract,$801.27 ,86,,,$512.44 ,$903.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$745.37 ,80,,,$512.44 ,$903.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$512.44 ,55,,,$512.44 ,$903.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$885.12 ,95,,,$512.44 ,$903.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$885.12 ,95,,,$512.44 ,$903.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$698.78 ,75,,,$512.44 ,$903.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$791.95 ,85,,,$512.44 ,$903.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$903.76 ,97,,,$512.44 ,$903.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$512.44 ,55,,,$512.44 ,$903.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$838.54 ,90,,,$512.44 ,$903.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$903.76 ,97,,,$512.44 ,$903.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$903.76 ,97,,,$512.44 ,$903.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$903.76 ,97,,,$512.44 ,$903.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$791.95 ,85,,,$512.44 ,$903.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$838.54 ,90,,,$512.44 ,$903.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$512.44 ,55,,,$512.44 ,$903.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$885.12 ,90,,,$512.44 ,$903.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$512.44 ,55,,,$512.44 ,$903.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$866.49 ,93,,,$512.44 ,$903.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS BONE SCREW T10 FULL THREAD 3.5MM/L55MM,9953140,CDM,278,RC,,HCPCS,both,,,$871.25 ,$653.44 ,,$801.55 ,92,,,$479.19 ,$845.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$479.19 ,$845.11 ,other,,Not applicable. No negotiated rates per contract,$749.28 ,86,,,$479.19 ,$845.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$697.00 ,80,,,$479.19 ,$845.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$653.44 ,75,,,$479.19 ,$845.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.26 ,93,,,$479.19 ,$845.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT WRIST XS-SMALL RT COMFORT FORM,8785112,CDM,270,RC,,HCPCS,outpatient,,,$104.47 ,$78.35 ,,$96.11 ,92,,,$57.46 ,$101.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.46 ,55,,,$57.46 ,$101.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.46 ,$101.34 ,other,,Not applicable. No negotiated rates per contract,$89.84 ,86,,,$57.46 ,$101.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.58 ,80,,,$57.46 ,$101.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.46 ,55,,,$57.46 ,$101.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.25 ,95,,,$57.46 ,$101.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.25 ,95,,,$57.46 ,$101.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.35 ,75,,,$57.46 ,$101.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.80 ,85,,,$57.46 ,$101.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.34 ,97,,,$57.46 ,$101.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.46 ,55,,,$57.46 ,$101.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.02 ,90,,,$57.46 ,$101.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.34 ,97,,,$57.46 ,$101.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.34 ,97,,,$57.46 ,$101.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.34 ,97,,,$57.46 ,$101.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.80 ,85,,,$57.46 ,$101.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.02 ,90,,,$57.46 ,$101.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.46 ,55,,,$57.46 ,$101.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.25 ,90,,,$57.46 ,$101.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.46 ,55,,,$57.46 ,$101.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.16 ,93,,,$57.46 ,$101.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 4.5 UNCUFFED  ENDO TRACH,8783037,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"UNDERCAST  PADDING STERILE (4"" X 4 YDS)",8785521,CDM,270,RC,,HCPCS,outpatient,,,$41.13 ,$30.85 ,,$37.84 ,92,,,$22.62 ,$39.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.62 ,55,,,$22.62 ,$39.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.62 ,$39.90 ,other,,Not applicable. No negotiated rates per contract,$35.37 ,86,,,$22.62 ,$39.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.90 ,80,,,$22.62 ,$39.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.62 ,55,,,$22.62 ,$39.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.07 ,95,,,$22.62 ,$39.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.07 ,95,,,$22.62 ,$39.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.85 ,75,,,$22.62 ,$39.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.96 ,85,,,$22.62 ,$39.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.90 ,97,,,$22.62 ,$39.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.62 ,55,,,$22.62 ,$39.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.02 ,90,,,$22.62 ,$39.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.90 ,97,,,$22.62 ,$39.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.90 ,97,,,$22.62 ,$39.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.90 ,97,,,$22.62 ,$39.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.96 ,85,,,$22.62 ,$39.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.02 ,90,,,$22.62 ,$39.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.62 ,55,,,$22.62 ,$39.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.07 ,90,,,$22.62 ,$39.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.62 ,55,,,$22.62 ,$39.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.25 ,93,,,$22.62 ,$39.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"#2 FIBERWIRE 38 "" WHITE/BLATAP.",8782097,CDM,270,RC,,HCPCS,outpatient,,,$403.13 ,$302.35 ,,$370.88 ,92,,,$221.72 ,$391.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$221.72 ,55,,,$221.72 ,$391.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$221.72 ,$391.04 ,other,,Not applicable. No negotiated rates per contract,$346.69 ,86,,,$221.72 ,$391.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$322.50 ,80,,,$221.72 ,$391.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$221.72 ,55,,,$221.72 ,$391.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.97 ,95,,,$221.72 ,$391.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$382.97 ,95,,,$221.72 ,$391.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.35 ,75,,,$221.72 ,$391.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$342.66 ,85,,,$221.72 ,$391.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.04 ,97,,,$221.72 ,$391.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.72 ,55,,,$221.72 ,$391.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$362.82 ,90,,,$221.72 ,$391.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.04 ,97,,,$221.72 ,$391.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.04 ,97,,,$221.72 ,$391.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.04 ,97,,,$221.72 ,$391.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$342.66 ,85,,,$221.72 ,$391.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$362.82 ,90,,,$221.72 ,$391.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.72 ,55,,,$221.72 ,$391.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.97 ,90,,,$221.72 ,$391.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.72 ,55,,,$221.72 ,$391.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$374.91 ,93,,,$221.72 ,$391.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
#2 FIBERWIRE C-13 REVE,8998664,CDM,270,RC,,HCPCS,outpatient,,,$178.13 ,$133.60 ,,$163.88 ,92,,,$97.97 ,$172.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.97 ,$172.79 ,other,,Not applicable. No negotiated rates per contract,$153.19 ,86,,,$97.97 ,$172.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.50 ,80,,,$97.97 ,$172.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.22 ,95,,,$97.97 ,$172.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.22 ,95,,,$97.97 ,$172.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.60 ,75,,,$97.97 ,$172.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.41 ,85,,,$97.97 ,$172.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.32 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.41 ,85,,,$97.97 ,$172.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.32 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.22 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.66 ,93,,,$97.97 ,$172.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
(HARMONIC FOCUS SHEARS (,8783813,CDM,270,RC,,HCPCS,outpatient,,,"$2,955.71 ","$2,216.78 ",,"$2,719.25 ",92,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,625.64 ",55,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,625.64 ","$2,867.04 ",other,,Not applicable. No negotiated rates per contract,"$2,541.91 ",86,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,364.57 ",80,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,625.64 ",55,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,807.92 ",95,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,807.92 ",95,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,216.78 ",75,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,512.35 ",85,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,867.04 ",97,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,625.64 ",55,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,660.14 ",90,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,867.04 ",97,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,867.04 ",97,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,867.04 ",97,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,512.35 ",85,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,660.14 ",90,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,625.64 ",55,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,807.92 ",90,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,625.64 ",55,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,748.81 ",93,,,"$1,625.64 ","$2,867.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
.9% NACL 1000ML IRRIGATI,8782629,CDM,270,RC,,HCPCS,outpatient,,,$38.15 ,$28.61 ,,$35.10 ,92,,,$20.98 ,$37.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.98 ,$37.01 ,other,,Not applicable. No negotiated rates per contract,$32.81 ,86,,,$20.98 ,$37.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.52 ,80,,,$20.98 ,$37.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.24 ,95,,,$20.98 ,$37.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.24 ,95,,,$20.98 ,$37.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.61 ,75,,,$20.98 ,$37.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.43 ,85,,,$20.98 ,$37.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.34 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.43 ,85,,,$20.98 ,$37.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.34 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.24 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.48 ,93,,,$20.98 ,$37.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.9% NACL 1000ML IRRIGATION 1000ML (B-BRAUN) R5200-01,10998721,CDM,272,RC,,HCPCS,outpatient,,,$38.33 ,$28.75 ,,$35.26 ,92,,,$21.08 ,$37.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.08 ,$37.18 ,other,,Not applicable. No negotiated rates per contract,$32.96 ,86,,,$21.08 ,$37.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.66 ,80,,,$21.08 ,$37.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.41 ,95,,,$21.08 ,$37.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.41 ,95,,,$21.08 ,$37.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.75 ,75,,,$21.08 ,$37.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.58 ,85,,,$21.08 ,$37.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.50 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.58 ,85,,,$21.08 ,$37.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.50 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.41 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.65 ,93,,,$21.08 ,$37.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
.9% NACL 250ML IRRIGATION,10495376,CDM,272,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
02  4000ML VOLUMETRIC  EXER.(NEW) GREEN (HUD8884719010),9793330,CDM,270,RC,,HCPCS,outpatient,,,$31.76 ,$23.82 ,,$29.22 ,92,,,$17.47 ,$30.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.47 ,$30.81 ,other,,Not applicable. No negotiated rates per contract,$27.31 ,86,,,$17.47 ,$30.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.41 ,80,,,$17.47 ,$30.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.82 ,75,,,$17.47 ,$30.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.54 ,93,,,$17.47 ,$30.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
02 ENRICHMENT ATTACHMENT,8786249,CDM,270,RC,,HCPCS,outpatient,,,$29.93 ,$22.45 ,,$27.54 ,92,,,$16.46 ,$29.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.46 ,$29.03 ,other,,Not applicable. No negotiated rates per contract,$25.74 ,86,,,$16.46 ,$29.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.94 ,80,,,$16.46 ,$29.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.43 ,95,,,$16.46 ,$29.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.43 ,95,,,$16.46 ,$29.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.45 ,75,,,$16.46 ,$29.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.44 ,85,,,$16.46 ,$29.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.94 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.44 ,85,,,$16.46 ,$29.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.94 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.43 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.83 ,93,,,$16.46 ,$29.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
02 HUMIDFIER 650ML,9793534,CDM,270,RC,,HCPCS,outpatient,,,$29.58 ,$22.19 ,,$27.21 ,92,,,$16.27 ,$28.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.27 ,55,,,$16.27 ,$28.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.27 ,$28.69 ,other,,Not applicable. No negotiated rates per contract,$25.44 ,86,,,$16.27 ,$28.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.66 ,80,,,$16.27 ,$28.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.27 ,55,,,$16.27 ,$28.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.10 ,95,,,$16.27 ,$28.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.10 ,95,,,$16.27 ,$28.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.19 ,75,,,$16.27 ,$28.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.14 ,85,,,$16.27 ,$28.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.69 ,97,,,$16.27 ,$28.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.27 ,55,,,$16.27 ,$28.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.62 ,90,,,$16.27 ,$28.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.69 ,97,,,$16.27 ,$28.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.69 ,97,,,$16.27 ,$28.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.69 ,97,,,$16.27 ,$28.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.14 ,85,,,$16.27 ,$28.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.62 ,90,,,$16.27 ,$28.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.27 ,55,,,$16.27 ,$28.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.10 ,90,,,$16.27 ,$28.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.27 ,55,,,$16.27 ,$28.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.51 ,93,,,$16.27 ,$28.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
02 HUMIDIFIER 340ML,8942817,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
18.MM DRILL FOR FIBERTAK,8942841,CDM,270,RC,,HCPCS,outpatient,,,$551.25 ,$413.44 ,,$507.15 ,92,,,$303.19 ,$534.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$303.19 ,55,,,$303.19 ,$534.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$303.19 ,$534.71 ,other,,Not applicable. No negotiated rates per contract,$474.08 ,86,,,$303.19 ,$534.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$441.00 ,80,,,$303.19 ,$534.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$303.19 ,55,,,$303.19 ,$534.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.69 ,95,,,$303.19 ,$534.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$523.69 ,95,,,$303.19 ,$534.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.44 ,75,,,$303.19 ,$534.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$468.56 ,85,,,$303.19 ,$534.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$534.71 ,97,,,$303.19 ,$534.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.19 ,55,,,$303.19 ,$534.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$496.13 ,90,,,$303.19 ,$534.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$534.71 ,97,,,$303.19 ,$534.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$534.71 ,97,,,$303.19 ,$534.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$534.71 ,97,,,$303.19 ,$534.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$468.56 ,85,,,$303.19 ,$534.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$496.13 ,90,,,$303.19 ,$534.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$303.19 ,55,,,$303.19 ,$534.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$523.69 ,90,,,$303.19 ,$534.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$303.19 ,55,,,$303.19 ,$534.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$512.66 ,93,,,$303.19 ,$534.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
2-0 STRATAFIX CT-1,9085724,CDM,270,RC,,HCPCS,outpatient,,,$144.93 ,$108.70 ,,$133.34 ,92,,,$79.71 ,$140.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.71 ,55,,,$79.71 ,$140.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$79.71 ,$140.58 ,other,,Not applicable. No negotiated rates per contract,$124.64 ,86,,,$79.71 ,$140.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$115.94 ,80,,,$79.71 ,$140.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.71 ,55,,,$79.71 ,$140.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.68 ,95,,,$79.71 ,$140.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.68 ,95,,,$79.71 ,$140.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.70 ,75,,,$79.71 ,$140.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$123.19 ,85,,,$79.71 ,$140.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.58 ,97,,,$79.71 ,$140.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.71 ,55,,,$79.71 ,$140.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$130.44 ,90,,,$79.71 ,$140.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.58 ,97,,,$79.71 ,$140.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.58 ,97,,,$79.71 ,$140.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.58 ,97,,,$79.71 ,$140.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.19 ,85,,,$79.71 ,$140.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$130.44 ,90,,,$79.71 ,$140.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.71 ,55,,,$79.71 ,$140.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.68 ,90,,,$79.71 ,$140.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.71 ,55,,,$79.71 ,$140.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.78 ,93,,,$79.71 ,$140.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
2-0 VICRYL CT-1 CONTROL RELEASE,9157218,CDM,270,RC,,HCPCS,outpatient,,,$127.18 ,$95.39 ,,$117.01 ,92,,,$69.95 ,$123.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.95 ,55,,,$69.95 ,$123.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.95 ,$123.36 ,other,,Not applicable. No negotiated rates per contract,$109.37 ,86,,,$69.95 ,$123.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.74 ,80,,,$69.95 ,$123.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.95 ,55,,,$69.95 ,$123.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.82 ,95,,,$69.95 ,$123.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.82 ,95,,,$69.95 ,$123.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.39 ,75,,,$69.95 ,$123.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.10 ,85,,,$69.95 ,$123.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.36 ,97,,,$69.95 ,$123.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.95 ,55,,,$69.95 ,$123.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.46 ,90,,,$69.95 ,$123.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.36 ,97,,,$69.95 ,$123.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.36 ,97,,,$69.95 ,$123.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.36 ,97,,,$69.95 ,$123.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.10 ,85,,,$69.95 ,$123.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,90,,,$69.95 ,$123.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.95 ,55,,,$69.95 ,$123.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.82 ,90,,,$69.95 ,$123.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.95 ,55,,,$69.95 ,$123.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.28 ,93,,,$69.95 ,$123.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
2.0 ETHILON SUTURE BLK MONO PSLX 30,9310039,CDM,270,RC,,HCPCS,outpatient,,,$30.63 ,$22.97 ,,$28.18 ,92,,,$16.85 ,$29.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.85 ,$29.71 ,other,,Not applicable. No negotiated rates per contract,$26.34 ,86,,,$16.85 ,$29.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.50 ,80,,,$16.85 ,$29.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.10 ,95,,,$16.85 ,$29.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.10 ,95,,,$16.85 ,$29.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.97 ,75,,,$16.85 ,$29.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.04 ,85,,,$16.85 ,$29.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.57 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.04 ,85,,,$16.85 ,$29.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.57 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.10 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.49 ,93,,,$16.85 ,$29.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
25 DEG TIGHT CURVE RIGHT,8942842,CDM,270,RC,,HCPCS,outpatient,,,$848.45 ,$636.34 ,,$780.57 ,92,,,$466.65 ,$823.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$466.65 ,55,,,$466.65 ,$823.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$466.65 ,$823.00 ,other,,Not applicable. No negotiated rates per contract,$729.67 ,86,,,$466.65 ,$823.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$678.76 ,80,,,$466.65 ,$823.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$466.65 ,55,,,$466.65 ,$823.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$806.03 ,95,,,$466.65 ,$823.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$806.03 ,95,,,$466.65 ,$823.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$636.34 ,75,,,$466.65 ,$823.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$721.18 ,85,,,$466.65 ,$823.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$823.00 ,97,,,$466.65 ,$823.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$466.65 ,55,,,$466.65 ,$823.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$763.61 ,90,,,$466.65 ,$823.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$823.00 ,97,,,$466.65 ,$823.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$823.00 ,97,,,$466.65 ,$823.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$823.00 ,97,,,$466.65 ,$823.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$721.18 ,85,,,$466.65 ,$823.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.61 ,90,,,$466.65 ,$823.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$466.65 ,55,,,$466.65 ,$823.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$806.03 ,90,,,$466.65 ,$823.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$466.65 ,55,,,$466.65 ,$823.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$789.06 ,93,,,$466.65 ,$823.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"3-0 ETHILON BLK 1X18"" PS-1",9085726,CDM,270,RC,,HCPCS,outpatient,,,$34.91 ,$26.18 ,,$32.12 ,92,,,$19.20 ,$33.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.20 ,$33.86 ,other,,Not applicable. No negotiated rates per contract,$30.02 ,86,,,$19.20 ,$33.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.93 ,80,,,$19.20 ,$33.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,95,,,$19.20 ,$33.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.16 ,95,,,$19.20 ,$33.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.18 ,75,,,$19.20 ,$33.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.67 ,85,,,$19.20 ,$33.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.42 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.67 ,85,,,$19.20 ,$33.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.42 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.47 ,93,,,$19.20 ,$33.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
4-0 VICRYL PS-2 UNDYED,9089141,CDM,272,RC,,HCPCS,outpatient,,,$26.25 ,$19.69 ,,$24.15 ,92,,,$14.44 ,$25.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.44 ,55,,,$14.44 ,$25.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.44 ,$25.46 ,other,,Not applicable. No negotiated rates per contract,$22.58 ,86,,,$14.44 ,$25.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.00 ,80,,,$14.44 ,$25.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.44 ,55,,,$14.44 ,$25.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.94 ,95,,,$14.44 ,$25.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.94 ,95,,,$14.44 ,$25.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.69 ,75,,,$14.44 ,$25.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.31 ,85,,,$14.44 ,$25.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.46 ,97,,,$14.44 ,$25.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.44 ,55,,,$14.44 ,$25.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.63 ,90,,,$14.44 ,$25.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.46 ,97,,,$14.44 ,$25.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.46 ,97,,,$14.44 ,$25.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.46 ,97,,,$14.44 ,$25.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.31 ,85,,,$14.44 ,$25.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.63 ,90,,,$14.44 ,$25.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.44 ,55,,,$14.44 ,$25.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.94 ,90,,,$14.44 ,$25.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.44 ,55,,,$14.44 ,$25.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.41 ,93,,,$14.44 ,$25.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
4MM 70 DEGREE  ARTHROSAC,8786853,CDM,270,RC,,HCPCS,outpatient,,,"$6,496.75 ","$4,872.56 ",,"$5,977.01 ",92,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,573.21 ",55,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,573.21 ","$6,301.85 ",other,,Not applicable. No negotiated rates per contract,"$5,587.21 ",86,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,197.40 ",80,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,573.21 ",55,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,171.91 ",95,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,171.91 ",95,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,872.56 ",75,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,522.24 ",85,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,301.85 ",97,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,573.21 ",55,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,847.08 ",90,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,301.85 ",97,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,301.85 ",97,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,301.85 ",97,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,522.24 ",85,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,847.08 ",90,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,573.21 ",55,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,171.91 ",90,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,573.21 ",55,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,041.98 ",93,,,"$3,573.21 ","$6,301.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
7 X 75MM CANNULA,8783805,CDM,270,RC,,HCPCS,outpatient,,,$240.56 ,$180.42 ,,$221.32 ,92,,,$132.31 ,$233.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.31 ,$233.34 ,other,,Not applicable. No negotiated rates per contract,$206.88 ,86,,,$132.31 ,$233.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.45 ,80,,,$132.31 ,$233.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.53 ,95,,,$132.31 ,$233.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.53 ,95,,,$132.31 ,$233.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.42 ,75,,,$132.31 ,$233.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.48 ,85,,,$132.31 ,$233.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.50 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.48 ,85,,,$132.31 ,$233.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.50 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.53 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.72 ,93,,,$132.31 ,$233.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
8.5 X 75MM YELLOW CANNULA,8783803,CDM,270,RC,,HCPCS,outpatient,,,$240.56 ,$180.42 ,,$221.32 ,92,,,$132.31 ,$233.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.31 ,$233.34 ,other,,Not applicable. No negotiated rates per contract,$206.88 ,86,,,$132.31 ,$233.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.45 ,80,,,$132.31 ,$233.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.53 ,95,,,$132.31 ,$233.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.53 ,95,,,$132.31 ,$233.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.42 ,75,,,$132.31 ,$233.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.48 ,85,,,$132.31 ,$233.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.50 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.34 ,97,,,$132.31 ,$233.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.48 ,85,,,$132.31 ,$233.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.50 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.53 ,90,,,$132.31 ,$233.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.31 ,55,,,$132.31 ,$233.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.72 ,93,,,$132.31 ,$233.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
A  C  L GRAFT (ALLOGRAFT 7-7.5 FOLDED DIAMETER,8786493,CDM,278,RC,L8699,HCPCS,both,,,"$7,150.00 ","$5,362.50 ",,"$6,578.00 ",92,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,932.50 ","$6,935.50 ",other,,Not applicable. No negotiated rates per contract,"$6,149.00 ",86,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,720.00 ",80,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,362.50 ",75,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,649.50 ",93,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"A-CELL BURN MATRIX-MESHED(5CM X 5CM) 2"" X2"" ) BMM0505",8782034,CDM,270,RC,,HCPCS,outpatient,,,"$3,215.13 ","$2,411.35 ",,"$2,957.92 ",92,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,768.32 ","$3,118.68 ",other,,Not applicable. No negotiated rates per contract,"$2,765.01 ",86,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,572.10 ",80,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,054.37 ",95,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,054.37 ",95,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,411.35 ",75,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,732.86 ",85,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,893.62 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,732.86 ",85,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,893.62 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,054.37 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,990.07 ",93,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"A-CELL BURN MATRIX-MESHED(7CM X 10CM) 2 3/4"" X 4"" (BMM0710)",8782035,CDM,270,RC,,HCPCS,outpatient,,,"$4,171.88 ","$3,128.91 ",,"$3,838.13 ",92,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,294.53 ",55,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,294.53 ","$4,046.72 ",other,,Not applicable. No negotiated rates per contract,"$3,587.82 ",86,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,337.50 ",80,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,294.53 ",55,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,963.29 ",95,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,963.29 ",95,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,128.91 ",75,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,546.10 ",85,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,046.72 ",97,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,294.53 ",55,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,754.69 ",90,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,046.72 ",97,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,046.72 ",97,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,046.72 ",97,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,546.10 ",85,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,754.69 ",90,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,294.53 ",55,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,963.29 ",90,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,294.53 ",55,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,879.85 ",93,,,"$2,294.53 ","$4,046.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
A-CELL MATRISTEM MICROMA,8782029,CDM,270,RC,,HCPCS,outpatient,,,"$1,210.40 ",$907.80 ,,"$1,113.57 ",92,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$665.72 ,55,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$665.72 ,"$1,174.09 ",other,,Not applicable. No negotiated rates per contract,"$1,040.94 ",86,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$968.32 ,80,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$665.72 ,55,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,149.88 ",95,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,149.88 ",95,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$907.80 ,75,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,028.84 ",85,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,174.09 ",97,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$665.72 ,55,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,089.36 ",90,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,174.09 ",97,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.09 ",97,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.09 ",97,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,028.84 ",85,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,089.36 ",90,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$665.72 ,55,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,149.88 ",90,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$665.72 ,55,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,125.67 ",93,,,$665.72 ,"$1,174.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
A-CELL MATRIXTEM MULTILAYER WOUND 5 X5CM (WSM0505),8782030,CDM,270,RC,,HCPCS,outpatient,,,"$3,215.13 ","$2,411.35 ",,"$2,957.92 ",92,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,768.32 ","$3,118.68 ",other,,Not applicable. No negotiated rates per contract,"$2,765.01 ",86,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,572.10 ",80,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,054.37 ",95,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,054.37 ",95,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,411.35 ",75,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,732.86 ",85,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,893.62 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,118.68 ",97,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,732.86 ",85,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,893.62 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,054.37 ",90,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,768.32 ",55,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,990.07 ",93,,,"$1,768.32 ","$3,118.68 ",percent of total billed charges,,93% of total billed charges for outpatient setting
A-CELL MATRIXTEM MULTILAYER WOUND 3CM X 7CM (WS0307),8782033,CDM,270,RC,,HCPCS,outpatient,,,$686.86 ,$515.15 ,,$631.91 ,92,,,$377.77 ,$666.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$377.77 ,55,,,$377.77 ,$666.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$377.77 ,$666.25 ,other,,Not applicable. No negotiated rates per contract,$590.70 ,86,,,$377.77 ,$666.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$549.49 ,80,,,$377.77 ,$666.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$377.77 ,55,,,$377.77 ,$666.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.52 ,95,,,$377.77 ,$666.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$652.52 ,95,,,$377.77 ,$666.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.15 ,75,,,$377.77 ,$666.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$583.83 ,85,,,$377.77 ,$666.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.25 ,97,,,$377.77 ,$666.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$377.77 ,55,,,$377.77 ,$666.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.17 ,90,,,$377.77 ,$666.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$666.25 ,97,,,$377.77 ,$666.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.25 ,97,,,$377.77 ,$666.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.25 ,97,,,$377.77 ,$666.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$583.83 ,85,,,$377.77 ,$666.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$618.17 ,90,,,$377.77 ,$666.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.77 ,55,,,$377.77 ,$666.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.52 ,90,,,$377.77 ,$666.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.77 ,55,,,$377.77 ,$666.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.78 ,93,,,$377.77 ,$666.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
A-CELL MICROMATRIX 60MG,8782032,CDM,270,RC,,HCPCS,outpatient,,,$715.79 ,$536.84 ,,$658.53 ,92,,,$393.68 ,$694.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$393.68 ,55,,,$393.68 ,$694.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$393.68 ,$694.32 ,other,,Not applicable. No negotiated rates per contract,$615.58 ,86,,,$393.68 ,$694.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$572.63 ,80,,,$393.68 ,$694.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$393.68 ,55,,,$393.68 ,$694.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.00 ,95,,,$393.68 ,$694.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$680.00 ,95,,,$393.68 ,$694.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$536.84 ,75,,,$393.68 ,$694.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$608.42 ,85,,,$393.68 ,$694.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$694.32 ,97,,,$393.68 ,$694.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.68 ,55,,,$393.68 ,$694.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$644.21 ,90,,,$393.68 ,$694.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$694.32 ,97,,,$393.68 ,$694.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$694.32 ,97,,,$393.68 ,$694.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$694.32 ,97,,,$393.68 ,$694.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$608.42 ,85,,,$393.68 ,$694.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$644.21 ,90,,,$393.68 ,$694.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.68 ,55,,,$393.68 ,$694.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.00 ,90,,,$393.68 ,$694.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$393.68 ,55,,,$393.68 ,$694.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$665.68 ,93,,,$393.68 ,$694.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
A-CELL WOUND MATRIX 1-LA,8782031,CDM,270,RC,,HCPCS,outpatient,,,$417.19 ,$312.89 ,,$383.81 ,92,,,$229.45 ,$404.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$229.45 ,55,,,$229.45 ,$404.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$229.45 ,$404.67 ,other,,Not applicable. No negotiated rates per contract,$358.78 ,86,,,$229.45 ,$404.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$333.75 ,80,,,$229.45 ,$404.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$229.45 ,55,,,$229.45 ,$404.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$396.33 ,95,,,$229.45 ,$404.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$396.33 ,95,,,$229.45 ,$404.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.89 ,75,,,$229.45 ,$404.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$354.61 ,85,,,$229.45 ,$404.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$404.67 ,97,,,$229.45 ,$404.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.45 ,55,,,$229.45 ,$404.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.47 ,90,,,$229.45 ,$404.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$404.67 ,97,,,$229.45 ,$404.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.67 ,97,,,$229.45 ,$404.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.67 ,97,,,$229.45 ,$404.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.61 ,85,,,$229.45 ,$404.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$375.47 ,90,,,$229.45 ,$404.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$229.45 ,55,,,$229.45 ,$404.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$396.33 ,90,,,$229.45 ,$404.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$229.45 ,55,,,$229.45 ,$404.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.99 ,93,,,$229.45 ,$404.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ABDOMINAL BINDER,8786125,CDM,270,RC,,HCPCS,outpatient,,,$118.03 ,$88.52 ,,$108.59 ,92,,,$64.92 ,$114.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.92 ,55,,,$64.92 ,$114.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.92 ,$114.49 ,other,,Not applicable. No negotiated rates per contract,$101.51 ,86,,,$64.92 ,$114.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$94.42 ,80,,,$64.92 ,$114.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.92 ,55,,,$64.92 ,$114.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.13 ,95,,,$64.92 ,$114.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.13 ,95,,,$64.92 ,$114.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.52 ,75,,,$64.92 ,$114.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.33 ,85,,,$64.92 ,$114.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.49 ,97,,,$64.92 ,$114.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.92 ,55,,,$64.92 ,$114.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.23 ,90,,,$64.92 ,$114.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.49 ,97,,,$64.92 ,$114.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.49 ,97,,,$64.92 ,$114.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.49 ,97,,,$64.92 ,$114.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.33 ,85,,,$64.92 ,$114.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.23 ,90,,,$64.92 ,$114.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.92 ,55,,,$64.92 ,$114.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.13 ,90,,,$64.92 ,$114.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.92 ,55,,,$64.92 ,$114.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.77 ,93,,,$64.92 ,$114.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ACAPELLA VIBRATORY DEVIC,8785343,CDM,270,RC,,HCPCS,outpatient,,,$292.61 ,$219.46 ,,$269.20 ,92,,,$160.94 ,$283.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.94 ,55,,,$160.94 ,$283.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$160.94 ,$283.83 ,other,,Not applicable. No negotiated rates per contract,$251.64 ,86,,,$160.94 ,$283.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$234.09 ,80,,,$160.94 ,$283.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.94 ,55,,,$160.94 ,$283.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.98 ,95,,,$160.94 ,$283.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.98 ,95,,,$160.94 ,$283.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.46 ,75,,,$160.94 ,$283.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$248.72 ,85,,,$160.94 ,$283.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.83 ,97,,,$160.94 ,$283.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.94 ,55,,,$160.94 ,$283.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.35 ,90,,,$160.94 ,$283.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$283.83 ,97,,,$160.94 ,$283.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.83 ,97,,,$160.94 ,$283.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.83 ,97,,,$160.94 ,$283.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.72 ,85,,,$160.94 ,$283.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.35 ,90,,,$160.94 ,$283.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.94 ,55,,,$160.94 ,$283.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.98 ,90,,,$160.94 ,$283.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.94 ,55,,,$160.94 ,$283.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.13 ,93,,,$160.94 ,$283.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ACHILLES GRAFT (ORTHRO PRO),8786494,CDM,278,RC,,HCPCS,both,,,"$8,800.00 ","$6,600.00 ",,"$8,096.00 ",92,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$4,840.00 ",55,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$4,840.00 ","$8,536.00 ",other,,Not applicable. No negotiated rates per contract,"$7,568.00 ",86,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$7,040.00 ",80,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$4,840.00 ",55,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$8,360.00 ",95,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$8,360.00 ",95,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,600.00 ",75,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$7,480.00 ",85,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$8,536.00 ",97,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,840.00 ",55,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,920.00 ",90,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$8,536.00 ",97,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,536.00 ",97,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,536.00 ",97,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,480.00 ",85,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,920.00 ",90,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,840.00 ",55,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$8,360.00 ",90,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,840.00 ",55,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$8,184.00 ",93,,,"$4,840.00 ","$8,536.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ACHILLES GRAFT (ORTHRO PRO) (453017),8786495,CDM,270,RC,,HCPCS,outpatient,,,"$7,150.00 ","$5,362.50 ",,"$6,578.00 ",92,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,932.50 ","$6,935.50 ",other,,Not applicable. No negotiated rates per contract,"$6,149.00 ",86,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,720.00 ",80,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,362.50 ",75,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,649.50 ",93,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ACL DISPOSABLES KIT,8783763,CDM,270,RC,,HCPCS,outpatient,,,"$2,320.50 ","$1,740.38 ",,"$2,134.86 ",92,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,276.28 ",55,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,276.28 ","$2,250.89 ",other,,Not applicable. No negotiated rates per contract,"$1,995.63 ",86,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,856.40 ",80,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,276.28 ",55,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,204.48 ",95,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,204.48 ",95,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,740.38 ",75,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,972.43 ",85,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,250.89 ",97,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,276.28 ",55,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,088.45 ",90,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,250.89 ",97,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,250.89 ",97,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,250.89 ",97,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,972.43 ",85,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,088.45 ",90,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,276.28 ",55,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,204.48 ",90,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,276.28 ",55,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,158.07 ",93,,,"$1,276.28 ","$2,250.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ACL TIGHTROPE RIGHT (OR),8782090,CDM,270,RC,,HCPCS,outpatient,,,"$1,670.25 ","$1,252.69 ",,"$1,536.63 ",92,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$918.64 ,55,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$918.64 ,"$1,620.14 ",other,,Not applicable. No negotiated rates per contract,"$1,436.42 ",86,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,336.20 ",80,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$918.64 ,55,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,586.74 ",95,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,586.74 ",95,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,252.69 ",75,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,419.71 ",85,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,620.14 ",97,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$918.64 ,55,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,503.23 ",90,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,620.14 ",97,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,620.14 ",97,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,620.14 ",97,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,419.71 ",85,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,503.23 ",90,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$918.64 ,55,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,586.74 ",90,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$918.64 ,55,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,553.33 ",93,,,$918.64 ,"$1,620.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
AIRCAST/ANKLE L4350,8971150,CDM,270,RC,L4350,HCPCS,outpatient,,,$69.00 ,$51.75 ,,$63.48 ,92,,,$37.95 ,$66.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.95 ,$66.93 ,other,,Not applicable. No negotiated rates per contract,$59.34 ,86,,,$37.95 ,$66.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.20 ,80,,,$37.95 ,$66.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.75 ,75,,,$37.95 ,$66.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.17 ,93,,,$37.95 ,$66.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY #6 CHILD  (60MM),8783022,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY #7 CHILD  (70MM),8785415,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY #7 RUSCH COLORED,8783064,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 100MM ADULT,8783014,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 110 MM ADULT,8783015,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 20FR NASOPHARYNGE,8783024,CDM,270,RC,,HCPCS,outpatient,,,$42.82 ,$32.12 ,,$39.39 ,92,,,$23.55 ,$41.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.55 ,$41.54 ,other,,Not applicable. No negotiated rates per contract,$36.83 ,86,,,$23.55 ,$41.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.26 ,80,,,$23.55 ,$41.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.12 ,75,,,$23.55 ,$41.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.82 ,93,,,$23.55 ,$41.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 22FR NASOPHARYNGE,8783026,CDM,270,RC,,HCPCS,outpatient,,,$31.33 ,$23.50 ,,$28.82 ,92,,,$17.23 ,$30.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.23 ,55,,,$17.23 ,$30.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.23 ,$30.39 ,other,,Not applicable. No negotiated rates per contract,$26.94 ,86,,,$17.23 ,$30.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.06 ,80,,,$17.23 ,$30.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.23 ,55,,,$17.23 ,$30.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.76 ,95,,,$17.23 ,$30.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.76 ,95,,,$17.23 ,$30.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.50 ,75,,,$17.23 ,$30.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.63 ,85,,,$17.23 ,$30.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.39 ,97,,,$17.23 ,$30.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.23 ,55,,,$17.23 ,$30.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.20 ,90,,,$17.23 ,$30.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.39 ,97,,,$17.23 ,$30.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.39 ,97,,,$17.23 ,$30.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.39 ,97,,,$17.23 ,$30.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.63 ,85,,,$17.23 ,$30.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.20 ,90,,,$17.23 ,$30.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.23 ,55,,,$17.23 ,$30.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.76 ,90,,,$17.23 ,$30.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.23 ,55,,,$17.23 ,$30.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.14 ,93,,,$17.23 ,$30.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 24FR NASOPHARYNGE,8783025,CDM,270,RC,,HCPCS,outpatient,,,$34.30 ,$25.73 ,,$31.56 ,92,,,$18.87 ,$33.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.87 ,$33.27 ,other,,Not applicable. No negotiated rates per contract,$29.50 ,86,,,$18.87 ,$33.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.44 ,80,,,$18.87 ,$33.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.73 ,75,,,$18.87 ,$33.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.90 ,93,,,$18.87 ,$33.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 26FR NASOPHARYNGE,8783027,CDM,270,RC,,HCPCS,outpatient,,,$38.50 ,$28.88 ,,$35.42 ,92,,,$21.18 ,$37.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.18 ,55,,,$21.18 ,$37.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.18 ,$37.35 ,other,,Not applicable. No negotiated rates per contract,$33.11 ,86,,,$21.18 ,$37.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.80 ,80,,,$21.18 ,$37.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.18 ,55,,,$21.18 ,$37.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.58 ,95,,,$21.18 ,$37.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.58 ,95,,,$21.18 ,$37.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.88 ,75,,,$21.18 ,$37.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.73 ,85,,,$21.18 ,$37.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.35 ,97,,,$21.18 ,$37.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.18 ,55,,,$21.18 ,$37.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.65 ,90,,,$21.18 ,$37.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.35 ,97,,,$21.18 ,$37.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.35 ,97,,,$21.18 ,$37.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.35 ,97,,,$21.18 ,$37.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.73 ,85,,,$21.18 ,$37.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.65 ,90,,,$21.18 ,$37.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.18 ,55,,,$21.18 ,$37.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.58 ,90,,,$21.18 ,$37.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.18 ,55,,,$21.18 ,$37.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.81 ,93,,,$21.18 ,$37.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 28FR NASOPHARYNGE,8783028,CDM,270,RC,,HCPCS,outpatient,,,$34.74 ,$26.06 ,,$31.96 ,92,,,$19.11 ,$33.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.11 ,55,,,$19.11 ,$33.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.11 ,$33.70 ,other,,Not applicable. No negotiated rates per contract,$29.88 ,86,,,$19.11 ,$33.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.79 ,80,,,$19.11 ,$33.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.11 ,55,,,$19.11 ,$33.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.00 ,95,,,$19.11 ,$33.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.00 ,95,,,$19.11 ,$33.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.06 ,75,,,$19.11 ,$33.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.53 ,85,,,$19.11 ,$33.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.70 ,97,,,$19.11 ,$33.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.11 ,55,,,$19.11 ,$33.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.27 ,90,,,$19.11 ,$33.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.70 ,97,,,$19.11 ,$33.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.70 ,97,,,$19.11 ,$33.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.70 ,97,,,$19.11 ,$33.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.53 ,85,,,$19.11 ,$33.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.27 ,90,,,$19.11 ,$33.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.11 ,55,,,$19.11 ,$33.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.00 ,90,,,$19.11 ,$33.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.11 ,55,,,$19.11 ,$33.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.31 ,93,,,$19.11 ,$33.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 30FR NASOPHARYNGE,8783029,CDM,270,RC,,HCPCS,outpatient,,,$42.82 ,$32.12 ,,$39.39 ,92,,,$23.55 ,$41.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.55 ,$41.54 ,other,,Not applicable. No negotiated rates per contract,$36.83 ,86,,,$23.55 ,$41.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.26 ,80,,,$23.55 ,$41.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.12 ,75,,,$23.55 ,$41.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.82 ,93,,,$23.55 ,$41.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 32 FR NASOPHARYNG,8783021,CDM,270,RC,,HCPCS,outpatient,,,$36.66 ,$27.50 ,,$33.73 ,92,,,$20.16 ,$35.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.16 ,$35.56 ,other,,Not applicable. No negotiated rates per contract,$31.53 ,86,,,$20.16 ,$35.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.33 ,80,,,$20.16 ,$35.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.83 ,95,,,$20.16 ,$35.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.83 ,95,,,$20.16 ,$35.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.50 ,75,,,$20.16 ,$35.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.16 ,85,,,$20.16 ,$35.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.99 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.16 ,85,,,$20.16 ,$35.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.99 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.83 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.09 ,93,,,$20.16 ,$35.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 34 FR NASOPHARYNG,8783031,CDM,270,RC,,HCPCS,outpatient,,,$34.04 ,$25.53 ,,$31.32 ,92,,,$18.72 ,$33.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.72 ,$33.02 ,other,,Not applicable. No negotiated rates per contract,$29.27 ,86,,,$18.72 ,$33.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.23 ,80,,,$18.72 ,$33.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.34 ,95,,,$18.72 ,$33.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.34 ,95,,,$18.72 ,$33.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.53 ,75,,,$18.72 ,$33.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.93 ,85,,,$18.72 ,$33.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.64 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.93 ,85,,,$18.72 ,$33.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.64 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.34 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.66 ,93,,,$18.72 ,$33.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 36 FR NASOPHARYNG,8783065,CDM,270,RC,,HCPCS,outpatient,,,$42.82 ,$32.12 ,,$39.39 ,92,,,$23.55 ,$41.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.55 ,$41.54 ,other,,Not applicable. No negotiated rates per contract,$36.83 ,86,,,$23.55 ,$41.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.26 ,80,,,$23.55 ,$41.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.68 ,95,,,$23.55 ,$41.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.12 ,75,,,$23.55 ,$41.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.54 ,97,,,$23.55 ,$41.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.40 ,85,,,$23.55 ,$41.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.54 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.68 ,90,,,$23.55 ,$41.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.55 ,55,,,$23.55 ,$41.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.82 ,93,,,$23.55 ,$41.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 80MM ADULT,8785414,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY 90MM ADULT,8785413,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY BERMAN 90MM (MEDI,8785749,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY BERMAN MEDCHOICE,8785434,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY INFANT  5.5MM,8783019,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY,8783081,CDM,270,RC,,HCPCS,outpatient,,,$286.88 ,$215.16 ,,$263.93 ,92,,,$157.78 ,$278.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$157.78 ,55,,,$157.78 ,$278.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$157.78 ,$278.27 ,other,,Not applicable. No negotiated rates per contract,$246.72 ,86,,,$157.78 ,$278.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$229.50 ,80,,,$157.78 ,$278.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$157.78 ,55,,,$157.78 ,$278.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.54 ,95,,,$157.78 ,$278.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.54 ,95,,,$157.78 ,$278.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$215.16 ,75,,,$157.78 ,$278.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$243.85 ,85,,,$157.78 ,$278.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$278.27 ,97,,,$157.78 ,$278.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.78 ,55,,,$157.78 ,$278.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.19 ,90,,,$157.78 ,$278.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.27 ,97,,,$157.78 ,$278.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.27 ,97,,,$157.78 ,$278.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.27 ,97,,,$157.78 ,$278.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.85 ,85,,,$157.78 ,$278.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$258.19 ,90,,,$157.78 ,$278.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.78 ,55,,,$157.78 ,$278.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.54 ,90,,,$157.78 ,$278.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.78 ,55,,,$157.78 ,$278.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.80 ,93,,,$157.78 ,$278.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY,8783078,CDM,270,RC,52061,HCPCS,outpatient,,,$318.26 ,$238.70 ,,$292.80 ,92,,,$175.04 ,$308.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$175.04 ,$308.71 ,other,,Not applicable. No negotiated rates per contract,$273.70 ,86,,,$175.04 ,$308.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.61 ,80,,,$175.04 ,$308.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.35 ,95,,,$175.04 ,$308.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.35 ,95,,,$175.04 ,$308.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.70 ,75,,,$175.04 ,$308.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.52 ,85,,,$175.04 ,$308.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.43 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.52 ,85,,,$175.04 ,$308.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.43 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.35 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.98 ,93,,,$175.04 ,$308.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY,8783079,CDM,270,RC,52062,HCPCS,outpatient,,,$316.91 ,$237.68 ,,$291.56 ,92,,,$174.30 ,$307.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$174.30 ,55,,,$174.30 ,$307.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$174.30 ,$307.40 ,other,,Not applicable. No negotiated rates per contract,$272.54 ,86,,,$174.30 ,$307.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$253.53 ,80,,,$174.30 ,$307.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$174.30 ,55,,,$174.30 ,$307.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.06 ,95,,,$174.30 ,$307.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$301.06 ,95,,,$174.30 ,$307.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.68 ,75,,,$174.30 ,$307.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$269.37 ,85,,,$174.30 ,$307.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$307.40 ,97,,,$174.30 ,$307.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.30 ,55,,,$174.30 ,$307.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$285.22 ,90,,,$174.30 ,$307.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$307.40 ,97,,,$174.30 ,$307.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.40 ,97,,,$174.30 ,$307.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.40 ,97,,,$174.30 ,$307.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.37 ,85,,,$174.30 ,$307.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$285.22 ,90,,,$174.30 ,$307.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.30 ,55,,,$174.30 ,$307.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$301.06 ,90,,,$174.30 ,$307.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$174.30 ,55,,,$174.30 ,$307.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$294.73 ,93,,,$174.30 ,$307.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY,8783080,CDM,270,RC,52063,HCPCS,outpatient,,,$318.26 ,$238.70 ,,$292.80 ,92,,,$175.04 ,$308.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$175.04 ,$308.71 ,other,,Not applicable. No negotiated rates per contract,$273.70 ,86,,,$175.04 ,$308.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.61 ,80,,,$175.04 ,$308.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.35 ,95,,,$175.04 ,$308.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.35 ,95,,,$175.04 ,$308.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.70 ,75,,,$175.04 ,$308.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.52 ,85,,,$175.04 ,$308.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.43 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.71 ,97,,,$175.04 ,$308.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.52 ,85,,,$175.04 ,$308.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.43 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.35 ,90,,,$175.04 ,$308.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.04 ,55,,,$175.04 ,$308.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.98 ,93,,,$175.04 ,$308.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRWAY120MM ADULT,8783016,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ALCOHOL REAG PATH MIX 1,8782480,CDM,270,RC,,HCPCS,outpatient,,,$97.11 ,$72.83 ,,$89.34 ,92,,,$53.41 ,$94.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.41 ,55,,,$53.41 ,$94.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$53.41 ,$94.20 ,other,,Not applicable. No negotiated rates per contract,$83.51 ,86,,,$53.41 ,$94.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$77.69 ,80,,,$53.41 ,$94.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.41 ,55,,,$53.41 ,$94.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.25 ,95,,,$53.41 ,$94.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.25 ,95,,,$53.41 ,$94.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.83 ,75,,,$53.41 ,$94.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$82.54 ,85,,,$53.41 ,$94.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.20 ,97,,,$53.41 ,$94.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.41 ,55,,,$53.41 ,$94.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.40 ,90,,,$53.41 ,$94.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.20 ,97,,,$53.41 ,$94.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.20 ,97,,,$53.41 ,$94.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.20 ,97,,,$53.41 ,$94.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.54 ,85,,,$53.41 ,$94.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.40 ,90,,,$53.41 ,$94.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.41 ,55,,,$53.41 ,$94.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.25 ,90,,,$53.41 ,$94.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.41 ,55,,,$53.41 ,$94.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.31 ,93,,,$53.41 ,$94.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ALERE I  RSV 24 TEST/EAC,8782539,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"ALISTRAP 3"" X 30"" WIDE R",8782077,CDM,270,RC,,HCPCS,outpatient,,,$561.95 ,$421.46 ,,$516.99 ,92,,,$309.07 ,$545.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.07 ,55,,,$309.07 ,$545.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$309.07 ,$545.09 ,other,,Not applicable. No negotiated rates per contract,$483.28 ,86,,,$309.07 ,$545.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$449.56 ,80,,,$309.07 ,$545.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.07 ,55,,,$309.07 ,$545.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$533.85 ,95,,,$309.07 ,$545.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$533.85 ,95,,,$309.07 ,$545.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$421.46 ,75,,,$309.07 ,$545.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$477.66 ,85,,,$309.07 ,$545.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$545.09 ,97,,,$309.07 ,$545.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.07 ,55,,,$309.07 ,$545.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$505.76 ,90,,,$309.07 ,$545.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.09 ,97,,,$309.07 ,$545.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.09 ,97,,,$309.07 ,$545.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.09 ,97,,,$309.07 ,$545.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.66 ,85,,,$309.07 ,$545.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$505.76 ,90,,,$309.07 ,$545.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.07 ,55,,,$309.07 ,$545.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$533.85 ,90,,,$309.07 ,$545.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.07 ,55,,,$309.07 ,$545.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$522.61 ,93,,,$309.07 ,$545.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AMBIENT SUPER MULTIVAC (,8782102,CDM,270,RC,,HCPCS,outpatient,,,$902.50 ,$676.88 ,,$830.30 ,92,,,$496.38 ,$875.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$496.38 ,$875.43 ,other,,Not applicable. No negotiated rates per contract,$776.15 ,86,,,$496.38 ,$875.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$722.00 ,80,,,$496.38 ,$875.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$857.38 ,95,,,$496.38 ,$875.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$857.38 ,95,,,$496.38 ,$875.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$676.88 ,75,,,$496.38 ,$875.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$767.13 ,85,,,$496.38 ,$875.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$812.25 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$767.13 ,85,,,$496.38 ,$875.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$812.25 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$857.38 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$839.33 ,93,,,$496.38 ,$875.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AMBIENT SUPER TURBOVAC 3,8782101,CDM,270,RC,,HCPCS,outpatient,,,$935.75 ,$701.81 ,,$860.89 ,92,,,$514.66 ,$907.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$514.66 ,55,,,$514.66 ,$907.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$514.66 ,$907.68 ,other,,Not applicable. No negotiated rates per contract,$804.75 ,86,,,$514.66 ,$907.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$748.60 ,80,,,$514.66 ,$907.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$514.66 ,55,,,$514.66 ,$907.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$888.96 ,95,,,$514.66 ,$907.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$888.96 ,95,,,$514.66 ,$907.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$701.81 ,75,,,$514.66 ,$907.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$795.39 ,85,,,$514.66 ,$907.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$907.68 ,97,,,$514.66 ,$907.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$514.66 ,55,,,$514.66 ,$907.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$842.18 ,90,,,$514.66 ,$907.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$907.68 ,97,,,$514.66 ,$907.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$907.68 ,97,,,$514.66 ,$907.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$907.68 ,97,,,$514.66 ,$907.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$795.39 ,85,,,$514.66 ,$907.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$842.18 ,90,,,$514.66 ,$907.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$514.66 ,55,,,$514.66 ,$907.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$888.96 ,90,,,$514.66 ,$907.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$514.66 ,55,,,$514.66 ,$907.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$870.25 ,93,,,$514.66 ,$907.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANCHOR SUTURE OSTEORAPTO,8786655,CDM,270,RC,,HCPCS,outpatient,,,"$1,627.75 ","$1,220.81 ",,"$1,497.53 ",92,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$895.26 ,55,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$895.26 ,"$1,578.92 ",other,,Not applicable. No negotiated rates per contract,"$1,399.87 ",86,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,302.20 ",80,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$895.26 ,55,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,546.36 ",95,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,546.36 ",95,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,220.81 ",75,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,383.59 ",85,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,578.92 ",97,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$895.26 ,55,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,464.98 ",90,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,578.92 ",97,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,578.92 ",97,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,578.92 ",97,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,383.59 ",85,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,464.98 ",90,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$895.26 ,55,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,546.36 ",90,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$895.26 ,55,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,513.81 ",93,,,$895.26 ,"$1,578.92 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ANCHOR TWINFIX ULTRA 5.5,8786651,CDM,270,RC,,HCPCS,outpatient,,,"$1,377.00 ","$1,032.75 ",,"$1,266.84 ",92,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$757.35 ,55,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$757.35 ,"$1,335.69 ",other,,Not applicable. No negotiated rates per contract,"$1,184.22 ",86,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,101.60 ",80,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$757.35 ,55,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,308.15 ",95,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,308.15 ",95,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,032.75 ",75,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,170.45 ",85,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,335.69 ",97,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$757.35 ,55,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,239.30 ",90,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,335.69 ",97,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,335.69 ",97,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,335.69 ",97,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,170.45 ",85,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,239.30 ",90,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$757.35 ,55,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,308.15 ",90,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$757.35 ,55,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,280.61 ",93,,,$757.35 ,"$1,335.69 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ANCHOR,8782877,CDM,270,RC,,HCPCS,outpatient,,,"$3,395.75 ","$2,546.81 ",,"$3,124.09 ",92,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,867.66 ","$3,293.88 ",other,,Not applicable. No negotiated rates per contract,"$2,920.35 ",86,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,716.60 ",80,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,225.96 ",95,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,225.96 ",95,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,546.81 ",75,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,886.39 ",85,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,056.18 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,886.39 ",85,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,056.18 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,225.96 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,158.05 ",93,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ANCHOR/ LUPRINE BR,8783762,CDM,270,RC,,HCPCS,outpatient,,,"$1,725.50 ","$1,294.13 ",,"$1,587.46 ",92,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$949.03 ,55,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$949.03 ,"$1,673.74 ",other,,Not applicable. No negotiated rates per contract,"$1,483.93 ",86,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,380.40 ",80,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$949.03 ,55,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,639.23 ",95,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,639.23 ",95,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,294.13 ",75,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,466.68 ",85,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,673.74 ",97,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$949.03 ,55,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,552.95 ",90,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,673.74 ",97,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,673.74 ",97,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,673.74 ",97,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,466.68 ",85,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,552.95 ",90,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$949.03 ,55,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,639.23 ",90,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$949.03 ,55,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,604.72 ",93,,,$949.03 ,"$1,673.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ANESTHESIA SET (ANTI SIP,8782123,CDM,270,RC,,HCPCS,outpatient,,,$30.98 ,$23.24 ,,$28.50 ,92,,,$17.04 ,$30.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.04 ,$30.05 ,other,,Not applicable. No negotiated rates per contract,$26.64 ,86,,,$17.04 ,$30.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.78 ,80,,,$17.04 ,$30.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.24 ,75,,,$17.04 ,$30.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.81 ,93,,,$17.04 ,$30.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANESTHESIA TECHNICAL FEE / SUPPLY BUNDLE,8942836,CDM,370,RC,,HCPCS,outpatient,,,$463.00 ,$347.25 ,,$425.96 ,92,,,$254.65 ,$449.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$254.65 ,55,,,$254.65 ,$449.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$254.65 ,$449.11 ,other,,Not applicable. No negotiated rates per contract,$398.18 ,86,,,$254.65 ,$449.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$370.40 ,80,,,$254.65 ,$449.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$254.65 ,55,,,$254.65 ,$449.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$439.85 ,95,,,$254.65 ,$449.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$439.85 ,95,,,$254.65 ,$449.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$347.25 ,75,,,$254.65 ,$449.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$393.55 ,85,,,$254.65 ,$449.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$449.11 ,97,,,$254.65 ,$449.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.65 ,55,,,$254.65 ,$449.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$416.70 ,90,,,$254.65 ,$449.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$449.11 ,97,,,$254.65 ,$449.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$449.11 ,97,,,$254.65 ,$449.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$449.11 ,97,,,$254.65 ,$449.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.55 ,85,,,$254.65 ,$449.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$416.70 ,90,,,$254.65 ,$449.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.65 ,55,,,$254.65 ,$449.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$439.85 ,90,,,$254.65 ,$449.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.65 ,55,,,$254.65 ,$449.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$430.59 ,93,,,$254.65 ,$449.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANKLE BRACE L1906,8971140,CDM,270,RC,L1906,HCPCS,outpatient,,,$187.00 ,$140.25 ,,$172.04 ,92,,,$102.85 ,$181.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.85 ,$181.39 ,other,,Not applicable. No negotiated rates per contract,$160.82 ,86,,,$102.85 ,$181.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$149.60 ,80,,,$102.85 ,$181.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,95,,,$102.85 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.65 ,95,,,$102.85 ,$181.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.25 ,75,,,$102.85 ,$181.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.95 ,85,,,$102.85 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.30 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.39 ,97,,,$102.85 ,$181.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.95 ,85,,,$102.85 ,$181.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.30 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.65 ,90,,,$102.85 ,$181.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.85 ,55,,,$102.85 ,$181.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.91 ,93,,,$102.85 ,$181.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANOSCOPE,8784124,CDM,270,RC,53193,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AP LAB SPECIMEN CHARGE,8992876,CDM,310,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
APOLLORF HOOK,8942843,CDM,270,RC,,HCPCS,outpatient,,,$777.00 ,$582.75 ,,$714.84 ,92,,,$427.35 ,$753.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$427.35 ,55,,,$427.35 ,$753.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$427.35 ,$753.69 ,other,,Not applicable. No negotiated rates per contract,$668.22 ,86,,,$427.35 ,$753.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$621.60 ,80,,,$427.35 ,$753.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$427.35 ,55,,,$427.35 ,$753.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$738.15 ,95,,,$427.35 ,$753.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$738.15 ,95,,,$427.35 ,$753.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$582.75 ,75,,,$427.35 ,$753.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$660.45 ,85,,,$427.35 ,$753.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$753.69 ,97,,,$427.35 ,$753.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$427.35 ,55,,,$427.35 ,$753.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$699.30 ,90,,,$427.35 ,$753.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$753.69 ,97,,,$427.35 ,$753.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$753.69 ,97,,,$427.35 ,$753.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$753.69 ,97,,,$427.35 ,$753.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$660.45 ,85,,,$427.35 ,$753.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$699.30 ,90,,,$427.35 ,$753.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$427.35 ,55,,,$427.35 ,$753.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$738.15 ,90,,,$427.35 ,$753.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$427.35 ,55,,,$427.35 ,$753.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$722.61 ,93,,,$427.35 ,$753.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
APPLIER LIGACLIP MULTIPLE CLIP MCM30 (OR),8785253,CDM,270,RC,,HCPCS,outpatient,,,$463.50 ,$347.63 ,,$426.42 ,92,,,$254.93 ,$449.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$254.93 ,55,,,$254.93 ,$449.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$254.93 ,$449.60 ,other,,Not applicable. No negotiated rates per contract,$398.61 ,86,,,$254.93 ,$449.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$370.80 ,80,,,$254.93 ,$449.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$254.93 ,55,,,$254.93 ,$449.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.33 ,95,,,$254.93 ,$449.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$440.33 ,95,,,$254.93 ,$449.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$347.63 ,75,,,$254.93 ,$449.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$393.98 ,85,,,$254.93 ,$449.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$449.60 ,97,,,$254.93 ,$449.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$254.93 ,55,,,$254.93 ,$449.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$417.15 ,90,,,$254.93 ,$449.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$449.60 ,97,,,$254.93 ,$449.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$449.60 ,97,,,$254.93 ,$449.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$449.60 ,97,,,$254.93 ,$449.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$393.98 ,85,,,$254.93 ,$449.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.15 ,90,,,$254.93 ,$449.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.93 ,55,,,$254.93 ,$449.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.33 ,90,,,$254.93 ,$449.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$254.93 ,55,,,$254.93 ,$449.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$431.06 ,93,,,$254.93 ,$449.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
APPLIER LIGACLIP MULTIPLE CLIP  MCS20 (OR),8785254,CDM,270,RC,,HCPCS,outpatient,,,$397.81 ,$298.36 ,,$365.99 ,92,,,$218.80 ,$385.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.80 ,55,,,$218.80 ,$385.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$218.80 ,$385.88 ,other,,Not applicable. No negotiated rates per contract,$342.12 ,86,,,$218.80 ,$385.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.25 ,80,,,$218.80 ,$385.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.80 ,55,,,$218.80 ,$385.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.92 ,95,,,$218.80 ,$385.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$377.92 ,95,,,$218.80 ,$385.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.36 ,75,,,$218.80 ,$385.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.14 ,85,,,$218.80 ,$385.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$385.88 ,97,,,$218.80 ,$385.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.80 ,55,,,$218.80 ,$385.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.03 ,90,,,$218.80 ,$385.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$385.88 ,97,,,$218.80 ,$385.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.88 ,97,,,$218.80 ,$385.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.88 ,97,,,$218.80 ,$385.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.14 ,85,,,$218.80 ,$385.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.03 ,90,,,$218.80 ,$385.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.80 ,55,,,$218.80 ,$385.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.92 ,90,,,$218.80 ,$385.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.80 ,55,,,$218.80 ,$385.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$369.96 ,93,,,$218.80 ,$385.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AQUAMANTYS  BIPOLAR SEALER 6.0,9181768,CDM,272,RC,,HCPCS,outpatient,,,"$1,657.50 ","$1,243.13 ",,"$1,524.90 ",92,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$911.63 ,55,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$911.63 ,"$1,607.78 ",other,,Not applicable. No negotiated rates per contract,"$1,425.45 ",86,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,326.00 ",80,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$911.63 ,55,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,574.63 ",95,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,574.63 ",95,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,243.13 ",75,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,408.88 ",85,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,607.78 ",97,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$911.63 ,55,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,491.75 ",90,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,607.78 ",97,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,607.78 ",97,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,607.78 ",97,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,408.88 ",85,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,491.75 ",90,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$911.63 ,55,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,574.63 ",90,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$911.63 ,55,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,541.48 ",93,,,$911.63 ,"$1,607.78 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARM SLEEVE BELLA,8786161,CDM,270,RC,,HCPCS,outpatient,,,$365.65 ,$274.24 ,,$336.40 ,92,,,$201.11 ,$354.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$201.11 ,55,,,$201.11 ,$354.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$201.11 ,$354.68 ,other,,Not applicable. No negotiated rates per contract,$314.46 ,86,,,$201.11 ,$354.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$292.52 ,80,,,$201.11 ,$354.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$201.11 ,55,,,$201.11 ,$354.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.37 ,95,,,$201.11 ,$354.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$347.37 ,95,,,$201.11 ,$354.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$274.24 ,75,,,$201.11 ,$354.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$310.80 ,85,,,$201.11 ,$354.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.68 ,97,,,$201.11 ,$354.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.11 ,55,,,$201.11 ,$354.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$329.09 ,90,,,$201.11 ,$354.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$354.68 ,97,,,$201.11 ,$354.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.68 ,97,,,$201.11 ,$354.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$354.68 ,97,,,$201.11 ,$354.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.80 ,85,,,$201.11 ,$354.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$329.09 ,90,,,$201.11 ,$354.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.11 ,55,,,$201.11 ,$354.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$347.37 ,90,,,$201.11 ,$354.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.11 ,55,,,$201.11 ,$354.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$340.05 ,93,,,$201.11 ,$354.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX  TORPEDO,8955883,CDM,270,RC,,HCPCS,outpatient,,,$530.25 ,$397.69 ,,$487.83 ,92,,,$291.64 ,$514.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$291.64 ,55,,,$291.64 ,$514.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$291.64 ,$514.34 ,other,,Not applicable. No negotiated rates per contract,$456.02 ,86,,,$291.64 ,$514.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$424.20 ,80,,,$291.64 ,$514.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$291.64 ,55,,,$291.64 ,$514.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$503.74 ,95,,,$291.64 ,$514.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$503.74 ,95,,,$291.64 ,$514.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$397.69 ,75,,,$291.64 ,$514.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$450.71 ,85,,,$291.64 ,$514.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$514.34 ,97,,,$291.64 ,$514.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$291.64 ,55,,,$291.64 ,$514.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$477.23 ,90,,,$291.64 ,$514.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$514.34 ,97,,,$291.64 ,$514.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$514.34 ,97,,,$291.64 ,$514.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$514.34 ,97,,,$291.64 ,$514.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$450.71 ,85,,,$291.64 ,$514.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$477.23 ,90,,,$291.64 ,$514.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.64 ,55,,,$291.64 ,$514.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$503.74 ,90,,,$291.64 ,$514.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$291.64 ,55,,,$291.64 ,$514.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$493.13 ,93,,,$291.64 ,$514.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX 4 PRONG GRAVITY TUBING,9089140,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX ARTHROSCOPY PUMP TUBING,8942862,CDM,270,RC,,HCPCS,outpatient,,,$329.40 ,$247.05 ,,$303.05 ,92,,,$181.17 ,$319.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$181.17 ,55,,,$181.17 ,$319.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$181.17 ,$319.52 ,other,,Not applicable. No negotiated rates per contract,$283.28 ,86,,,$181.17 ,$319.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$263.52 ,80,,,$181.17 ,$319.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$181.17 ,55,,,$181.17 ,$319.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.93 ,95,,,$181.17 ,$319.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.93 ,95,,,$181.17 ,$319.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.05 ,75,,,$181.17 ,$319.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$279.99 ,85,,,$181.17 ,$319.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$319.52 ,97,,,$181.17 ,$319.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.17 ,55,,,$181.17 ,$319.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.46 ,90,,,$181.17 ,$319.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.52 ,97,,,$181.17 ,$319.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.52 ,97,,,$181.17 ,$319.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.52 ,97,,,$181.17 ,$319.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.99 ,85,,,$181.17 ,$319.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$296.46 ,90,,,$181.17 ,$319.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.17 ,55,,,$181.17 ,$319.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.93 ,90,,,$181.17 ,$319.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.17 ,55,,,$181.17 ,$319.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.34 ,93,,,$181.17 ,$319.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX GEMINI SR8,8942844,CDM,270,RC,,HCPCS,outpatient,,,$260.13 ,$195.10 ,,$239.32 ,92,,,$143.07 ,$252.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.07 ,$252.33 ,other,,Not applicable. No negotiated rates per contract,$223.71 ,86,,,$143.07 ,$252.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$208.10 ,80,,,$143.07 ,$252.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.10 ,75,,,$143.07 ,$252.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.92 ,93,,,$143.07 ,$252.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX SUTUE PASSING WIRE,9381810,CDM,272,RC,,HCPCS,outpatient,,,$484.38 ,$363.29 ,,$445.63 ,92,,,$266.41 ,$469.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.41 ,$469.85 ,other,,Not applicable. No negotiated rates per contract,$416.57 ,86,,,$266.41 ,$469.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.50 ,80,,,$266.41 ,$469.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.29 ,75,,,$266.41 ,$469.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.47 ,93,,,$266.41 ,$469.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163934,CDM,272,RC,,HCPCS,outpatient,,,$376.45 ,$282.34 ,,$346.33 ,92,,,$207.05 ,$365.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.05 ,$365.16 ,other,,Not applicable. No negotiated rates per contract,$323.75 ,86,,,$207.05 ,$365.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$301.16 ,80,,,$207.05 ,$365.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.34 ,75,,,$207.05 ,$365.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$350.10 ,93,,,$207.05 ,$365.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163940,CDM,278,RC,55775,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10163954,CDM,272,RC,,HCPCS,outpatient,,,"$1,253.75 ",$940.31 ,,"$1,153.45 ",92,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$689.56 ,55,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$689.56 ,"$1,216.14 ",other,,Not applicable. No negotiated rates per contract,"$1,078.23 ",86,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,003.00 ",80,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$689.56 ,55,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.06 ",95,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,191.06 ",95,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$940.31 ,75,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,065.69 ",85,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,216.14 ",97,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$689.56 ,55,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,128.38 ",90,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,216.14 ",97,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.14 ",97,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,216.14 ",97,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,065.69 ",85,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,128.38 ",90,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.56 ,55,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.06 ",90,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$689.56 ,55,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,165.99 ",93,,,$689.56 ,"$1,216.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163946,CDM,278,RC,55776,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10163952,CDM,278,RC,,HCPCS,both,,,"$5,980.00 ","$4,485.00 ",,"$5,501.60 ",92,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,289.00 ",55,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,289.00 ","$5,800.60 ",other,,Not applicable. No negotiated rates per contract,"$5,142.80 ",86,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,784.00 ",80,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,289.00 ",55,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,681.00 ",95,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,681.00 ",95,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,485.00 ",75,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,083.00 ",85,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,800.60 ",97,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,289.00 ",55,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,382.00 ",90,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,800.60 ",97,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,800.60 ",97,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,800.60 ",97,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,083.00 ",85,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,382.00 ",90,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,289.00 ",55,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,681.00 ",90,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,289.00 ",55,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,561.40 ",93,,,"$3,289.00 ","$5,800.60 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163942,CDM,278,RC,,HCPCS,both,,,"$3,451.00 ","$2,588.25 ",,"$3,174.92 ",92,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,898.05 ",55,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,898.05 ","$3,347.47 ",other,,Not applicable. No negotiated rates per contract,"$2,967.86 ",86,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,760.80 ",80,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,898.05 ",55,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,278.45 ",95,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,278.45 ",95,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,588.25 ",75,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,933.35 ",85,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,347.47 ",97,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,898.05 ",55,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,105.90 ",90,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,347.47 ",97,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,347.47 ",97,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,347.47 ",97,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,933.35 ",85,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,105.90 ",90,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,898.05 ",55,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,278.45 ",90,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,898.05 ",55,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,209.43 ",93,,,"$1,898.05 ","$3,347.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163948,CDM,278,RC,55777,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10163950,CDM,278,RC,55778,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10060474,CDM,278,RC,,HCPCS,both,,,$484.38 ,$363.29 ,,$445.63 ,92,,,$266.41 ,$469.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.41 ,$469.85 ,other,,Not applicable. No negotiated rates per contract,$416.57 ,86,,,$266.41 ,$469.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.50 ,80,,,$266.41 ,$469.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.29 ,75,,,$266.41 ,$469.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.47 ,93,,,$266.41 ,$469.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9142252,CDM,272,RC,,HCPCS,outpatient,,,$756.20 ,$567.15 ,,$695.70 ,92,,,$415.91 ,$733.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$415.91 ,55,,,$415.91 ,$733.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$415.91 ,$733.51 ,other,,Not applicable. No negotiated rates per contract,$650.33 ,86,,,$415.91 ,$733.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$604.96 ,80,,,$415.91 ,$733.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$415.91 ,55,,,$415.91 ,$733.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$718.39 ,95,,,$415.91 ,$733.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$718.39 ,95,,,$415.91 ,$733.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$567.15 ,75,,,$415.91 ,$733.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$642.77 ,85,,,$415.91 ,$733.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$733.51 ,97,,,$415.91 ,$733.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$415.91 ,55,,,$415.91 ,$733.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.58 ,90,,,$415.91 ,$733.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$733.51 ,97,,,$415.91 ,$733.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.51 ,97,,,$415.91 ,$733.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$733.51 ,97,,,$415.91 ,$733.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$642.77 ,85,,,$415.91 ,$733.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$680.58 ,90,,,$415.91 ,$733.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$415.91 ,55,,,$415.91 ,$733.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$718.39 ,90,,,$415.91 ,$733.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$415.91 ,55,,,$415.91 ,$733.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.27 ,93,,,$415.91 ,$733.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8955927,CDM,270,RC,54575,HCPCS,outpatient,,,$722.00 ,$541.50 ,,$664.24 ,92,,,$397.10 ,$700.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$397.10 ,55,,,$397.10 ,$700.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$397.10 ,$700.34 ,other,,Not applicable. No negotiated rates per contract,$620.92 ,86,,,$397.10 ,$700.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$577.60 ,80,,,$397.10 ,$700.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$397.10 ,55,,,$397.10 ,$700.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$685.90 ,95,,,$397.10 ,$700.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$685.90 ,95,,,$397.10 ,$700.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$541.50 ,75,,,$397.10 ,$700.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$613.70 ,85,,,$397.10 ,$700.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$700.34 ,97,,,$397.10 ,$700.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.10 ,55,,,$397.10 ,$700.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$649.80 ,90,,,$397.10 ,$700.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$700.34 ,97,,,$397.10 ,$700.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$700.34 ,97,,,$397.10 ,$700.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$700.34 ,97,,,$397.10 ,$700.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$613.70 ,85,,,$397.10 ,$700.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$649.80 ,90,,,$397.10 ,$700.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$397.10 ,55,,,$397.10 ,$700.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$685.90 ,90,,,$397.10 ,$700.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$397.10 ,55,,,$397.10 ,$700.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$671.46 ,93,,,$397.10 ,$700.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9868115,CDM,272,RC,,HCPCS,outpatient,,,$484.38 ,$363.29 ,,$445.63 ,92,,,$266.41 ,$469.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.41 ,$469.85 ,other,,Not applicable. No negotiated rates per contract,$416.57 ,86,,,$266.41 ,$469.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.50 ,80,,,$266.41 ,$469.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.29 ,75,,,$266.41 ,$469.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.47 ,93,,,$266.41 ,$469.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9243968,CDM,272,RC,,HCPCS,outpatient,,,$203.58 ,$152.69 ,,$187.29 ,92,,,$111.97 ,$197.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$111.97 ,$197.47 ,other,,Not applicable. No negotiated rates per contract,$175.08 ,86,,,$111.97 ,$197.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.86 ,80,,,$111.97 ,$197.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.40 ,95,,,$111.97 ,$197.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.40 ,95,,,$111.97 ,$197.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.69 ,75,,,$111.97 ,$197.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$173.04 ,85,,,$111.97 ,$197.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.22 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.04 ,85,,,$111.97 ,$197.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.22 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.40 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.33 ,93,,,$111.97 ,$197.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9243967,CDM,270,RC,,HCPCS,outpatient,,,"$2,015.52 ","$1,511.64 ",,"$1,854.28 ",92,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,108.54 ",55,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,108.54 ","$1,955.05 ",other,,Not applicable. No negotiated rates per contract,"$1,733.35 ",86,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,612.42 ",80,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,108.54 ",55,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,914.74 ",95,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,914.74 ",95,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,511.64 ",75,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,713.19 ",85,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,955.05 ",97,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,108.54 ",55,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,813.97 ",90,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,955.05 ",97,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,955.05 ",97,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,955.05 ",97,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,713.19 ",85,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,813.97 ",90,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,108.54 ",55,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,914.74 ",90,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,108.54 ",55,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,874.43 ",93,,,"$1,108.54 ","$1,955.05 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8782088,CDM,270,RC,,HCPCS,outpatient,,,$770.64 ,$577.98 ,,$708.99 ,92,,,$423.85 ,$747.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$423.85 ,55,,,$423.85 ,$747.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$423.85 ,$747.52 ,other,,Not applicable. No negotiated rates per contract,$662.75 ,86,,,$423.85 ,$747.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$616.51 ,80,,,$423.85 ,$747.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$423.85 ,55,,,$423.85 ,$747.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$732.11 ,95,,,$423.85 ,$747.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$732.11 ,95,,,$423.85 ,$747.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$577.98 ,75,,,$423.85 ,$747.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$655.04 ,85,,,$423.85 ,$747.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$747.52 ,97,,,$423.85 ,$747.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$423.85 ,55,,,$423.85 ,$747.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$693.58 ,90,,,$423.85 ,$747.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$747.52 ,97,,,$423.85 ,$747.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$747.52 ,97,,,$423.85 ,$747.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$747.52 ,97,,,$423.85 ,$747.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$655.04 ,85,,,$423.85 ,$747.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$693.58 ,90,,,$423.85 ,$747.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$423.85 ,55,,,$423.85 ,$747.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$732.11 ,90,,,$423.85 ,$747.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$423.85 ,55,,,$423.85 ,$747.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$716.70 ,93,,,$423.85 ,$747.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8942848,CDM,270,RC,54519,HCPCS,outpatient,,,$298.69 ,$224.02 ,,$274.79 ,92,,,$164.28 ,$289.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$164.28 ,55,,,$164.28 ,$289.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$164.28 ,$289.73 ,other,,Not applicable. No negotiated rates per contract,$256.87 ,86,,,$164.28 ,$289.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$238.95 ,80,,,$164.28 ,$289.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$164.28 ,55,,,$164.28 ,$289.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.76 ,95,,,$164.28 ,$289.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.76 ,95,,,$164.28 ,$289.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.02 ,75,,,$164.28 ,$289.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$253.89 ,85,,,$164.28 ,$289.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$289.73 ,97,,,$164.28 ,$289.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.28 ,55,,,$164.28 ,$289.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.82 ,90,,,$164.28 ,$289.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$289.73 ,97,,,$164.28 ,$289.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.73 ,97,,,$164.28 ,$289.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$289.73 ,97,,,$164.28 ,$289.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.89 ,85,,,$164.28 ,$289.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$268.82 ,90,,,$164.28 ,$289.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.28 ,55,,,$164.28 ,$289.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.76 ,90,,,$164.28 ,$289.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.28 ,55,,,$164.28 ,$289.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.78 ,93,,,$164.28 ,$289.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9159960,CDM,272,RC,54841,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9369936,CDM,272,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,8955881,CDM,270,RC,54573,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9159959,CDM,272,RC,,HCPCS,outpatient,,,$924.89 ,$693.67 ,,$850.90 ,92,,,$508.69 ,$897.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$508.69 ,55,,,$508.69 ,$897.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$508.69 ,$897.14 ,other,,Not applicable. No negotiated rates per contract,$795.41 ,86,,,$508.69 ,$897.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$739.91 ,80,,,$508.69 ,$897.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$508.69 ,55,,,$508.69 ,$897.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$878.65 ,95,,,$508.69 ,$897.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$878.65 ,95,,,$508.69 ,$897.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$693.67 ,75,,,$508.69 ,$897.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$786.16 ,85,,,$508.69 ,$897.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$897.14 ,97,,,$508.69 ,$897.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$508.69 ,55,,,$508.69 ,$897.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$832.40 ,90,,,$508.69 ,$897.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$897.14 ,97,,,$508.69 ,$897.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$897.14 ,97,,,$508.69 ,$897.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$897.14 ,97,,,$508.69 ,$897.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$786.16 ,85,,,$508.69 ,$897.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$832.40 ,90,,,$508.69 ,$897.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$508.69 ,55,,,$508.69 ,$897.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$878.65 ,90,,,$508.69 ,$897.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$508.69 ,55,,,$508.69 ,$897.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$860.15 ,93,,,$508.69 ,$897.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9243971,CDM,272,RC,54945,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9142251,CDM,272,RC,54811,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9383624,CDM,272,RC,,HCPCS,outpatient,,,$376.45 ,$282.34 ,,$346.33 ,92,,,$207.05 ,$365.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.05 ,$365.16 ,other,,Not applicable. No negotiated rates per contract,$323.75 ,86,,,$207.05 ,$365.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$301.16 ,80,,,$207.05 ,$365.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.34 ,75,,,$207.05 ,$365.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$350.10 ,93,,,$207.05 ,$365.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9383625,CDM,272,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9243969,CDM,270,RC,54943,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10060473,CDM,278,RC,55690,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9303487,CDM,250,RC,54974,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9369935,CDM,278,RC,,HCPCS,both,,,"$3,198.98 ","$2,399.24 ",,"$2,943.06 ",92,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,759.44 ",55,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,759.44 ","$3,103.01 ",other,,Not applicable. No negotiated rates per contract,"$2,751.12 ",86,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,559.18 ",80,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,759.44 ",55,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,039.03 ",95,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,039.03 ",95,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,399.24 ",75,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,719.13 ",85,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,103.01 ",97,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,759.44 ",55,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,879.08 ",90,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,103.01 ",97,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,103.01 ",97,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,103.01 ",97,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,719.13 ",85,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,879.08 ",90,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,759.44 ",55,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,039.03 ",90,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,759.44 ",55,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,975.05 ",93,,,"$1,759.44 ","$3,103.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9383616,CDM,272,RC,55059,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,8955879,CDM,270,RC,54571,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,8955878,CDM,270,RC,54570,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,8942865,CDM,270,RC,,HCPCS,outpatient,,,$900.32 ,$675.24 ,,$828.29 ,92,,,$495.18 ,$873.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$495.18 ,55,,,$495.18 ,$873.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$495.18 ,$873.31 ,other,,Not applicable. No negotiated rates per contract,$774.28 ,86,,,$495.18 ,$873.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$720.26 ,80,,,$495.18 ,$873.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$495.18 ,55,,,$495.18 ,$873.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.30 ,95,,,$495.18 ,$873.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$855.30 ,95,,,$495.18 ,$873.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$675.24 ,75,,,$495.18 ,$873.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$765.27 ,85,,,$495.18 ,$873.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$873.31 ,97,,,$495.18 ,$873.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$495.18 ,55,,,$495.18 ,$873.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.29 ,90,,,$495.18 ,$873.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$873.31 ,97,,,$495.18 ,$873.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.31 ,97,,,$495.18 ,$873.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.31 ,97,,,$495.18 ,$873.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$765.27 ,85,,,$495.18 ,$873.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$810.29 ,90,,,$495.18 ,$873.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.18 ,55,,,$495.18 ,$873.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.30 ,90,,,$495.18 ,$873.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$495.18 ,55,,,$495.18 ,$873.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$837.30 ,93,,,$495.18 ,$873.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9868118,CDM,272,RC,,HCPCS,outpatient,,,$787.50 ,$590.63 ,,$724.50 ,92,,,$433.13 ,$763.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$433.13 ,$763.88 ,other,,Not applicable. No negotiated rates per contract,$677.25 ,86,,,$433.13 ,$763.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$630.00 ,80,,,$433.13 ,$763.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.13 ,95,,,$433.13 ,$763.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$748.13 ,95,,,$433.13 ,$763.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$590.63 ,75,,,$433.13 ,$763.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$669.38 ,85,,,$433.13 ,$763.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.75 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$669.38 ,85,,,$433.13 ,$763.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$708.75 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.13 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$732.38 ,93,,,$433.13 ,$763.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8942867,CDM,270,RC,,HCPCS,outpatient,,,"$6,302.01 ","$4,726.51 ",,"$5,797.85 ",92,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,466.11 ",55,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,466.11 ","$6,112.95 ",other,,Not applicable. No negotiated rates per contract,"$5,419.73 ",86,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,041.61 ",80,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,466.11 ",55,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,986.91 ",95,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,986.91 ",95,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,726.51 ",75,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,356.71 ",85,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,112.95 ",97,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,466.11 ",55,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,671.81 ",90,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,112.95 ",97,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,112.95 ",97,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,112.95 ",97,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,356.71 ",85,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,671.81 ",90,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,466.11 ",55,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,986.91 ",90,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,466.11 ",55,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,860.87 ",93,,,"$3,466.11 ","$6,112.95 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8782099,CDM,270,RC,,HCPCS,outpatient,,,$178.13 ,$133.60 ,,$163.88 ,92,,,$97.97 ,$172.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.97 ,$172.79 ,other,,Not applicable. No negotiated rates per contract,$153.19 ,86,,,$97.97 ,$172.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.50 ,80,,,$97.97 ,$172.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.22 ,95,,,$97.97 ,$172.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.22 ,95,,,$97.97 ,$172.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.60 ,75,,,$97.97 ,$172.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.41 ,85,,,$97.97 ,$172.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.32 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.79 ,97,,,$97.97 ,$172.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.41 ,85,,,$97.97 ,$172.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.32 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.22 ,90,,,$97.97 ,$172.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,55,,,$97.97 ,$172.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.66 ,93,,,$97.97 ,$172.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163930,CDM,270,RC,,HCPCS,outpatient,,,$376.45 ,$282.34 ,,$346.33 ,92,,,$207.05 ,$365.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.05 ,$365.16 ,other,,Not applicable. No negotiated rates per contract,$323.75 ,86,,,$207.05 ,$365.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$301.16 ,80,,,$207.05 ,$365.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.34 ,75,,,$207.05 ,$365.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$350.10 ,93,,,$207.05 ,$365.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9868116,CDM,272,RC,,HCPCS,outpatient,,,$547.17 ,$410.38 ,,$503.40 ,92,,,$300.94 ,$530.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$300.94 ,$530.75 ,other,,Not applicable. No negotiated rates per contract,$470.57 ,86,,,$300.94 ,$530.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$437.74 ,80,,,$300.94 ,$530.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.81 ,95,,,$300.94 ,$530.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$519.81 ,95,,,$300.94 ,$530.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.38 ,75,,,$300.94 ,$530.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$465.09 ,85,,,$300.94 ,$530.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$492.45 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$465.09 ,85,,,$300.94 ,$530.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$492.45 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.81 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.87 ,93,,,$300.94 ,$530.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9383620,CDM,272,RC,,HCPCS,outpatient,,,"$2,061.93 ","$1,546.45 ",,"$1,896.98 ",92,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,134.06 ",55,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,134.06 ","$2,000.07 ",other,,Not applicable. No negotiated rates per contract,"$1,773.26 ",86,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,649.54 ",80,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,134.06 ",55,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,958.83 ",95,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,958.83 ",95,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,546.45 ",75,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,752.64 ",85,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,000.07 ",97,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,134.06 ",55,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,855.74 ",90,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,000.07 ",97,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,000.07 ",97,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,000.07 ",97,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,752.64 ",85,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,855.74 ",90,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.06 ",55,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,958.83 ",90,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,134.06 ",55,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,917.59 ",93,,,"$1,134.06 ","$2,000.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,8955877,CDM,270,RC,,HCPCS,outpatient,,,$169.65 ,$127.24 ,,$156.08 ,92,,,$93.31 ,$164.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$93.31 ,$164.56 ,other,,Not applicable. No negotiated rates per contract,$145.90 ,86,,,$93.31 ,$164.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$135.72 ,80,,,$93.31 ,$164.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,95,,,$93.31 ,$164.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.17 ,95,,,$93.31 ,$164.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$127.24 ,75,,,$93.31 ,$164.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$144.20 ,85,,,$93.31 ,$164.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.69 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.20 ,85,,,$93.31 ,$164.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.69 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.77 ,93,,,$93.31 ,$164.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9383619,CDM,272,RC,55061,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9369938,CDM,272,RC,55024,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9243970,CDM,272,RC,,HCPCS,outpatient,,,$376.45 ,$282.34 ,,$346.33 ,92,,,$207.05 ,$365.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.05 ,$365.16 ,other,,Not applicable. No negotiated rates per contract,$323.75 ,86,,,$207.05 ,$365.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$301.16 ,80,,,$207.05 ,$365.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.63 ,95,,,$207.05 ,$365.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.34 ,75,,,$207.05 ,$365.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$365.16 ,97,,,$207.05 ,$365.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.98 ,85,,,$207.05 ,$365.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$338.81 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$357.63 ,90,,,$207.05 ,$365.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.05 ,55,,,$207.05 ,$365.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$350.10 ,93,,,$207.05 ,$365.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,9243966,CDM,270,RC,,HCPCS,outpatient,,,$484.38 ,$363.29 ,,$445.63 ,92,,,$266.41 ,$469.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.41 ,$469.85 ,other,,Not applicable. No negotiated rates per contract,$416.57 ,86,,,$266.41 ,$469.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.50 ,80,,,$266.41 ,$469.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$460.16 ,95,,,$266.41 ,$469.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$363.29 ,75,,,$266.41 ,$469.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.85 ,97,,,$266.41 ,$469.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.72 ,85,,,$266.41 ,$469.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.94 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.16 ,90,,,$266.41 ,$469.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.41 ,55,,,$266.41 ,$469.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.47 ,93,,,$266.41 ,$469.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ARTHREX,10163936,CDM,278,RC,55771,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,10163938,CDM,272,RC,55772,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ARTHREX,9243965,CDM,272,RC,,HCPCS,outpatient,,,$161.17 ,$120.88 ,,$148.28 ,92,,,$88.64 ,$156.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$88.64 ,55,,,$88.64 ,$156.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$88.64 ,$156.33 ,other,,Not applicable. No negotiated rates per contract,$138.61 ,86,,,$88.64 ,$156.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$128.94 ,80,,,$88.64 ,$156.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$88.64 ,55,,,$88.64 ,$156.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.11 ,95,,,$88.64 ,$156.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.11 ,95,,,$88.64 ,$156.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.88 ,75,,,$88.64 ,$156.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$136.99 ,85,,,$88.64 ,$156.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.33 ,97,,,$88.64 ,$156.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.64 ,55,,,$88.64 ,$156.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.05 ,90,,,$88.64 ,$156.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.33 ,97,,,$88.64 ,$156.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.33 ,97,,,$88.64 ,$156.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.33 ,97,,,$88.64 ,$156.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.99 ,85,,,$88.64 ,$156.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.05 ,90,,,$88.64 ,$156.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.64 ,55,,,$88.64 ,$156.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.11 ,90,,,$88.64 ,$156.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.64 ,55,,,$88.64 ,$156.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.89 ,93,,,$88.64 ,$156.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 12228 STAPHYLOCOCCU,8782486,CDM,270,RC,,HCPCS,outpatient,,,$304.63 ,$228.47 ,,$280.26 ,92,,,$167.55 ,$295.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$167.55 ,$295.49 ,other,,Not applicable. No negotiated rates per contract,$261.98 ,86,,,$167.55 ,$295.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$243.70 ,80,,,$167.55 ,$295.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.40 ,95,,,$167.55 ,$295.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$289.40 ,95,,,$167.55 ,$295.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.47 ,75,,,$167.55 ,$295.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$258.94 ,85,,,$167.55 ,$295.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.17 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.94 ,85,,,$167.55 ,$295.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.17 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.40 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.31 ,93,,,$167.55 ,$295.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 122386 STREPTOCOCCU,8782487,CDM,270,RC,,HCPCS,outpatient,,,$334.26 ,$250.70 ,,$307.52 ,92,,,$183.84 ,$324.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.84 ,$324.23 ,other,,Not applicable. No negotiated rates per contract,$287.46 ,86,,,$183.84 ,$324.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.41 ,80,,,$183.84 ,$324.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.70 ,75,,,$183.84 ,$324.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.86 ,93,,,$183.84 ,$324.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 13880 SERRATTA MARC,8782484,CDM,270,RC,,HCPCS,outpatient,,,$334.26 ,$250.70 ,,$307.52 ,92,,,$183.84 ,$324.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.84 ,$324.23 ,other,,Not applicable. No negotiated rates per contract,$287.46 ,86,,,$183.84 ,$324.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.41 ,80,,,$183.84 ,$324.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.70 ,75,,,$183.84 ,$324.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.86 ,93,,,$183.84 ,$324.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 19615 STREPTOCOCCUS,8782488,CDM,270,RC,,HCPCS,outpatient,,,$334.26 ,$250.70 ,,$307.52 ,92,,,$183.84 ,$324.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.84 ,$324.23 ,other,,Not applicable. No negotiated rates per contract,$287.46 ,86,,,$183.84 ,$324.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.41 ,80,,,$183.84 ,$324.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.70 ,75,,,$183.84 ,$324.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.86 ,93,,,$183.84 ,$324.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 27853 PSEUDOMONAS A,8782483,CDM,270,RC,,HCPCS,outpatient,,,$304.63 ,$228.47 ,,$280.26 ,92,,,$167.55 ,$295.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$167.55 ,$295.49 ,other,,Not applicable. No negotiated rates per contract,$261.98 ,86,,,$167.55 ,$295.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$243.70 ,80,,,$167.55 ,$295.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.40 ,95,,,$167.55 ,$295.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$289.40 ,95,,,$167.55 ,$295.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.47 ,75,,,$167.55 ,$295.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$258.94 ,85,,,$167.55 ,$295.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.17 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.49 ,97,,,$167.55 ,$295.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.94 ,85,,,$167.55 ,$295.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.17 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$289.40 ,90,,,$167.55 ,$295.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$167.55 ,55,,,$167.55 ,$295.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.31 ,93,,,$167.55 ,$295.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 33591DTSPHYLOCOCCUS,8782485,CDM,270,RC,,HCPCS,outpatient,,,$334.26 ,$250.70 ,,$307.52 ,92,,,$183.84 ,$324.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.84 ,$324.23 ,other,,Not applicable. No negotiated rates per contract,$287.46 ,86,,,$183.84 ,$324.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.41 ,80,,,$183.84 ,$324.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.70 ,75,,,$183.84 ,$324.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.86 ,93,,,$183.84 ,$324.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ATCC 35659 PROTEUS MIRAB,8782482,CDM,270,RC,,HCPCS,outpatient,,,$334.26 ,$250.70 ,,$307.52 ,92,,,$183.84 ,$324.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$183.84 ,$324.23 ,other,,Not applicable. No negotiated rates per contract,$287.46 ,86,,,$183.84 ,$324.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$267.41 ,80,,,$183.84 ,$324.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$317.55 ,95,,,$183.84 ,$324.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$250.70 ,75,,,$183.84 ,$324.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.23 ,97,,,$183.84 ,$324.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.12 ,85,,,$183.84 ,$324.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$300.83 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$317.55 ,90,,,$183.84 ,$324.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.84 ,55,,,$183.84 ,$324.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$310.86 ,93,,,$183.84 ,$324.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AUGULATION AND STOPPER A,8784761,CDM,270,RC,,HCPCS,outpatient,,,"$1,763.75 ","$1,322.81 ",,"$1,622.65 ",92,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$970.06 ,55,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$970.06 ,"$1,710.84 ",other,,Not applicable. No negotiated rates per contract,"$1,516.83 ",86,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,411.00 ",80,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$970.06 ,55,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,675.56 ",95,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,675.56 ",95,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,322.81 ",75,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,499.19 ",85,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,710.84 ",97,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$970.06 ,55,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,587.38 ",90,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,710.84 ",97,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,710.84 ",97,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,710.84 ",97,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,499.19 ",85,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,587.38 ",90,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$970.06 ,55,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,675.56 ",90,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$970.06 ,55,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,640.29 ",93,,,$970.06 ,"$1,710.84 ",percent of total billed charges,,93% of total billed charges for outpatient setting
AWL 3.8 TAPERED DISPOSAB,8786657,CDM,270,RC,,HCPCS,outpatient,,,$371.25 ,$278.44 ,,$341.55 ,92,,,$204.19 ,$360.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.19 ,55,,,$204.19 ,$360.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.19 ,$360.11 ,other,,Not applicable. No negotiated rates per contract,$319.28 ,86,,,$204.19 ,$360.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$297.00 ,80,,,$204.19 ,$360.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.19 ,55,,,$204.19 ,$360.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.69 ,95,,,$204.19 ,$360.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$352.69 ,95,,,$204.19 ,$360.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.44 ,75,,,$204.19 ,$360.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$315.56 ,85,,,$204.19 ,$360.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.11 ,97,,,$204.19 ,$360.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.19 ,55,,,$204.19 ,$360.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.13 ,90,,,$204.19 ,$360.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.11 ,97,,,$204.19 ,$360.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.11 ,97,,,$204.19 ,$360.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.11 ,97,,,$204.19 ,$360.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.56 ,85,,,$204.19 ,$360.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.13 ,90,,,$204.19 ,$360.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.19 ,55,,,$204.19 ,$360.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.69 ,90,,,$204.19 ,$360.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.19 ,55,,,$204.19 ,$360.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.26 ,93,,,$204.19 ,$360.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Abdominal Binder L0625,8971134,CDM,270,RC,L0625,HCPCS,outpatient,,,$278.00 ,$208.50 ,,$255.76 ,92,,,$152.90 ,$269.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$152.90 ,55,,,$152.90 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$152.90 ,$269.66 ,other,,Not applicable. No negotiated rates per contract,$239.08 ,86,,,$152.90 ,$269.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$222.40 ,80,,,$152.90 ,$269.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$152.90 ,55,,,$152.90 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.10 ,95,,,$152.90 ,$269.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.10 ,95,,,$152.90 ,$269.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.50 ,75,,,$152.90 ,$269.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$236.30 ,85,,,$152.90 ,$269.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.66 ,97,,,$152.90 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.90 ,55,,,$152.90 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.20 ,90,,,$152.90 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.66 ,97,,,$152.90 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.66 ,97,,,$152.90 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.66 ,97,,,$152.90 ,$269.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.30 ,85,,,$152.90 ,$269.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.20 ,90,,,$152.90 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.90 ,55,,,$152.90 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.10 ,90,,,$152.90 ,$269.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.90 ,55,,,$152.90 ,$269.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.54 ,93,,,$152.90 ,$269.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BABCOCK  ENDOPATH 5MM DISPOSABLE R,8783811,CDM,270,RC,,HCPCS,outpatient,,,$477.88 ,$358.41 ,,$439.65 ,92,,,$262.83 ,$463.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$262.83 ,55,,,$262.83 ,$463.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$262.83 ,$463.54 ,other,,Not applicable. No negotiated rates per contract,$410.98 ,86,,,$262.83 ,$463.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$382.30 ,80,,,$262.83 ,$463.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$262.83 ,55,,,$262.83 ,$463.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.99 ,95,,,$262.83 ,$463.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$453.99 ,95,,,$262.83 ,$463.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$358.41 ,75,,,$262.83 ,$463.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$406.20 ,85,,,$262.83 ,$463.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$463.54 ,97,,,$262.83 ,$463.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.83 ,55,,,$262.83 ,$463.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$430.09 ,90,,,$262.83 ,$463.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$463.54 ,97,,,$262.83 ,$463.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.54 ,97,,,$262.83 ,$463.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.54 ,97,,,$262.83 ,$463.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.20 ,85,,,$262.83 ,$463.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$430.09 ,90,,,$262.83 ,$463.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.83 ,55,,,$262.83 ,$463.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.99 ,90,,,$262.83 ,$463.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.83 ,55,,,$262.83 ,$463.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.43 ,93,,,$262.83 ,$463.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BACK BRACE HORIZON 456 TLSO (993740),10078473,CDM,270,RC,,HCPCS,outpatient,,,"$1,929.20 ","$1,446.90 ",,"$1,774.86 ",92,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,061.06 ",55,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,061.06 ","$1,871.32 ",other,,Not applicable. No negotiated rates per contract,"$1,659.11 ",86,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,543.36 ",80,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,061.06 ",55,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,832.74 ",95,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,832.74 ",95,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,446.90 ",75,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,639.82 ",85,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,871.32 ",97,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,061.06 ",55,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,736.28 ",90,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,871.32 ",97,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,871.32 ",97,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,871.32 ",97,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,639.82 ",85,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,736.28 ",90,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.06 ",55,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,832.74 ",90,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,061.06 ",55,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,794.16 ",93,,,"$1,061.06 ","$1,871.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BACK SUPPORT ROLYAN AM 2,8786147,CDM,270,RC,,HCPCS,outpatient,,,$179.08 ,$134.31 ,,$164.75 ,92,,,$98.49 ,$173.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$98.49 ,$173.71 ,other,,Not applicable. No negotiated rates per contract,$154.01 ,86,,,$98.49 ,$173.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$143.26 ,80,,,$98.49 ,$173.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.13 ,95,,,$98.49 ,$173.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.13 ,95,,,$98.49 ,$173.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.31 ,75,,,$98.49 ,$173.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.22 ,85,,,$98.49 ,$173.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.22 ,85,,,$98.49 ,$173.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.17 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.13 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.54 ,93,,,$98.49 ,$173.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BACK SUPPORT,8786144,CDM,270,RC,,HCPCS,outpatient,,,$179.08 ,$134.31 ,,$164.75 ,92,,,$98.49 ,$173.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$98.49 ,$173.71 ,other,,Not applicable. No negotiated rates per contract,$154.01 ,86,,,$98.49 ,$173.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$143.26 ,80,,,$98.49 ,$173.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.13 ,95,,,$98.49 ,$173.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.13 ,95,,,$98.49 ,$173.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.31 ,75,,,$98.49 ,$173.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$152.22 ,85,,,$98.49 ,$173.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.71 ,97,,,$98.49 ,$173.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.22 ,85,,,$98.49 ,$173.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.17 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.13 ,90,,,$98.49 ,$173.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.49 ,55,,,$98.49 ,$173.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.54 ,93,,,$98.49 ,$173.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BADGE,8784564,CDM,270,RC,,HCPCS,outpatient,,,$255.00 ,$191.25 ,,$234.60 ,92,,,$140.25 ,$247.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$140.25 ,$247.35 ,other,,Not applicable. No negotiated rates per contract,$219.30 ,86,,,$140.25 ,$247.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$204.00 ,80,,,$140.25 ,$247.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.25 ,95,,,$140.25 ,$247.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$242.25 ,95,,,$140.25 ,$247.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$191.25 ,75,,,$140.25 ,$247.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$216.75 ,85,,,$140.25 ,$247.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$229.50 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$247.35 ,97,,,$140.25 ,$247.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.75 ,85,,,$140.25 ,$247.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$229.50 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.25 ,90,,,$140.25 ,$247.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.25 ,55,,,$140.25 ,$247.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.15 ,93,,,$140.25 ,$247.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BAG URINARY DRAINAGE,8785497,CDM,270,RC,,HCPCS,outpatient,,,$26.95 ,$20.21 ,,$24.79 ,92,,,$14.82 ,$26.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.82 ,55,,,$14.82 ,$26.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.82 ,$26.14 ,other,,Not applicable. No negotiated rates per contract,$23.18 ,86,,,$14.82 ,$26.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.56 ,80,,,$14.82 ,$26.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.82 ,55,,,$14.82 ,$26.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.60 ,95,,,$14.82 ,$26.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.60 ,95,,,$14.82 ,$26.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.21 ,75,,,$14.82 ,$26.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.91 ,85,,,$14.82 ,$26.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.14 ,97,,,$14.82 ,$26.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.82 ,55,,,$14.82 ,$26.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.26 ,90,,,$14.82 ,$26.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.14 ,97,,,$14.82 ,$26.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.14 ,97,,,$14.82 ,$26.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.14 ,97,,,$14.82 ,$26.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.91 ,85,,,$14.82 ,$26.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.26 ,90,,,$14.82 ,$26.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.82 ,55,,,$14.82 ,$26.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.60 ,90,,,$14.82 ,$26.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.82 ,55,,,$14.82 ,$26.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.06 ,93,,,$14.82 ,$26.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BAIR HUGGER BLANKET UPPER BODY (OR),8785310,CDM,270,RC,,HCPCS,outpatient,,,$49.67 ,$37.25 ,,$45.70 ,92,,,$27.32 ,$48.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.32 ,55,,,$27.32 ,$48.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.32 ,$48.18 ,other,,Not applicable. No negotiated rates per contract,$42.72 ,86,,,$27.32 ,$48.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.74 ,80,,,$27.32 ,$48.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.32 ,55,,,$27.32 ,$48.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.19 ,95,,,$27.32 ,$48.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.19 ,95,,,$27.32 ,$48.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.25 ,75,,,$27.32 ,$48.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.22 ,85,,,$27.32 ,$48.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.18 ,97,,,$27.32 ,$48.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.32 ,55,,,$27.32 ,$48.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.70 ,90,,,$27.32 ,$48.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.18 ,97,,,$27.32 ,$48.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.18 ,97,,,$27.32 ,$48.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.18 ,97,,,$27.32 ,$48.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.22 ,85,,,$27.32 ,$48.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.70 ,90,,,$27.32 ,$48.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.32 ,55,,,$27.32 ,$48.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.19 ,90,,,$27.32 ,$48.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.32 ,55,,,$27.32 ,$48.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.19 ,93,,,$27.32 ,$48.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BALLAST,8783452,CDM,270,RC,52330,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BALLOON DILATION CATHETE,8782230,CDM,270,RC,,HCPCS,outpatient,,,"$1,397.40 ","$1,048.05 ",,"$1,285.61 ",92,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$768.57 ,55,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$768.57 ,"$1,355.48 ",other,,Not applicable. No negotiated rates per contract,"$1,201.76 ",86,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,117.92 ",80,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$768.57 ,55,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,327.53 ",95,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,327.53 ",95,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,048.05 ",75,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,187.79 ",85,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,355.48 ",97,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$768.57 ,55,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,257.66 ",90,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,355.48 ",97,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,355.48 ",97,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,355.48 ",97,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,187.79 ",85,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,257.66 ",90,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$768.57 ,55,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,327.53 ",90,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$768.57 ,55,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,299.58 ",93,,,$768.57 ,"$1,355.48 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE 1/2  STERI-STRIP,8785757,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE 1/4 STERI-STRIP,8785756,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE 1/8 STERI-STRIP,8785755,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BANDAGE 2"" ACE SELF CLOSURE (MEDLINE)",8785350,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE 3 ACE,8785349,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BANDAGE 3"" ACE NONSTERILE SELF CLOSURE",9033784,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE 4 ACE,8785353,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BANDAGE 4"" COBAN(2084) ( HOME HEALTH)",8785484,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE ACE STERILE 6 IN,8785517,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE ACE STREILE 4 IN,8785518,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE ESMARK LF 4 X 9,8785499,CDM,270,RC,,HCPCS,outpatient,,,$81.38 ,$61.04 ,,$74.87 ,92,,,$44.76 ,$78.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.76 ,$78.94 ,other,,Not applicable. No negotiated rates per contract,$69.99 ,86,,,$44.76 ,$78.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.10 ,80,,,$44.76 ,$78.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.31 ,95,,,$44.76 ,$78.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.31 ,95,,,$44.76 ,$78.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.04 ,75,,,$44.76 ,$78.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.17 ,85,,,$44.76 ,$78.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.24 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.17 ,85,,,$44.76 ,$78.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.24 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.31 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.68 ,93,,,$44.76 ,$78.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE ESMARK LF 6 X 9,8785500,CDM,270,RC,,HCPCS,outpatient,,,$57.42 ,$43.07 ,,$52.83 ,92,,,$31.58 ,$55.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.58 ,$55.70 ,other,,Not applicable. No negotiated rates per contract,$49.38 ,86,,,$31.58 ,$55.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.94 ,80,,,$31.58 ,$55.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.55 ,95,,,$31.58 ,$55.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.55 ,95,,,$31.58 ,$55.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.07 ,75,,,$31.58 ,$55.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.81 ,85,,,$31.58 ,$55.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.68 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.81 ,85,,,$31.58 ,$55.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.68 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.55 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.40 ,93,,,$31.58 ,$55.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BANDAGE PEDI-FOAM .63"" T",8783595,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE,8785352,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGE,8785351,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BANDAGES SUPER HERO GIRL,8786627,CDM,270,RC,,HCPCS,outpatient,,,$74.17 ,$55.63 ,,$68.24 ,92,,,$40.79 ,$71.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$40.79 ,$71.94 ,other,,Not applicable. No negotiated rates per contract,$63.79 ,86,,,$40.79 ,$71.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.34 ,80,,,$40.79 ,$71.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.46 ,95,,,$40.79 ,$71.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.46 ,95,,,$40.79 ,$71.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.63 ,75,,,$40.79 ,$71.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.04 ,85,,,$40.79 ,$71.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.75 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.04 ,85,,,$40.79 ,$71.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.75 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.46 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.98 ,93,,,$40.79 ,$71.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BARD MESH VENTRALEX ST HERNIA PATCH W/STRAP,9535134,CDM,272,RC,,HCPCS,outpatient,,,"$1,799.45 ","$1,349.59 ",,"$1,655.49 ",92,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$989.70 ,55,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$989.70 ,"$1,745.47 ",other,,Not applicable. No negotiated rates per contract,"$1,547.53 ",86,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,439.56 ",80,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$989.70 ,55,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,709.48 ",95,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,709.48 ",95,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,349.59 ",75,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,529.53 ",85,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,745.47 ",97,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$989.70 ,55,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,619.51 ",90,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,745.47 ",97,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,745.47 ",97,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,745.47 ",97,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,529.53 ",85,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,619.51 ",90,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$989.70 ,55,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,709.48 ",90,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$989.70 ,55,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,673.49 ",93,,,$989.70 ,"$1,745.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BARRIER RING ADAPT CERARING (8805),8785322,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BAT MASK ADULT (OR),8786522,CDM,270,RC,,HCPCS,outpatient,,,$44.55 ,$33.41 ,,$40.99 ,92,,,$24.50 ,$43.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.50 ,$43.21 ,other,,Not applicable. No negotiated rates per contract,$38.31 ,86,,,$24.50 ,$43.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.64 ,80,,,$24.50 ,$43.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.41 ,75,,,$24.50 ,$43.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.43 ,93,,,$24.50 ,$43.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BATTERY,8782801,CDM,270,RC,,HCPCS,outpatient,,,$325.00 ,$243.75 ,,$299.00 ,92,,,$178.75 ,$315.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$178.75 ,$315.25 ,other,,Not applicable. No negotiated rates per contract,$279.50 ,86,,,$178.75 ,$315.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$260.00 ,80,,,$178.75 ,$315.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$308.75 ,95,,,$178.75 ,$315.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.75 ,75,,,$178.75 ,$315.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.25 ,97,,,$178.75 ,$315.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.25 ,85,,,$178.75 ,$315.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$292.50 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.75 ,90,,,$178.75 ,$315.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.75 ,55,,,$178.75 ,$315.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.25 ,93,,,$178.75 ,$315.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BELLA LITE LONG READY TO WEAR ARM SLEEVE &GAUNTLET MED.,8951885,CDM,270,RC,,HCPCS,outpatient,,,$292.48 ,$219.36 ,,$269.08 ,92,,,$160.86 ,$283.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$160.86 ,55,,,$160.86 ,$283.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$160.86 ,$283.71 ,other,,Not applicable. No negotiated rates per contract,$251.53 ,86,,,$160.86 ,$283.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$233.98 ,80,,,$160.86 ,$283.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$160.86 ,55,,,$160.86 ,$283.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.86 ,95,,,$160.86 ,$283.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.86 ,95,,,$160.86 ,$283.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.36 ,75,,,$160.86 ,$283.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$248.61 ,85,,,$160.86 ,$283.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.71 ,97,,,$160.86 ,$283.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.86 ,55,,,$160.86 ,$283.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.23 ,90,,,$160.86 ,$283.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$283.71 ,97,,,$160.86 ,$283.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.71 ,97,,,$160.86 ,$283.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$283.71 ,97,,,$160.86 ,$283.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.61 ,85,,,$160.86 ,$283.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.23 ,90,,,$160.86 ,$283.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.86 ,55,,,$160.86 ,$283.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.86 ,90,,,$160.86 ,$283.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.86 ,55,,,$160.86 ,$283.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.01 ,93,,,$160.86 ,$283.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BIOCOMPOSITE SCREW 9 X 2,8782092,CDM,270,RC,,HCPCS,outpatient,,,"$1,368.50 ","$1,026.38 ",,"$1,259.02 ",92,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$752.68 ,55,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$752.68 ,"$1,327.45 ",other,,Not applicable. No negotiated rates per contract,"$1,176.91 ",86,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,094.80 ",80,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$752.68 ,55,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,300.08 ",95,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,300.08 ",95,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,026.38 ",75,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,163.23 ",85,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,327.45 ",97,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$752.68 ,55,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,231.65 ",90,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,327.45 ",97,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,327.45 ",97,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,327.45 ",97,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,163.23 ",85,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,231.65 ",90,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$752.68 ,55,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,300.08 ",90,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$752.68 ,55,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,272.71 ",93,,,$752.68 ,"$1,327.45 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BIOINTRAFIX TIBIAL LARGE SHEALG,8783772,CDM,270,RC,,HCPCS,outpatient,,,"$1,390.01 ","$1,042.51 ",,"$1,278.81 ",92,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$764.51 ,55,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$764.51 ,"$1,348.31 ",other,,Not applicable. No negotiated rates per contract,"$1,195.41 ",86,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,112.01 ",80,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$764.51 ,55,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,320.51 ",95,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,320.51 ",95,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,042.51 ",75,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,181.51 ",85,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,348.31 ",97,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$764.51 ,55,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,251.01 ",90,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,348.31 ",97,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,348.31 ",97,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,348.31 ",97,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,181.51 ",85,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,251.01 ",90,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$764.51 ,55,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,320.51 ",90,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$764.51 ,55,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,292.71 ",93,,,$764.51 ,"$1,348.31 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BIOMET BONE CEMENT R 1X,8787045,CDM,270,RC,,HCPCS,outpatient,,,$437.50 ,$328.13 ,,$402.50 ,92,,,$240.63 ,$424.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$240.63 ,55,,,$240.63 ,$424.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$240.63 ,$424.38 ,other,,Not applicable. No negotiated rates per contract,$376.25 ,86,,,$240.63 ,$424.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$350.00 ,80,,,$240.63 ,$424.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$240.63 ,55,,,$240.63 ,$424.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.63 ,95,,,$240.63 ,$424.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$415.63 ,95,,,$240.63 ,$424.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$328.13 ,75,,,$240.63 ,$424.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$371.88 ,85,,,$240.63 ,$424.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$424.38 ,97,,,$240.63 ,$424.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.63 ,55,,,$240.63 ,$424.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.75 ,90,,,$240.63 ,$424.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.38 ,97,,,$240.63 ,$424.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$424.38 ,97,,,$240.63 ,$424.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$424.38 ,97,,,$240.63 ,$424.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$371.88 ,85,,,$240.63 ,$424.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$393.75 ,90,,,$240.63 ,$424.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$240.63 ,55,,,$240.63 ,$424.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.63 ,90,,,$240.63 ,$424.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$240.63 ,55,,,$240.63 ,$424.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$406.88 ,93,,,$240.63 ,$424.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BIOPSY PUNCH 2MM,8785571,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BIOPSY PUNCH 5MM,8785572,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BIPAP VISION DISP V60 CI,8786255,CDM,270,RC,,HCPCS,outpatient,,,$52.14 ,$39.11 ,,$47.97 ,92,,,$28.68 ,$50.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.68 ,55,,,$28.68 ,$50.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.68 ,$50.58 ,other,,Not applicable. No negotiated rates per contract,$44.84 ,86,,,$28.68 ,$50.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.71 ,80,,,$28.68 ,$50.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.68 ,55,,,$28.68 ,$50.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.53 ,95,,,$28.68 ,$50.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.53 ,95,,,$28.68 ,$50.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.11 ,75,,,$28.68 ,$50.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.32 ,85,,,$28.68 ,$50.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.58 ,97,,,$28.68 ,$50.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.68 ,55,,,$28.68 ,$50.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.93 ,90,,,$28.68 ,$50.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.58 ,97,,,$28.68 ,$50.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.58 ,97,,,$28.68 ,$50.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.58 ,97,,,$28.68 ,$50.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.32 ,85,,,$28.68 ,$50.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.93 ,90,,,$28.68 ,$50.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.68 ,55,,,$28.68 ,$50.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.53 ,90,,,$28.68 ,$50.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.68 ,55,,,$28.68 ,$50.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.49 ,93,,,$28.68 ,$50.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLACK HOLE SUCTION RING(,8782114,CDM,270,RC,,HCPCS,outpatient,,,$156.24 ,$117.18 ,,$143.74 ,92,,,$85.93 ,$151.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.93 ,55,,,$85.93 ,$151.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.93 ,$151.55 ,other,,Not applicable. No negotiated rates per contract,$134.37 ,86,,,$85.93 ,$151.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.99 ,80,,,$85.93 ,$151.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.93 ,55,,,$85.93 ,$151.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.43 ,95,,,$85.93 ,$151.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.43 ,95,,,$85.93 ,$151.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.18 ,75,,,$85.93 ,$151.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.80 ,85,,,$85.93 ,$151.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.55 ,97,,,$85.93 ,$151.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.93 ,55,,,$85.93 ,$151.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.62 ,90,,,$85.93 ,$151.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.55 ,97,,,$85.93 ,$151.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.55 ,97,,,$85.93 ,$151.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.55 ,97,,,$85.93 ,$151.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.80 ,85,,,$85.93 ,$151.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.62 ,90,,,$85.93 ,$151.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.93 ,55,,,$85.93 ,$151.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.43 ,90,,,$85.93 ,$151.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.93 ,55,,,$85.93 ,$151.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.30 ,93,,,$85.93 ,$151.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE DUAL CUT SAGITTAL,8960448,CDM,270,RC,,HCPCS,outpatient,,,$315.50 ,$236.63 ,,$290.26 ,92,,,$173.53 ,$306.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$173.53 ,$306.04 ,other,,Not applicable. No negotiated rates per contract,$271.33 ,86,,,$173.53 ,$306.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$252.40 ,80,,,$173.53 ,$306.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.73 ,95,,,$173.53 ,$306.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.73 ,95,,,$173.53 ,$306.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.63 ,75,,,$173.53 ,$306.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$268.18 ,85,,,$173.53 ,$306.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.95 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.18 ,85,,,$173.53 ,$306.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.95 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.73 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.42 ,93,,,$173.53 ,$306.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE LONG MEDIUM AGGRES,8786800,CDM,270,RC,,HCPCS,outpatient,,,$171.83 ,$128.87 ,,$158.08 ,92,,,$94.51 ,$166.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.51 ,$166.68 ,other,,Not applicable. No negotiated rates per contract,$147.77 ,86,,,$94.51 ,$166.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.46 ,80,,,$94.51 ,$166.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.87 ,75,,,$94.51 ,$166.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.80 ,93,,,$94.51 ,$166.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE MICRO SAW BLADE (O,8786805,CDM,270,RC,,HCPCS,outpatient,,,$270.06 ,$202.55 ,,$248.46 ,92,,,$148.53 ,$261.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$148.53 ,55,,,$148.53 ,$261.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$148.53 ,$261.96 ,other,,Not applicable. No negotiated rates per contract,$232.25 ,86,,,$148.53 ,$261.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.05 ,80,,,$148.53 ,$261.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$148.53 ,55,,,$148.53 ,$261.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.56 ,95,,,$148.53 ,$261.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$256.56 ,95,,,$148.53 ,$261.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.55 ,75,,,$148.53 ,$261.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$229.55 ,85,,,$148.53 ,$261.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.96 ,97,,,$148.53 ,$261.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.53 ,55,,,$148.53 ,$261.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.05 ,90,,,$148.53 ,$261.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.96 ,97,,,$148.53 ,$261.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.96 ,97,,,$148.53 ,$261.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.96 ,97,,,$148.53 ,$261.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.55 ,85,,,$148.53 ,$261.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.05 ,90,,,$148.53 ,$261.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.53 ,55,,,$148.53 ,$261.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.56 ,90,,,$148.53 ,$261.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.53 ,55,,,$148.53 ,$261.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.16 ,93,,,$148.53 ,$261.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE RECIP (OPEN (0277-,8786806,CDM,270,RC,,HCPCS,outpatient,,,$289.78 ,$217.34 ,,$266.60 ,92,,,$159.38 ,$281.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.38 ,$281.09 ,other,,Not applicable. No negotiated rates per contract,$249.21 ,86,,,$159.38 ,$281.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$231.82 ,80,,,$159.38 ,$281.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.29 ,95,,,$159.38 ,$281.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.29 ,95,,,$159.38 ,$281.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.34 ,75,,,$159.38 ,$281.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.31 ,85,,,$159.38 ,$281.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.80 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.09 ,97,,,$159.38 ,$281.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.31 ,85,,,$159.38 ,$281.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.80 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.29 ,90,,,$159.38 ,$281.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.38 ,55,,,$159.38 ,$281.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.50 ,93,,,$159.38 ,$281.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE RECIP (OPEN) FOR H,8786809,CDM,270,RC,,HCPCS,outpatient,,,$301.59 ,$226.19 ,,$277.46 ,92,,,$165.87 ,$292.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$165.87 ,55,,,$165.87 ,$292.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$165.87 ,$292.54 ,other,,Not applicable. No negotiated rates per contract,$259.37 ,86,,,$165.87 ,$292.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$241.27 ,80,,,$165.87 ,$292.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$165.87 ,55,,,$165.87 ,$292.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.51 ,95,,,$165.87 ,$292.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$286.51 ,95,,,$165.87 ,$292.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$226.19 ,75,,,$165.87 ,$292.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$256.35 ,85,,,$165.87 ,$292.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$292.54 ,97,,,$165.87 ,$292.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,55,,,$165.87 ,$292.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.43 ,90,,,$165.87 ,$292.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$292.54 ,97,,,$165.87 ,$292.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$292.54 ,97,,,$165.87 ,$292.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$292.54 ,97,,,$165.87 ,$292.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.35 ,85,,,$165.87 ,$292.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$271.43 ,90,,,$165.87 ,$292.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,55,,,$165.87 ,$292.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.51 ,90,,,$165.87 ,$292.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,55,,,$165.87 ,$292.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.48 ,93,,,$165.87 ,$292.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE SAGE (HOLD) 4135-0,8786807,CDM,270,RC,,HCPCS,outpatient,,,$363.96 ,$272.97 ,,$334.84 ,92,,,$200.18 ,$353.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$200.18 ,55,,,$200.18 ,$353.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$200.18 ,$353.04 ,other,,Not applicable. No negotiated rates per contract,$313.01 ,86,,,$200.18 ,$353.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$291.17 ,80,,,$200.18 ,$353.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$200.18 ,55,,,$200.18 ,$353.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.76 ,95,,,$200.18 ,$353.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$345.76 ,95,,,$200.18 ,$353.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.97 ,75,,,$200.18 ,$353.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$309.37 ,85,,,$200.18 ,$353.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$353.04 ,97,,,$200.18 ,$353.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.18 ,55,,,$200.18 ,$353.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.56 ,90,,,$200.18 ,$353.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$353.04 ,97,,,$200.18 ,$353.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$353.04 ,97,,,$200.18 ,$353.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$353.04 ,97,,,$200.18 ,$353.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.37 ,85,,,$200.18 ,$353.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$327.56 ,90,,,$200.18 ,$353.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$200.18 ,55,,,$200.18 ,$353.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.76 ,90,,,$200.18 ,$353.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$200.18 ,55,,,$200.18 ,$353.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.48 ,93,,,$200.18 ,$353.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE SAGE (OPEN) 6118-1,8786808,CDM,270,RC,,HCPCS,outpatient,,,$393.19 ,$294.89 ,,$361.73 ,92,,,$216.25 ,$381.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.25 ,55,,,$216.25 ,$381.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.25 ,$381.39 ,other,,Not applicable. No negotiated rates per contract,$338.14 ,86,,,$216.25 ,$381.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$314.55 ,80,,,$216.25 ,$381.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.25 ,55,,,$216.25 ,$381.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.53 ,95,,,$216.25 ,$381.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.53 ,95,,,$216.25 ,$381.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$294.89 ,75,,,$216.25 ,$381.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.21 ,85,,,$216.25 ,$381.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$381.39 ,97,,,$216.25 ,$381.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.25 ,55,,,$216.25 ,$381.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.87 ,90,,,$216.25 ,$381.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.39 ,97,,,$216.25 ,$381.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.39 ,97,,,$216.25 ,$381.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.39 ,97,,,$216.25 ,$381.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.21 ,85,,,$216.25 ,$381.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$353.87 ,90,,,$216.25 ,$381.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.25 ,55,,,$216.25 ,$381.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.53 ,90,,,$216.25 ,$381.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.25 ,55,,,$216.25 ,$381.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.67 ,93,,,$216.25 ,$381.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE SPIRAL GIGLI SAW B,8786676,CDM,270,RC,,HCPCS,outpatient,,,$221.13 ,$165.85 ,,$203.44 ,92,,,$121.62 ,$214.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.62 ,55,,,$121.62 ,$214.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.62 ,$214.50 ,other,,Not applicable. No negotiated rates per contract,$190.17 ,86,,,$121.62 ,$214.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.90 ,80,,,$121.62 ,$214.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.62 ,55,,,$121.62 ,$214.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.07 ,95,,,$121.62 ,$214.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$210.07 ,95,,,$121.62 ,$214.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.85 ,75,,,$121.62 ,$214.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.96 ,85,,,$121.62 ,$214.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.50 ,97,,,$121.62 ,$214.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.62 ,55,,,$121.62 ,$214.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.02 ,90,,,$121.62 ,$214.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.50 ,97,,,$121.62 ,$214.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.50 ,97,,,$121.62 ,$214.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.50 ,97,,,$121.62 ,$214.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.96 ,85,,,$121.62 ,$214.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$199.02 ,90,,,$121.62 ,$214.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.62 ,55,,,$121.62 ,$214.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.07 ,90,,,$121.62 ,$214.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.62 ,55,,,$121.62 ,$214.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.65 ,93,,,$121.62 ,$214.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE STAINLESS STEEL BLADE (371210),8785723,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE SURGICAL CLIPPER S,8785514,CDM,270,RC,,HCPCS,outpatient,,,$50.33 ,$37.75 ,,$46.30 ,92,,,$27.68 ,$48.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.68 ,55,,,$27.68 ,$48.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.68 ,$48.82 ,other,,Not applicable. No negotiated rates per contract,$43.28 ,86,,,$27.68 ,$48.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.26 ,80,,,$27.68 ,$48.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.68 ,55,,,$27.68 ,$48.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.81 ,95,,,$27.68 ,$48.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.81 ,95,,,$27.68 ,$48.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.75 ,75,,,$27.68 ,$48.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.78 ,85,,,$27.68 ,$48.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.82 ,97,,,$27.68 ,$48.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.68 ,55,,,$27.68 ,$48.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.30 ,90,,,$27.68 ,$48.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.82 ,97,,,$27.68 ,$48.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.82 ,97,,,$27.68 ,$48.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.82 ,97,,,$27.68 ,$48.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.78 ,85,,,$27.68 ,$48.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.30 ,90,,,$27.68 ,$48.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.68 ,55,,,$27.68 ,$48.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.81 ,90,,,$27.68 ,$48.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.68 ,55,,,$27.68 ,$48.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.81 ,93,,,$27.68 ,$48.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,8782946,CDM,270,RC,42820,HCPCS,outpatient,,,$574.71 ,$431.03 ,,$528.73 ,92,,,$316.09 ,$557.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$316.09 ,$557.47 ,other,,Not applicable. No negotiated rates per contract,$494.25 ,86,,,$316.09 ,$557.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$459.77 ,80,,,$316.09 ,$557.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$545.97 ,95,,,$316.09 ,$557.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$545.97 ,95,,,$316.09 ,$557.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.03 ,75,,,$316.09 ,$557.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$488.50 ,85,,,$316.09 ,$557.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$517.24 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$488.50 ,85,,,$316.09 ,$557.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$517.24 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$545.97 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.48 ,93,,,$316.09 ,$557.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,8782947,CDM,270,RC,42820,HCPCS,outpatient,,,$574.71 ,$431.03 ,,$528.73 ,92,,,$316.09 ,$557.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$316.09 ,$557.47 ,other,,Not applicable. No negotiated rates per contract,$494.25 ,86,,,$316.09 ,$557.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$459.77 ,80,,,$316.09 ,$557.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$545.97 ,95,,,$316.09 ,$557.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$545.97 ,95,,,$316.09 ,$557.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.03 ,75,,,$316.09 ,$557.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$488.50 ,85,,,$316.09 ,$557.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$517.24 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.47 ,97,,,$316.09 ,$557.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$488.50 ,85,,,$316.09 ,$557.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$517.24 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$545.97 ,90,,,$316.09 ,$557.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.09 ,55,,,$316.09 ,$557.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.48 ,93,,,$316.09 ,$557.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,9244213,CDM,270,RC,42820,HCPCS,outpatient,,,$171.83 ,$128.87 ,,$158.08 ,92,,,$94.51 ,$166.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.51 ,$166.68 ,other,,Not applicable. No negotiated rates per contract,$147.77 ,86,,,$94.51 ,$166.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.46 ,80,,,$94.51 ,$166.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.87 ,75,,,$94.51 ,$166.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.80 ,93,,,$94.51 ,$166.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,8786814,CDM,270,RC,42820,HCPCS,outpatient,,,$171.83 ,$128.87 ,,$158.08 ,92,,,$94.51 ,$166.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.51 ,$166.68 ,other,,Not applicable. No negotiated rates per contract,$147.77 ,86,,,$94.51 ,$166.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.46 ,80,,,$94.51 ,$166.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.87 ,75,,,$94.51 ,$166.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.80 ,93,,,$94.51 ,$166.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,8786817,CDM,270,RC,42820,HCPCS,outpatient,,,$261.29 ,$195.97 ,,$240.39 ,92,,,$143.71 ,$253.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.71 ,55,,,$143.71 ,$253.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.71 ,$253.45 ,other,,Not applicable. No negotiated rates per contract,$224.71 ,86,,,$143.71 ,$253.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$209.03 ,80,,,$143.71 ,$253.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.71 ,55,,,$143.71 ,$253.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.23 ,95,,,$143.71 ,$253.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.23 ,95,,,$143.71 ,$253.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.97 ,75,,,$143.71 ,$253.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$222.10 ,85,,,$143.71 ,$253.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$253.45 ,97,,,$143.71 ,$253.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.71 ,55,,,$143.71 ,$253.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.16 ,90,,,$143.71 ,$253.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.45 ,97,,,$143.71 ,$253.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.45 ,97,,,$143.71 ,$253.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.45 ,97,,,$143.71 ,$253.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.10 ,85,,,$143.71 ,$253.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.16 ,90,,,$143.71 ,$253.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.71 ,55,,,$143.71 ,$253.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.23 ,90,,,$143.71 ,$253.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.71 ,55,,,$143.71 ,$253.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.00 ,93,,,$143.71 ,$253.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLADE,8786759,CDM,270,RC,42820,HCPCS,outpatient,,,$329.33 ,$247.00 ,,$302.98 ,92,,,$181.13 ,$319.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$181.13 ,55,,,$181.13 ,$319.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$181.13 ,$319.45 ,other,,Not applicable. No negotiated rates per contract,$283.22 ,86,,,$181.13 ,$319.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$263.46 ,80,,,$181.13 ,$319.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$181.13 ,55,,,$181.13 ,$319.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.86 ,95,,,$181.13 ,$319.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$312.86 ,95,,,$181.13 ,$319.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.00 ,75,,,$181.13 ,$319.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$279.93 ,85,,,$181.13 ,$319.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$319.45 ,97,,,$181.13 ,$319.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.13 ,55,,,$181.13 ,$319.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$181.13 ,$319.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$319.45 ,97,,,$181.13 ,$319.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.45 ,97,,,$181.13 ,$319.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$319.45 ,97,,,$181.13 ,$319.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.93 ,85,,,$181.13 ,$319.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$296.40 ,90,,,$181.13 ,$319.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.13 ,55,,,$181.13 ,$319.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.86 ,90,,,$181.13 ,$319.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.13 ,55,,,$181.13 ,$319.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.28 ,93,,,$181.13 ,$319.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLANKET LOWER BODY (OR),8785342,CDM,270,RC,,HCPCS,outpatient,,,$67.82 ,$50.87 ,,$62.39 ,92,,,$37.30 ,$65.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.30 ,55,,,$37.30 ,$65.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.30 ,$65.79 ,other,,Not applicable. No negotiated rates per contract,$58.33 ,86,,,$37.30 ,$65.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$54.26 ,80,,,$37.30 ,$65.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.30 ,55,,,$37.30 ,$65.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.43 ,95,,,$37.30 ,$65.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.43 ,95,,,$37.30 ,$65.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.87 ,75,,,$37.30 ,$65.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.65 ,85,,,$37.30 ,$65.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.79 ,97,,,$37.30 ,$65.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.30 ,55,,,$37.30 ,$65.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.04 ,90,,,$37.30 ,$65.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.79 ,97,,,$37.30 ,$65.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.79 ,97,,,$37.30 ,$65.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.79 ,97,,,$37.30 ,$65.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.65 ,85,,,$37.30 ,$65.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.04 ,90,,,$37.30 ,$65.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.30 ,55,,,$37.30 ,$65.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.43 ,90,,,$37.30 ,$65.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.30 ,55,,,$37.30 ,$65.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.07 ,93,,,$37.30 ,$65.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLANKET MULTI ACCESS,8785309,CDM,270,RC,,HCPCS,outpatient,,,$42.18 ,$31.64 ,,$38.81 ,92,,,$23.20 ,$40.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.20 ,55,,,$23.20 ,$40.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.20 ,$40.91 ,other,,Not applicable. No negotiated rates per contract,$36.27 ,86,,,$23.20 ,$40.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.74 ,80,,,$23.20 ,$40.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.20 ,55,,,$23.20 ,$40.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.07 ,95,,,$23.20 ,$40.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.07 ,95,,,$23.20 ,$40.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.64 ,75,,,$23.20 ,$40.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.85 ,85,,,$23.20 ,$40.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.91 ,97,,,$23.20 ,$40.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.20 ,55,,,$23.20 ,$40.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.96 ,90,,,$23.20 ,$40.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.91 ,97,,,$23.20 ,$40.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.91 ,97,,,$23.20 ,$40.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.91 ,97,,,$23.20 ,$40.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.85 ,85,,,$23.20 ,$40.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.96 ,90,,,$23.20 ,$40.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.20 ,55,,,$23.20 ,$40.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.07 ,90,,,$23.20 ,$40.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.20 ,55,,,$23.20 ,$40.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.23 ,93,,,$23.20 ,$40.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLOCK BITE,8784173,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLOCK BITE LATEX FREE AD,8781907,CDM,270,RC,,HCPCS,outpatient,,,$26.43 ,$19.82 ,,$24.32 ,92,,,$14.54 ,$25.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.54 ,55,,,$14.54 ,$25.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.54 ,$25.64 ,other,,Not applicable. No negotiated rates per contract,$22.73 ,86,,,$14.54 ,$25.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.14 ,80,,,$14.54 ,$25.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.54 ,55,,,$14.54 ,$25.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.11 ,95,,,$14.54 ,$25.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.11 ,95,,,$14.54 ,$25.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.82 ,75,,,$14.54 ,$25.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.47 ,85,,,$14.54 ,$25.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.64 ,97,,,$14.54 ,$25.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.54 ,55,,,$14.54 ,$25.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.79 ,90,,,$14.54 ,$25.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.64 ,97,,,$14.54 ,$25.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.64 ,97,,,$14.54 ,$25.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.64 ,97,,,$14.54 ,$25.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.47 ,85,,,$14.54 ,$25.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.79 ,90,,,$14.54 ,$25.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.54 ,55,,,$14.54 ,$25.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.11 ,90,,,$14.54 ,$25.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.54 ,55,,,$14.54 ,$25.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.58 ,93,,,$14.54 ,$25.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BLOOD GAS SYRINGE (KIT A,8785793,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BONE CEMENT,8787030,CDM,270,RC,26785,HCPCS,outpatient,,,"$1,487.50 ","$1,115.63 ",,"$1,368.50 ",92,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$818.13 ,55,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$818.13 ,"$1,442.88 ",other,,Not applicable. No negotiated rates per contract,"$1,279.25 ",86,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,190.00 ",80,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$818.13 ,55,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,413.13 ",95,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,413.13 ",95,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,115.63 ",75,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,264.38 ",85,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,442.88 ",97,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$818.13 ,55,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,338.75 ",90,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.88 ",97,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.88 ",97,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.88 ",97,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,264.38 ",85,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,338.75 ",90,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$818.13 ,55,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,413.13 ",90,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$818.13 ,55,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,383.38 ",93,,,$818.13 ,"$1,442.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
BONE FILE #12CA 5 & 7MM,8783617,CDM,270,RC,,HCPCS,outpatient,,,$420.00 ,$315.00 ,,$386.40 ,92,,,$231.00 ,$407.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$231.00 ,55,,,$231.00 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$231.00 ,$407.40 ,other,,Not applicable. No negotiated rates per contract,$361.20 ,86,,,$231.00 ,$407.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$336.00 ,80,,,$231.00 ,$407.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$231.00 ,55,,,$231.00 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.00 ,95,,,$231.00 ,$407.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$399.00 ,95,,,$231.00 ,$407.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$315.00 ,75,,,$231.00 ,$407.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$357.00 ,85,,,$231.00 ,$407.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$407.40 ,97,,,$231.00 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.00 ,55,,,$231.00 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.00 ,90,,,$231.00 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.40 ,97,,,$231.00 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.40 ,97,,,$231.00 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.40 ,97,,,$231.00 ,$407.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$357.00 ,85,,,$231.00 ,$407.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$378.00 ,90,,,$231.00 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.00 ,55,,,$231.00 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$399.00 ,90,,,$231.00 ,$407.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$231.00 ,55,,,$231.00 ,$407.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$390.60 ,93,,,$231.00 ,$407.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BONE TAMPER 10MM 6,8783645,CDM,270,RC,,HCPCS,outpatient,,,$394.74 ,$296.06 ,,$363.16 ,92,,,$217.11 ,$382.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$217.11 ,$382.90 ,other,,Not applicable. No negotiated rates per contract,$339.48 ,86,,,$217.11 ,$382.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$315.79 ,80,,,$217.11 ,$382.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.00 ,95,,,$217.11 ,$382.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$375.00 ,95,,,$217.11 ,$382.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.06 ,75,,,$217.11 ,$382.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$335.53 ,85,,,$217.11 ,$382.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.27 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.53 ,85,,,$217.11 ,$382.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$355.27 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.00 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$367.11 ,93,,,$217.11 ,$382.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BONE TAMPER 3MM,8783646,CDM,270,RC,,HCPCS,outpatient,,,$394.74 ,$296.06 ,,$363.16 ,92,,,$217.11 ,$382.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$217.11 ,$382.90 ,other,,Not applicable. No negotiated rates per contract,$339.48 ,86,,,$217.11 ,$382.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$315.79 ,80,,,$217.11 ,$382.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.00 ,95,,,$217.11 ,$382.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$375.00 ,95,,,$217.11 ,$382.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.06 ,75,,,$217.11 ,$382.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$335.53 ,85,,,$217.11 ,$382.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$355.27 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.90 ,97,,,$217.11 ,$382.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.53 ,85,,,$217.11 ,$382.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$355.27 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.00 ,90,,,$217.11 ,$382.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.11 ,55,,,$217.11 ,$382.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$367.11 ,93,,,$217.11 ,$382.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BOWL,8787031,CDM,270,RC,,HCPCS,outpatient,,,$714.00 ,$535.50 ,,$656.88 ,92,,,$392.70 ,$692.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$392.70 ,55,,,$392.70 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$392.70 ,$692.58 ,other,,Not applicable. No negotiated rates per contract,$614.04 ,86,,,$392.70 ,$692.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$571.20 ,80,,,$392.70 ,$692.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$392.70 ,55,,,$392.70 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$678.30 ,95,,,$392.70 ,$692.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$678.30 ,95,,,$392.70 ,$692.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.50 ,75,,,$392.70 ,$692.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$606.90 ,85,,,$392.70 ,$692.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$692.58 ,97,,,$392.70 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.70 ,55,,,$392.70 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$642.60 ,90,,,$392.70 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$692.58 ,97,,,$392.70 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.58 ,97,,,$392.70 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.58 ,97,,,$392.70 ,$692.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$606.90 ,85,,,$392.70 ,$692.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$642.60 ,90,,,$392.70 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.70 ,55,,,$392.70 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$678.30 ,90,,,$392.70 ,$692.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.70 ,55,,,$392.70 ,$692.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.02 ,93,,,$392.70 ,$692.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE AIRCAST LEFT,8785178,CDM,270,RC,,HCPCS,outpatient,,,$271.88 ,$203.91 ,,$250.13 ,92,,,$149.53 ,$263.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.53 ,55,,,$149.53 ,$263.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.53 ,$263.72 ,other,,Not applicable. No negotiated rates per contract,$233.82 ,86,,,$149.53 ,$263.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$217.50 ,80,,,$149.53 ,$263.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.53 ,55,,,$149.53 ,$263.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.29 ,95,,,$149.53 ,$263.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.29 ,95,,,$149.53 ,$263.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.91 ,75,,,$149.53 ,$263.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$231.10 ,85,,,$149.53 ,$263.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.72 ,97,,,$149.53 ,$263.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,55,,,$149.53 ,$263.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.69 ,90,,,$149.53 ,$263.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.72 ,97,,,$149.53 ,$263.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.72 ,97,,,$149.53 ,$263.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.72 ,97,,,$149.53 ,$263.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.10 ,85,,,$149.53 ,$263.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.69 ,90,,,$149.53 ,$263.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,55,,,$149.53 ,$263.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.29 ,90,,,$149.53 ,$263.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,55,,,$149.53 ,$263.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.85 ,93,,,$149.53 ,$263.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE AIRCAST LG RIGHT,8785179,CDM,270,RC,,HCPCS,outpatient,,,$271.95 ,$203.96 ,,$250.19 ,92,,,$149.57 ,$263.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.57 ,55,,,$149.57 ,$263.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.57 ,$263.79 ,other,,Not applicable. No negotiated rates per contract,$233.88 ,86,,,$149.57 ,$263.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$217.56 ,80,,,$149.57 ,$263.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.57 ,55,,,$149.57 ,$263.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.35 ,95,,,$149.57 ,$263.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.35 ,95,,,$149.57 ,$263.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.96 ,75,,,$149.57 ,$263.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$231.16 ,85,,,$149.57 ,$263.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.79 ,97,,,$149.57 ,$263.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.57 ,55,,,$149.57 ,$263.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.76 ,90,,,$149.57 ,$263.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.79 ,97,,,$149.57 ,$263.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.79 ,97,,,$149.57 ,$263.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.79 ,97,,,$149.57 ,$263.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.16 ,85,,,$149.57 ,$263.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.76 ,90,,,$149.57 ,$263.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.57 ,55,,,$149.57 ,$263.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.35 ,90,,,$149.57 ,$263.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.57 ,55,,,$149.57 ,$263.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.91 ,93,,,$149.57 ,$263.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE LG ANKLE BRACE W/S (B-21200004),8785186,CDM,270,RC,,HCPCS,outpatient,,,$171.46 ,$128.60 ,,$157.74 ,92,,,$94.30 ,$166.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.30 ,$166.32 ,other,,Not applicable. No negotiated rates per contract,$147.46 ,86,,,$94.30 ,$166.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.17 ,80,,,$94.30 ,$166.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.89 ,95,,,$94.30 ,$166.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.89 ,95,,,$94.30 ,$166.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.60 ,75,,,$94.30 ,$166.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.74 ,85,,,$94.30 ,$166.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.31 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.74 ,85,,,$94.30 ,$166.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.31 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.89 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.46 ,93,,,$94.30 ,$166.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE LG HINGED KNEE BRACE,8785090,CDM,270,RC,,HCPCS,outpatient,,,$191.91 ,$143.93 ,,$176.56 ,92,,,$105.55 ,$186.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.55 ,55,,,$105.55 ,$186.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.55 ,$186.15 ,other,,Not applicable. No negotiated rates per contract,$165.04 ,86,,,$105.55 ,$186.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$153.53 ,80,,,$105.55 ,$186.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.55 ,55,,,$105.55 ,$186.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.31 ,95,,,$105.55 ,$186.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.31 ,95,,,$105.55 ,$186.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.93 ,75,,,$105.55 ,$186.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.12 ,85,,,$105.55 ,$186.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.15 ,97,,,$105.55 ,$186.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.55 ,55,,,$105.55 ,$186.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.72 ,90,,,$105.55 ,$186.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.15 ,97,,,$105.55 ,$186.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.15 ,97,,,$105.55 ,$186.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.15 ,97,,,$105.55 ,$186.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.12 ,85,,,$105.55 ,$186.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.72 ,90,,,$105.55 ,$186.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.55 ,55,,,$105.55 ,$186.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.31 ,90,,,$105.55 ,$186.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.55 ,55,,,$105.55 ,$186.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.48 ,93,,,$105.55 ,$186.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE MED ANKLE BRACE W/STRAP (B-212000003),8785185,CDM,270,RC,L1902,HCPCS,outpatient,,,$134.93 ,$101.20 ,,$124.14 ,92,,,$74.21 ,$130.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.21 ,55,,,$74.21 ,$130.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$74.21 ,$130.88 ,other,,Not applicable. No negotiated rates per contract,$116.04 ,86,,,$74.21 ,$130.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$107.94 ,80,,,$74.21 ,$130.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.21 ,55,,,$74.21 ,$130.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.18 ,95,,,$74.21 ,$130.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.18 ,95,,,$74.21 ,$130.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.20 ,75,,,$74.21 ,$130.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$114.69 ,85,,,$74.21 ,$130.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$130.88 ,97,,,$74.21 ,$130.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.21 ,55,,,$74.21 ,$130.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.44 ,90,,,$74.21 ,$130.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$130.88 ,97,,,$74.21 ,$130.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.88 ,97,,,$74.21 ,$130.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.88 ,97,,,$74.21 ,$130.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.69 ,85,,,$74.21 ,$130.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.44 ,90,,,$74.21 ,$130.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.21 ,55,,,$74.21 ,$130.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.18 ,90,,,$74.21 ,$130.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.21 ,55,,,$74.21 ,$130.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.48 ,93,,,$74.21 ,$130.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE MED HINGED KNEE BR,8785089,CDM,270,RC,,HCPCS,outpatient,,,$191.98 ,$143.99 ,,$176.62 ,92,,,$105.59 ,$186.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.59 ,55,,,$105.59 ,$186.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.59 ,$186.22 ,other,,Not applicable. No negotiated rates per contract,$165.10 ,86,,,$105.59 ,$186.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$153.58 ,80,,,$105.59 ,$186.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.59 ,55,,,$105.59 ,$186.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.38 ,95,,,$105.59 ,$186.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.38 ,95,,,$105.59 ,$186.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.99 ,75,,,$105.59 ,$186.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.18 ,85,,,$105.59 ,$186.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.22 ,97,,,$105.59 ,$186.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.59 ,55,,,$105.59 ,$186.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.78 ,90,,,$105.59 ,$186.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.22 ,97,,,$105.59 ,$186.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.22 ,97,,,$105.59 ,$186.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.22 ,97,,,$105.59 ,$186.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.18 ,85,,,$105.59 ,$186.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.78 ,90,,,$105.59 ,$186.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.59 ,55,,,$105.59 ,$186.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.38 ,90,,,$105.59 ,$186.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.59 ,55,,,$105.59 ,$186.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.54 ,93,,,$105.59 ,$186.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE SM ANKLE BRACE W/S,8785184,CDM,270,RC,,HCPCS,outpatient,,,$171.46 ,$128.60 ,,$157.74 ,92,,,$94.30 ,$166.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.30 ,$166.32 ,other,,Not applicable. No negotiated rates per contract,$147.46 ,86,,,$94.30 ,$166.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.17 ,80,,,$94.30 ,$166.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.89 ,95,,,$94.30 ,$166.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.89 ,95,,,$94.30 ,$166.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.60 ,75,,,$94.30 ,$166.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.74 ,85,,,$94.30 ,$166.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.31 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.32 ,97,,,$94.30 ,$166.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.74 ,85,,,$94.30 ,$166.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.31 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.89 ,90,,,$94.30 ,$166.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.30 ,55,,,$94.30 ,$166.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.46 ,93,,,$94.30 ,$166.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE SM HINGED KNEE BRA,8785088,CDM,270,RC,,HCPCS,outpatient,,,$184.15 ,$138.11 ,,$169.42 ,92,,,$101.28 ,$178.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$101.28 ,$178.63 ,other,,Not applicable. No negotiated rates per contract,$158.37 ,86,,,$101.28 ,$178.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$147.32 ,80,,,$101.28 ,$178.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.94 ,95,,,$101.28 ,$178.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.94 ,95,,,$101.28 ,$178.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.11 ,75,,,$101.28 ,$178.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.53 ,85,,,$101.28 ,$178.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.74 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.53 ,85,,,$101.28 ,$178.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.74 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.94 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.26 ,93,,,$101.28 ,$178.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE XLG ANKE BRACE W/S,8785187,CDM,270,RC,,HCPCS,outpatient,,,$122.61 ,$91.96 ,,$112.80 ,92,,,$67.44 ,$118.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.44 ,55,,,$67.44 ,$118.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$67.44 ,$118.93 ,other,,Not applicable. No negotiated rates per contract,$105.44 ,86,,,$67.44 ,$118.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$98.09 ,80,,,$67.44 ,$118.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.44 ,55,,,$67.44 ,$118.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.48 ,95,,,$67.44 ,$118.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.48 ,95,,,$67.44 ,$118.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.96 ,75,,,$67.44 ,$118.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$104.22 ,85,,,$67.44 ,$118.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.93 ,97,,,$67.44 ,$118.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.44 ,55,,,$67.44 ,$118.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.35 ,90,,,$67.44 ,$118.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.93 ,97,,,$67.44 ,$118.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.93 ,97,,,$67.44 ,$118.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.93 ,97,,,$67.44 ,$118.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.22 ,85,,,$67.44 ,$118.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.35 ,90,,,$67.44 ,$118.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.44 ,55,,,$67.44 ,$118.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.48 ,90,,,$67.44 ,$118.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.44 ,55,,,$67.44 ,$118.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.03 ,93,,,$67.44 ,$118.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE XSM ANKLE BRACE W/,8785183,CDM,270,RC,,HCPCS,outpatient,,,$132.53 ,$99.40 ,,$121.93 ,92,,,$72.89 ,$128.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.89 ,$128.55 ,other,,Not applicable. No negotiated rates per contract,$113.98 ,86,,,$72.89 ,$128.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$106.02 ,80,,,$72.89 ,$128.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.90 ,95,,,$72.89 ,$128.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.90 ,95,,,$72.89 ,$128.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.40 ,75,,,$72.89 ,$128.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.65 ,85,,,$72.89 ,$128.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.28 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.65 ,85,,,$72.89 ,$128.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.28 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.90 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.25 ,93,,,$72.89 ,$128.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE,8786141,CDM,270,RC,,HCPCS,outpatient,,,$912.29 ,$684.22 ,,$839.31 ,92,,,$501.76 ,$884.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$501.76 ,55,,,$501.76 ,$884.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$501.76 ,$884.92 ,other,,Not applicable. No negotiated rates per contract,$784.57 ,86,,,$501.76 ,$884.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$729.83 ,80,,,$501.76 ,$884.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$501.76 ,55,,,$501.76 ,$884.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$866.68 ,95,,,$501.76 ,$884.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$866.68 ,95,,,$501.76 ,$884.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$684.22 ,75,,,$501.76 ,$884.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$775.45 ,85,,,$501.76 ,$884.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$884.92 ,97,,,$501.76 ,$884.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$501.76 ,55,,,$501.76 ,$884.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$821.06 ,90,,,$501.76 ,$884.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$884.92 ,97,,,$501.76 ,$884.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$884.92 ,97,,,$501.76 ,$884.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$884.92 ,97,,,$501.76 ,$884.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$775.45 ,85,,,$501.76 ,$884.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$821.06 ,90,,,$501.76 ,$884.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$501.76 ,55,,,$501.76 ,$884.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$866.68 ,90,,,$501.76 ,$884.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$501.76 ,55,,,$501.76 ,$884.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$848.43 ,93,,,$501.76 ,$884.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE,8786154,CDM,270,RC,52619,HCPCS,outpatient,,,$184.08 ,$138.06 ,,$169.35 ,92,,,$101.24 ,$178.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$101.24 ,$178.56 ,other,,Not applicable. No negotiated rates per contract,$158.31 ,86,,,$101.24 ,$178.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$147.26 ,80,,,$101.24 ,$178.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.88 ,95,,,$101.24 ,$178.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.88 ,95,,,$101.24 ,$178.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.06 ,75,,,$101.24 ,$178.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.47 ,85,,,$101.24 ,$178.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.67 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.47 ,85,,,$101.24 ,$178.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.67 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.88 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.19 ,93,,,$101.24 ,$178.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE,8786155,CDM,270,RC,52621,HCPCS,outpatient,,,$184.08 ,$138.06 ,,$169.35 ,92,,,$101.24 ,$178.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$101.24 ,$178.56 ,other,,Not applicable. No negotiated rates per contract,$158.31 ,86,,,$101.24 ,$178.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$147.26 ,80,,,$101.24 ,$178.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.88 ,95,,,$101.24 ,$178.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.88 ,95,,,$101.24 ,$178.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.06 ,75,,,$101.24 ,$178.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.47 ,85,,,$101.24 ,$178.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.67 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.56 ,97,,,$101.24 ,$178.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.47 ,85,,,$101.24 ,$178.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.67 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.88 ,90,,,$101.24 ,$178.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.24 ,55,,,$101.24 ,$178.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.19 ,93,,,$101.24 ,$178.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BRACE,8786145,CDM,270,RC,,HCPCS,outpatient,,,$145.86 ,$109.40 ,,$134.19 ,92,,,$80.22 ,$141.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.22 ,55,,,$80.22 ,$141.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.22 ,$141.48 ,other,,Not applicable. No negotiated rates per contract,$125.44 ,86,,,$80.22 ,$141.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.69 ,80,,,$80.22 ,$141.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.22 ,55,,,$80.22 ,$141.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.57 ,95,,,$80.22 ,$141.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.57 ,95,,,$80.22 ,$141.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.40 ,75,,,$80.22 ,$141.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$123.98 ,85,,,$80.22 ,$141.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.48 ,97,,,$80.22 ,$141.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.22 ,55,,,$80.22 ,$141.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.27 ,90,,,$80.22 ,$141.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.48 ,97,,,$80.22 ,$141.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.48 ,97,,,$80.22 ,$141.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.48 ,97,,,$80.22 ,$141.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.98 ,85,,,$80.22 ,$141.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.27 ,90,,,$80.22 ,$141.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.22 ,55,,,$80.22 ,$141.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.57 ,90,,,$80.22 ,$141.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.22 ,55,,,$80.22 ,$141.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.65 ,93,,,$80.22 ,$141.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BREG,9945693,CDM,270,RC,55563,HCPCS,outpatient,,,$785.41 ,$589.06 ,,$722.58 ,92,,,$431.98 ,$761.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.98 ,55,,,$431.98 ,$761.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.98 ,$761.85 ,other,,Not applicable. No negotiated rates per contract,$675.45 ,86,,,$431.98 ,$761.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$628.33 ,80,,,$431.98 ,$761.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.98 ,55,,,$431.98 ,$761.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$746.14 ,95,,,$431.98 ,$761.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$746.14 ,95,,,$431.98 ,$761.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.06 ,75,,,$431.98 ,$761.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$667.60 ,85,,,$431.98 ,$761.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$761.85 ,97,,,$431.98 ,$761.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.98 ,55,,,$431.98 ,$761.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.87 ,90,,,$431.98 ,$761.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$761.85 ,97,,,$431.98 ,$761.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$761.85 ,97,,,$431.98 ,$761.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$761.85 ,97,,,$431.98 ,$761.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$667.60 ,85,,,$431.98 ,$761.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$706.87 ,90,,,$431.98 ,$761.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.98 ,55,,,$431.98 ,$761.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$746.14 ,90,,,$431.98 ,$761.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.98 ,55,,,$431.98 ,$761.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$730.43 ,93,,,$431.98 ,$761.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#0) 9""",8783627,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#1) 9""",8783628,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#2) 9""",8783629,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#3) 9""",8783630,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#4) 9""",8783631,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL ANGLED (#5) 9""",8783632,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#0) 9""",8783620,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#1) 9""",8783622,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#2) 9""",8783623,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#3) 9""",8783624,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#4) 9""",8783625,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"BRUNS CURETTE OVAL STRAIGHT (#5) 9""",8783626,CDM,270,RC,,HCPCS,outpatient,,,$248.60 ,$186.45 ,,$228.71 ,92,,,$136.73 ,$241.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$136.73 ,$241.14 ,other,,Not applicable. No negotiated rates per contract,$213.80 ,86,,,$136.73 ,$241.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$198.88 ,80,,,$136.73 ,$241.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.17 ,95,,,$136.73 ,$241.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.45 ,75,,,$136.73 ,$241.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.14 ,97,,,$136.73 ,$241.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.31 ,85,,,$136.73 ,$241.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$223.74 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.17 ,90,,,$136.73 ,$241.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.73 ,55,,,$136.73 ,$241.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.20 ,93,,,$136.73 ,$241.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BULB SYRINGE( IRRIGATION) W/PROTECTOR CAP,8977419,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BULBS,8783451,CDM,270,RC,52103,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BULBS,8783455,CDM,270,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
BUNNELL TENDON STRIPPER,8782745,CDM,270,RC,,HCPCS,outpatient,,,$286.40 ,$214.80 ,,$263.49 ,92,,,$157.52 ,$277.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$157.52 ,55,,,$157.52 ,$277.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$157.52 ,$277.81 ,other,,Not applicable. No negotiated rates per contract,$246.30 ,86,,,$157.52 ,$277.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$229.12 ,80,,,$157.52 ,$277.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$157.52 ,55,,,$157.52 ,$277.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.08 ,95,,,$157.52 ,$277.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.08 ,95,,,$157.52 ,$277.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.80 ,75,,,$157.52 ,$277.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$243.44 ,85,,,$157.52 ,$277.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.81 ,97,,,$157.52 ,$277.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.52 ,55,,,$157.52 ,$277.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.76 ,90,,,$157.52 ,$277.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.81 ,97,,,$157.52 ,$277.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.81 ,97,,,$157.52 ,$277.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.81 ,97,,,$157.52 ,$277.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.44 ,85,,,$157.52 ,$277.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.76 ,90,,,$157.52 ,$277.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.52 ,55,,,$157.52 ,$277.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.08 ,90,,,$157.52 ,$277.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.52 ,55,,,$157.52 ,$277.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.35 ,93,,,$157.52 ,$277.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BUR,8786760,CDM,270,RC,52780,HCPCS,outpatient,,,$315.56 ,$236.67 ,,$290.32 ,92,,,$173.56 ,$306.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$173.56 ,55,,,$173.56 ,$306.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$173.56 ,$306.09 ,other,,Not applicable. No negotiated rates per contract,$271.38 ,86,,,$173.56 ,$306.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$252.45 ,80,,,$173.56 ,$306.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$173.56 ,55,,,$173.56 ,$306.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.78 ,95,,,$173.56 ,$306.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.78 ,95,,,$173.56 ,$306.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.67 ,75,,,$173.56 ,$306.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$268.23 ,85,,,$173.56 ,$306.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.09 ,97,,,$173.56 ,$306.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.56 ,55,,,$173.56 ,$306.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.00 ,90,,,$173.56 ,$306.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.09 ,97,,,$173.56 ,$306.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.09 ,97,,,$173.56 ,$306.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.09 ,97,,,$173.56 ,$306.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.23 ,85,,,$173.56 ,$306.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.00 ,90,,,$173.56 ,$306.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.56 ,55,,,$173.56 ,$306.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.78 ,90,,,$173.56 ,$306.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.56 ,55,,,$173.56 ,$306.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.47 ,93,,,$173.56 ,$306.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BUR,8786758,CDM,270,RC,50239,HCPCS,outpatient,,,$357.21 ,$267.91 ,,$328.63 ,92,,,$196.47 ,$346.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$196.47 ,$346.49 ,other,,Not applicable. No negotiated rates per contract,$307.20 ,86,,,$196.47 ,$346.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$285.77 ,80,,,$196.47 ,$346.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.35 ,95,,,$196.47 ,$346.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$339.35 ,95,,,$196.47 ,$346.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.91 ,75,,,$196.47 ,$346.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$303.63 ,85,,,$196.47 ,$346.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.49 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.63 ,85,,,$196.47 ,$346.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.49 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.35 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.21 ,93,,,$196.47 ,$346.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
BUR,8942845,CDM,270,RC,54516,HCPCS,outpatient,,,$357.21 ,$267.91 ,,$328.63 ,92,,,$196.47 ,$346.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$196.47 ,$346.49 ,other,,Not applicable. No negotiated rates per contract,$307.20 ,86,,,$196.47 ,$346.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$285.77 ,80,,,$196.47 ,$346.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.35 ,95,,,$196.47 ,$346.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$339.35 ,95,,,$196.47 ,$346.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.91 ,75,,,$196.47 ,$346.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$303.63 ,85,,,$196.47 ,$346.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.49 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.49 ,97,,,$196.47 ,$346.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.63 ,85,,,$196.47 ,$346.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.49 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.35 ,90,,,$196.47 ,$346.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.47 ,55,,,$196.47 ,$346.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.21 ,93,,,$196.47 ,$346.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR ADULT STIFNECK SELECT,8783054,CDM,270,RC,,HCPCS,outpatient,,,$82.42 ,$61.82 ,,$75.83 ,92,,,$45.33 ,$79.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.33 ,$79.95 ,other,,Not applicable. No negotiated rates per contract,$70.88 ,86,,,$45.33 ,$79.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.94 ,80,,,$45.33 ,$79.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,95,,,$45.33 ,$79.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.30 ,95,,,$45.33 ,$79.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.82 ,75,,,$45.33 ,$79.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$70.06 ,85,,,$45.33 ,$79.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.18 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.06 ,85,,,$45.33 ,$79.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.18 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.65 ,93,,,$45.33 ,$79.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR BABY NO-NECK,8783052,CDM,270,RC,,HCPCS,outpatient,,,$74.25 ,$55.69 ,,$68.31 ,92,,,$40.84 ,$72.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$40.84 ,$72.02 ,other,,Not applicable. No negotiated rates per contract,$63.86 ,86,,,$40.84 ,$72.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.40 ,80,,,$40.84 ,$72.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.54 ,95,,,$40.84 ,$72.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.54 ,95,,,$40.84 ,$72.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.69 ,75,,,$40.84 ,$72.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.11 ,85,,,$40.84 ,$72.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.11 ,85,,,$40.84 ,$72.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.83 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.54 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.05 ,93,,,$40.84 ,$72.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR LARGE FORM FIT CERVIC,8785100,CDM,270,RC,,HCPCS,outpatient,,,$27.21 ,$20.41 ,,$25.03 ,92,,,$14.97 ,$26.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.97 ,$26.39 ,other,,Not applicable. No negotiated rates per contract,$23.40 ,86,,,$14.97 ,$26.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.77 ,80,,,$14.97 ,$26.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.41 ,75,,,$14.97 ,$26.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.31 ,93,,,$14.97 ,$26.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR MEDIUM  FOAM CERVICAL,8785099,CDM,270,RC,,HCPCS,outpatient,,,$27.13 ,$20.35 ,,$24.96 ,92,,,$14.92 ,$26.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.92 ,55,,,$14.92 ,$26.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.92 ,$26.32 ,other,,Not applicable. No negotiated rates per contract,$23.33 ,86,,,$14.92 ,$26.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.70 ,80,,,$14.92 ,$26.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.92 ,55,,,$14.92 ,$26.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.77 ,95,,,$14.92 ,$26.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.77 ,95,,,$14.92 ,$26.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.35 ,75,,,$14.92 ,$26.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.06 ,85,,,$14.92 ,$26.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.32 ,97,,,$14.92 ,$26.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.92 ,55,,,$14.92 ,$26.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.42 ,90,,,$14.92 ,$26.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.32 ,97,,,$14.92 ,$26.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.32 ,97,,,$14.92 ,$26.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.32 ,97,,,$14.92 ,$26.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.06 ,85,,,$14.92 ,$26.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.42 ,90,,,$14.92 ,$26.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.92 ,55,,,$14.92 ,$26.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.77 ,90,,,$14.92 ,$26.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.92 ,55,,,$14.92 ,$26.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.23 ,93,,,$14.92 ,$26.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR NONECK ADULT/PE,8783053,CDM,270,RC,,HCPCS,outpatient,,,$74.25 ,$55.69 ,,$68.31 ,92,,,$40.84 ,$72.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$40.84 ,$72.02 ,other,,Not applicable. No negotiated rates per contract,$63.86 ,86,,,$40.84 ,$72.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.40 ,80,,,$40.84 ,$72.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.54 ,95,,,$40.84 ,$72.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.54 ,95,,,$40.84 ,$72.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.69 ,75,,,$40.84 ,$72.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.11 ,85,,,$40.84 ,$72.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.02 ,97,,,$40.84 ,$72.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.11 ,85,,,$40.84 ,$72.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.83 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.54 ,90,,,$40.84 ,$72.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.84 ,55,,,$40.84 ,$72.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.05 ,93,,,$40.84 ,$72.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR SMALL FORM FIT CERVIC,8785098,CDM,270,RC,,HCPCS,outpatient,,,$31.76 ,$23.82 ,,$29.22 ,92,,,$17.47 ,$30.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.47 ,$30.81 ,other,,Not applicable. No negotiated rates per contract,$27.31 ,86,,,$17.47 ,$30.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.41 ,80,,,$17.47 ,$30.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.82 ,75,,,$17.47 ,$30.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.54 ,93,,,$17.47 ,$30.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR STIFNECK  PEDIA,8783051,CDM,270,RC,,HCPCS,outpatient,,,$81.10 ,$60.83 ,,$74.61 ,92,,,$44.61 ,$78.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.61 ,55,,,$44.61 ,$78.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.61 ,$78.67 ,other,,Not applicable. No negotiated rates per contract,$69.75 ,86,,,$44.61 ,$78.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.88 ,80,,,$44.61 ,$78.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.61 ,55,,,$44.61 ,$78.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.05 ,95,,,$44.61 ,$78.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.05 ,95,,,$44.61 ,$78.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.83 ,75,,,$44.61 ,$78.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.94 ,85,,,$44.61 ,$78.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.67 ,97,,,$44.61 ,$78.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.61 ,55,,,$44.61 ,$78.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.99 ,90,,,$44.61 ,$78.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.67 ,97,,,$44.61 ,$78.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.67 ,97,,,$44.61 ,$78.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.67 ,97,,,$44.61 ,$78.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.94 ,85,,,$44.61 ,$78.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.99 ,90,,,$44.61 ,$78.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.61 ,55,,,$44.61 ,$78.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.05 ,90,,,$44.61 ,$78.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.61 ,55,,,$44.61 ,$78.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.42 ,93,,,$44.61 ,$78.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR X-LG FORM FIT CERVICAL,8785101,CDM,270,RC,,HCPCS,outpatient,,,$29.31 ,$21.98 ,,$26.97 ,92,,,$16.12 ,$28.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.12 ,$28.43 ,other,,Not applicable. No negotiated rates per contract,$25.21 ,86,,,$16.12 ,$28.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.45 ,80,,,$16.12 ,$28.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.84 ,95,,,$16.12 ,$28.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.84 ,95,,,$16.12 ,$28.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.98 ,75,,,$16.12 ,$28.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.91 ,85,,,$16.12 ,$28.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.38 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.91 ,85,,,$16.12 ,$28.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.38 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.84 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.26 ,93,,,$16.12 ,$28.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C-COLLAR X-LNG,8785192,CDM,270,RC,,HCPCS,outpatient,,,$34.83 ,$26.12 ,,$32.04 ,92,,,$19.16 ,$33.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.16 ,$33.79 ,other,,Not applicable. No negotiated rates per contract,$29.95 ,86,,,$19.16 ,$33.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.86 ,80,,,$19.16 ,$33.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.09 ,95,,,$19.16 ,$33.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.09 ,95,,,$19.16 ,$33.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.12 ,75,,,$19.16 ,$33.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.61 ,85,,,$19.16 ,$33.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.61 ,85,,,$19.16 ,$33.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.35 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.09 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.39 ,93,,,$19.16 ,$33.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C02 ADULT DETECTOR,8783086,CDM,270,RC,,HCPCS,outpatient,,,$80.29 ,$60.22 ,,$73.87 ,92,,,$44.16 ,$77.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.16 ,55,,,$44.16 ,$77.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.16 ,$77.88 ,other,,Not applicable. No negotiated rates per contract,$69.05 ,86,,,$44.16 ,$77.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.23 ,80,,,$44.16 ,$77.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.16 ,55,,,$44.16 ,$77.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.28 ,95,,,$44.16 ,$77.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.28 ,95,,,$44.16 ,$77.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.22 ,75,,,$44.16 ,$77.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.25 ,85,,,$44.16 ,$77.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.88 ,97,,,$44.16 ,$77.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.16 ,55,,,$44.16 ,$77.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.26 ,90,,,$44.16 ,$77.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.88 ,97,,,$44.16 ,$77.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.88 ,97,,,$44.16 ,$77.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.88 ,97,,,$44.16 ,$77.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.25 ,85,,,$44.16 ,$77.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.26 ,90,,,$44.16 ,$77.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.16 ,55,,,$44.16 ,$77.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.28 ,90,,,$44.16 ,$77.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.16 ,55,,,$44.16 ,$77.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.67 ,93,,,$44.16 ,$77.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
C02 PED. DETECTOR,8781902,CDM,270,RC,,HCPCS,outpatient,,,$82.07 ,$61.55 ,,$75.50 ,92,,,$45.14 ,$79.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.14 ,55,,,$45.14 ,$79.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.14 ,$79.61 ,other,,Not applicable. No negotiated rates per contract,$70.58 ,86,,,$45.14 ,$79.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.66 ,80,,,$45.14 ,$79.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.14 ,55,,,$45.14 ,$79.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.97 ,95,,,$45.14 ,$79.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.97 ,95,,,$45.14 ,$79.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.55 ,75,,,$45.14 ,$79.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.76 ,85,,,$45.14 ,$79.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.61 ,97,,,$45.14 ,$79.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.14 ,55,,,$45.14 ,$79.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.86 ,90,,,$45.14 ,$79.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.61 ,97,,,$45.14 ,$79.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.61 ,97,,,$45.14 ,$79.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.61 ,97,,,$45.14 ,$79.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.76 ,85,,,$45.14 ,$79.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.86 ,90,,,$45.14 ,$79.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.14 ,55,,,$45.14 ,$79.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.97 ,90,,,$45.14 ,$79.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.14 ,55,,,$45.14 ,$79.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.33 ,93,,,$45.14 ,$79.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CABLE 5833SL SURGICAL DI,8784134,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CALVICLE SPLINT,8971143,CDM,270,RC,L3650,HCPCS,outpatient,,,$107.00 ,$80.25 ,,$98.44 ,92,,,$58.85 ,$103.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.85 ,55,,,$58.85 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$58.85 ,$103.79 ,other,,Not applicable. No negotiated rates per contract,$92.02 ,86,,,$58.85 ,$103.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$85.60 ,80,,,$58.85 ,$103.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.85 ,55,,,$58.85 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,95,,,$58.85 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.65 ,95,,,$58.85 ,$103.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.25 ,75,,,$58.85 ,$103.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.95 ,85,,,$58.85 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.79 ,97,,,$58.85 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.85 ,55,,,$58.85 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.30 ,90,,,$58.85 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.79 ,97,,,$58.85 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$58.85 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.79 ,97,,,$58.85 ,$103.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.95 ,85,,,$58.85 ,$103.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.30 ,90,,,$58.85 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$58.85 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.65 ,90,,,$58.85 ,$103.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.85 ,55,,,$58.85 ,$103.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.51 ,93,,,$58.85 ,$103.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CANNULA WITH OBTURATOR(7,8786678,CDM,270,RC,,HCPCS,outpatient,,,$182.92 ,$137.19 ,,$168.29 ,92,,,$100.61 ,$177.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$100.61 ,55,,,$100.61 ,$177.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$100.61 ,$177.43 ,other,,Not applicable. No negotiated rates per contract,$157.31 ,86,,,$100.61 ,$177.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$146.34 ,80,,,$100.61 ,$177.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$100.61 ,55,,,$100.61 ,$177.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.77 ,95,,,$100.61 ,$177.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.77 ,95,,,$100.61 ,$177.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.19 ,75,,,$100.61 ,$177.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$155.48 ,85,,,$100.61 ,$177.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.43 ,97,,,$100.61 ,$177.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.61 ,55,,,$100.61 ,$177.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.63 ,90,,,$100.61 ,$177.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$177.43 ,97,,,$100.61 ,$177.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.43 ,97,,,$100.61 ,$177.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$177.43 ,97,,,$100.61 ,$177.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.48 ,85,,,$100.61 ,$177.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.63 ,90,,,$100.61 ,$177.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.61 ,55,,,$100.61 ,$177.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.77 ,90,,,$100.61 ,$177.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.61 ,55,,,$100.61 ,$177.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.12 ,93,,,$100.61 ,$177.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAPNOLINE H INFANT/NEO C,8786264,CDM,270,RC,,HCPCS,outpatient,,,$90.52 ,$67.89 ,,$83.28 ,92,,,$49.79 ,$87.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.79 ,55,,,$49.79 ,$87.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.79 ,$87.80 ,other,,Not applicable. No negotiated rates per contract,$77.85 ,86,,,$49.79 ,$87.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.42 ,80,,,$49.79 ,$87.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.79 ,55,,,$49.79 ,$87.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.99 ,95,,,$49.79 ,$87.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.99 ,95,,,$49.79 ,$87.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.89 ,75,,,$49.79 ,$87.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$76.94 ,85,,,$49.79 ,$87.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.80 ,97,,,$49.79 ,$87.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.79 ,55,,,$49.79 ,$87.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.47 ,90,,,$49.79 ,$87.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.80 ,97,,,$49.79 ,$87.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.80 ,97,,,$49.79 ,$87.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.80 ,97,,,$49.79 ,$87.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.94 ,85,,,$49.79 ,$87.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.47 ,90,,,$49.79 ,$87.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.79 ,55,,,$49.79 ,$87.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.99 ,90,,,$49.79 ,$87.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.79 ,55,,,$49.79 ,$87.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.18 ,93,,,$49.79 ,$87.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAPNOLINE H PEDIATRIC C02 NASAL CANNULA MICROSTREAM ETCO2 ( M4681A),8786263,CDM,270,RC,,HCPCS,outpatient,,,$125.94 ,$94.46 ,,$115.86 ,92,,,$69.27 ,$122.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.27 ,55,,,$69.27 ,$122.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.27 ,$122.16 ,other,,Not applicable. No negotiated rates per contract,$108.31 ,86,,,$69.27 ,$122.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.75 ,80,,,$69.27 ,$122.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.27 ,55,,,$69.27 ,$122.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.64 ,95,,,$69.27 ,$122.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.64 ,95,,,$69.27 ,$122.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.46 ,75,,,$69.27 ,$122.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.05 ,85,,,$69.27 ,$122.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.16 ,97,,,$69.27 ,$122.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.27 ,55,,,$69.27 ,$122.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.35 ,90,,,$69.27 ,$122.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.16 ,97,,,$69.27 ,$122.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.16 ,97,,,$69.27 ,$122.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.16 ,97,,,$69.27 ,$122.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.05 ,85,,,$69.27 ,$122.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.35 ,90,,,$69.27 ,$122.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.27 ,55,,,$69.27 ,$122.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.64 ,90,,,$69.27 ,$122.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.27 ,55,,,$69.27 ,$122.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.12 ,93,,,$69.27 ,$122.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CARRAKLENZ SPRAY  8OZ(1719),8785258,CDM,270,RC,,HCPCS,outpatient,,,$32.73 ,$24.55 ,,$30.11 ,92,,,$18.00 ,$31.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.00 ,$31.75 ,other,,Not applicable. No negotiated rates per contract,$28.15 ,86,,,$18.00 ,$31.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.18 ,80,,,$18.00 ,$31.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.09 ,95,,,$18.00 ,$31.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.09 ,95,,,$18.00 ,$31.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.55 ,75,,,$18.00 ,$31.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.82 ,85,,,$18.00 ,$31.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.46 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.82 ,85,,,$18.00 ,$31.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.46 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.09 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.44 ,93,,,$18.00 ,$31.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CARRY POUCH FITS 250-500,8782113,CDM,270,RC,,HCPCS,outpatient,,,$124.00 ,$93.00 ,,$114.08 ,92,,,$68.20 ,$120.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.20 ,55,,,$68.20 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.20 ,$120.28 ,other,,Not applicable. No negotiated rates per contract,$106.64 ,86,,,$68.20 ,$120.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$99.20 ,80,,,$68.20 ,$120.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.20 ,55,,,$68.20 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,95,,,$68.20 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.80 ,95,,,$68.20 ,$120.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.00 ,75,,,$68.20 ,$120.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.40 ,85,,,$68.20 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.28 ,97,,,$68.20 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.20 ,55,,,$68.20 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.60 ,90,,,$68.20 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.28 ,97,,,$68.20 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$68.20 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.28 ,97,,,$68.20 ,$120.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.40 ,85,,,$68.20 ,$120.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.60 ,90,,,$68.20 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$68.20 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.80 ,90,,,$68.20 ,$120.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.20 ,55,,,$68.20 ,$120.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.32 ,93,,,$68.20 ,$120.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CARRY POUCH FITS 50-125ml,8782112,CDM,270,RC,,HCPCS,outpatient,,,$85.25 ,$63.94 ,,$78.43 ,92,,,$46.89 ,$82.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.89 ,55,,,$46.89 ,$82.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.89 ,$82.69 ,other,,Not applicable. No negotiated rates per contract,$73.32 ,86,,,$46.89 ,$82.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.20 ,80,,,$46.89 ,$82.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.89 ,55,,,$46.89 ,$82.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.99 ,95,,,$46.89 ,$82.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.99 ,95,,,$46.89 ,$82.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.94 ,75,,,$46.89 ,$82.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.46 ,85,,,$46.89 ,$82.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.69 ,97,,,$46.89 ,$82.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.89 ,55,,,$46.89 ,$82.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.73 ,90,,,$46.89 ,$82.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.69 ,97,,,$46.89 ,$82.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.69 ,97,,,$46.89 ,$82.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.69 ,97,,,$46.89 ,$82.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.46 ,85,,,$46.89 ,$82.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.73 ,90,,,$46.89 ,$82.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.89 ,55,,,$46.89 ,$82.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.99 ,90,,,$46.89 ,$82.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.89 ,55,,,$46.89 ,$82.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.28 ,93,,,$46.89 ,$82.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CARTILAGE GRASPER- ANGLED TEETH,9049274,CDM,270,RC,,HCPCS,outpatient,,,"$2,121.69 ","$1,591.27 ",,"$1,951.95 ",92,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,166.93 ",55,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,166.93 ","$2,058.04 ",other,,Not applicable. No negotiated rates per contract,"$1,824.65 ",86,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,697.35 ",80,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,166.93 ",55,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,015.61 ",95,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,015.61 ",95,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,591.27 ",75,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,803.44 ",85,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,058.04 ",97,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,166.93 ",55,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,909.52 ",90,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,058.04 ",97,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,058.04 ",97,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,058.04 ",97,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,803.44 ",85,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,909.52 ",90,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.93 ",55,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,015.61 ",90,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.93 ",55,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,973.17 ",93,,,"$1,166.93 ","$2,058.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CAST ADULT ARM CAST PROT,8785160,CDM,270,RC,,HCPCS,outpatient,,,$146.45 ,$109.84 ,,$134.73 ,92,,,$80.55 ,$142.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.55 ,55,,,$80.55 ,$142.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.55 ,$142.06 ,other,,Not applicable. No negotiated rates per contract,$125.95 ,86,,,$80.55 ,$142.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.16 ,80,,,$80.55 ,$142.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.55 ,55,,,$80.55 ,$142.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.13 ,95,,,$80.55 ,$142.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.13 ,95,,,$80.55 ,$142.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.84 ,75,,,$80.55 ,$142.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.48 ,85,,,$80.55 ,$142.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.06 ,97,,,$80.55 ,$142.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.55 ,55,,,$80.55 ,$142.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.81 ,90,,,$80.55 ,$142.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.06 ,97,,,$80.55 ,$142.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.06 ,97,,,$80.55 ,$142.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.06 ,97,,,$80.55 ,$142.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.48 ,85,,,$80.55 ,$142.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.81 ,90,,,$80.55 ,$142.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.55 ,55,,,$80.55 ,$142.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.13 ,90,,,$80.55 ,$142.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.55 ,55,,,$80.55 ,$142.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.20 ,93,,,$80.55 ,$142.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAST ADULT LEG CAST PROT,8785162,CDM,270,RC,,HCPCS,outpatient,,,$114.62 ,$85.97 ,,$105.45 ,92,,,$63.04 ,$111.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.04 ,$111.18 ,other,,Not applicable. No negotiated rates per contract,$98.57 ,86,,,$63.04 ,$111.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$91.70 ,80,,,$63.04 ,$111.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.89 ,95,,,$63.04 ,$111.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.89 ,95,,,$63.04 ,$111.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.97 ,75,,,$63.04 ,$111.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.43 ,85,,,$63.04 ,$111.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.16 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.43 ,85,,,$63.04 ,$111.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.16 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.89 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.60 ,93,,,$63.04 ,$111.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAST PAD UNDERCAST WEBRIL 4 X 4,9021885,CDM,270,RC,,HCPCS,outpatient,,,$29.31 ,$21.98 ,,$26.97 ,92,,,$16.12 ,$28.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.12 ,$28.43 ,other,,Not applicable. No negotiated rates per contract,$25.21 ,86,,,$16.12 ,$28.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.45 ,80,,,$16.12 ,$28.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.84 ,95,,,$16.12 ,$28.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.84 ,95,,,$16.12 ,$28.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.98 ,75,,,$16.12 ,$28.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.91 ,85,,,$16.12 ,$28.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.38 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.43 ,97,,,$16.12 ,$28.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.91 ,85,,,$16.12 ,$28.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.38 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.84 ,90,,,$16.12 ,$28.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.12 ,55,,,$16.12 ,$28.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.26 ,93,,,$16.12 ,$28.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CAST PADDING 2"" (DELTA D",8786193,CDM,270,RC,,HCPCS,outpatient,,,$79.52 ,$59.64 ,,$73.16 ,92,,,$43.74 ,$77.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.74 ,55,,,$43.74 ,$77.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.74 ,$77.13 ,other,,Not applicable. No negotiated rates per contract,$68.39 ,86,,,$43.74 ,$77.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.62 ,80,,,$43.74 ,$77.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.74 ,55,,,$43.74 ,$77.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.54 ,95,,,$43.74 ,$77.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.54 ,95,,,$43.74 ,$77.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.64 ,75,,,$43.74 ,$77.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.59 ,85,,,$43.74 ,$77.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.13 ,97,,,$43.74 ,$77.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.74 ,55,,,$43.74 ,$77.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.57 ,90,,,$43.74 ,$77.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.13 ,97,,,$43.74 ,$77.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.13 ,97,,,$43.74 ,$77.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.13 ,97,,,$43.74 ,$77.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.59 ,85,,,$43.74 ,$77.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.57 ,90,,,$43.74 ,$77.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.74 ,55,,,$43.74 ,$77.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.54 ,90,,,$43.74 ,$77.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.74 ,55,,,$43.74 ,$77.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.95 ,93,,,$43.74 ,$77.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CAST PADDING 3"" (DELTA D",8786192,CDM,270,RC,,HCPCS,outpatient,,,$85.17 ,$63.88 ,,$78.36 ,92,,,$46.84 ,$82.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.84 ,55,,,$46.84 ,$82.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.84 ,$82.61 ,other,,Not applicable. No negotiated rates per contract,$73.25 ,86,,,$46.84 ,$82.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.14 ,80,,,$46.84 ,$82.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.84 ,55,,,$46.84 ,$82.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,95,,,$46.84 ,$82.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.91 ,95,,,$46.84 ,$82.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.88 ,75,,,$46.84 ,$82.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.39 ,85,,,$46.84 ,$82.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.61 ,97,,,$46.84 ,$82.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.84 ,55,,,$46.84 ,$82.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.65 ,90,,,$46.84 ,$82.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.61 ,97,,,$46.84 ,$82.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.61 ,97,,,$46.84 ,$82.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.61 ,97,,,$46.84 ,$82.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.39 ,85,,,$46.84 ,$82.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.65 ,90,,,$46.84 ,$82.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.84 ,55,,,$46.84 ,$82.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,90,,,$46.84 ,$82.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.84 ,55,,,$46.84 ,$82.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.21 ,93,,,$46.84 ,$82.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CAST PADDING 6"" (YUMA CL",8785520,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAST YOUTH ARM CAST PROT,8785161,CDM,270,RC,,HCPCS,outpatient,,,$114.62 ,$85.97 ,,$105.45 ,92,,,$63.04 ,$111.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.04 ,$111.18 ,other,,Not applicable. No negotiated rates per contract,$98.57 ,86,,,$63.04 ,$111.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$91.70 ,80,,,$63.04 ,$111.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.89 ,95,,,$63.04 ,$111.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.89 ,95,,,$63.04 ,$111.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.97 ,75,,,$63.04 ,$111.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.43 ,85,,,$63.04 ,$111.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.16 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.18 ,97,,,$63.04 ,$111.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.43 ,85,,,$63.04 ,$111.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.16 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.89 ,90,,,$63.04 ,$111.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.04 ,55,,,$63.04 ,$111.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.60 ,93,,,$63.04 ,$111.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAST YOUTH LOWER LEG CAS,8785015,CDM,270,RC,,HCPCS,outpatient,,,$108.42 ,$81.32 ,,$99.75 ,92,,,$59.63 ,$105.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$59.63 ,55,,,$59.63 ,$105.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$59.63 ,$105.17 ,other,,Not applicable. No negotiated rates per contract,$93.24 ,86,,,$59.63 ,$105.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$86.74 ,80,,,$59.63 ,$105.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$59.63 ,55,,,$59.63 ,$105.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.00 ,95,,,$59.63 ,$105.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.00 ,95,,,$59.63 ,$105.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.32 ,75,,,$59.63 ,$105.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$92.16 ,85,,,$59.63 ,$105.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.17 ,97,,,$59.63 ,$105.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.63 ,55,,,$59.63 ,$105.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.58 ,90,,,$59.63 ,$105.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.17 ,97,,,$59.63 ,$105.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.17 ,97,,,$59.63 ,$105.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.17 ,97,,,$59.63 ,$105.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.16 ,85,,,$59.63 ,$105.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.58 ,90,,,$59.63 ,$105.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.63 ,55,,,$59.63 ,$105.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.00 ,90,,,$59.63 ,$105.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.63 ,55,,,$59.63 ,$105.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.83 ,93,,,$59.63 ,$105.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD  LI,8785370,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD BLA,8785366,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD BLUE,8785367,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD BRI,8785373,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD GRE,8785369,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD PIN,8785374,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE 2 X 4YD PURPLE (82002U),8785372,CDM,270,RC,,HCPCS,outpatient,,,$42.96 ,$32.22 ,,$39.52 ,92,,,$23.63 ,$41.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.63 ,$41.67 ,other,,Not applicable. No negotiated rates per contract,$36.95 ,86,,,$23.63 ,$41.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.37 ,80,,,$23.63 ,$41.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.81 ,95,,,$23.63 ,$41.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.81 ,95,,,$23.63 ,$41.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.22 ,75,,,$23.63 ,$41.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.52 ,85,,,$23.63 ,$41.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.66 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.52 ,85,,,$23.63 ,$41.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.66 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.81 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.95 ,93,,,$23.63 ,$41.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 2"" X 4YD BL",8785368,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 2""X 4YD RED",8785371,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 3"" X 4YD BR",8785379,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 3"" X 4YD GR",8785376,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 3"" X 4YD PURPLE",8785378,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CASTING TAPE 3""X 4YD RED",8785377,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CASTING TAPE BLACK 3 X 4,8785375,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH ALL SILIC. 16FR 5CC FOLEY,8785022,CDM,270,RC,,HCPCS,outpatient,,,$28.26 ,$21.20 ,,$26.00 ,92,,,$15.54 ,$27.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.54 ,55,,,$15.54 ,$27.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.54 ,$27.41 ,other,,Not applicable. No negotiated rates per contract,$24.30 ,86,,,$15.54 ,$27.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.61 ,80,,,$15.54 ,$27.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.54 ,55,,,$15.54 ,$27.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.85 ,95,,,$15.54 ,$27.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.85 ,95,,,$15.54 ,$27.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.20 ,75,,,$15.54 ,$27.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.02 ,85,,,$15.54 ,$27.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.41 ,97,,,$15.54 ,$27.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.54 ,55,,,$15.54 ,$27.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.43 ,90,,,$15.54 ,$27.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.41 ,97,,,$15.54 ,$27.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.41 ,97,,,$15.54 ,$27.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.41 ,97,,,$15.54 ,$27.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.02 ,85,,,$15.54 ,$27.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.43 ,90,,,$15.54 ,$27.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.54 ,55,,,$15.54 ,$27.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.85 ,90,,,$15.54 ,$27.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.54 ,55,,,$15.54 ,$27.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.28 ,93,,,$15.54 ,$27.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH ALL-SILIC.20FR 30CC FOLEY,9391544,CDM,270,RC,,HCPCS,outpatient,,,$32.81 ,$24.61 ,,$30.19 ,92,,,$18.05 ,$31.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.05 ,55,,,$18.05 ,$31.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.05 ,$31.83 ,other,,Not applicable. No negotiated rates per contract,$28.22 ,86,,,$18.05 ,$31.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.25 ,80,,,$18.05 ,$31.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.05 ,55,,,$18.05 ,$31.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.17 ,95,,,$18.05 ,$31.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.17 ,95,,,$18.05 ,$31.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.61 ,75,,,$18.05 ,$31.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.89 ,85,,,$18.05 ,$31.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.83 ,97,,,$18.05 ,$31.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.05 ,55,,,$18.05 ,$31.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.53 ,90,,,$18.05 ,$31.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.83 ,97,,,$18.05 ,$31.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.83 ,97,,,$18.05 ,$31.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.83 ,97,,,$18.05 ,$31.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.89 ,85,,,$18.05 ,$31.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.53 ,90,,,$18.05 ,$31.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.05 ,55,,,$18.05 ,$31.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.17 ,90,,,$18.05 ,$31.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.05 ,55,,,$18.05 ,$31.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.51 ,93,,,$18.05 ,$31.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH ALL-SILICONE  18FR 5CC FOLEY,8785023,CDM,270,RC,,HCPCS,outpatient,,,$28.35 ,$21.26 ,,$26.08 ,92,,,$15.59 ,$27.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.59 ,$27.50 ,other,,Not applicable. No negotiated rates per contract,$24.38 ,86,,,$15.59 ,$27.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.68 ,80,,,$15.59 ,$27.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.26 ,75,,,$15.59 ,$27.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.37 ,93,,,$15.59 ,$27.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH PICC V-LOCK SECURE,8785745,CDM,270,RC,,HCPCS,outpatient,,,$38.76 ,$29.07 ,,$35.66 ,92,,,$21.32 ,$37.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.32 ,$37.60 ,other,,Not applicable. No negotiated rates per contract,$33.33 ,86,,,$21.32 ,$37.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.01 ,80,,,$21.32 ,$37.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.82 ,95,,,$21.32 ,$37.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.82 ,95,,,$21.32 ,$37.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.07 ,75,,,$21.32 ,$37.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.95 ,85,,,$21.32 ,$37.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.88 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.95 ,85,,,$21.32 ,$37.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.88 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.82 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.05 ,93,,,$21.32 ,$37.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH SIL. 24FR 30CC 3WAY,8785149,CDM,270,RC,,HCPCS,outpatient,,,$59.57 ,$44.68 ,,$54.80 ,92,,,$32.76 ,$57.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.76 ,55,,,$32.76 ,$57.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.76 ,$57.78 ,other,,Not applicable. No negotiated rates per contract,$51.23 ,86,,,$32.76 ,$57.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.66 ,80,,,$32.76 ,$57.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.76 ,55,,,$32.76 ,$57.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.59 ,95,,,$32.76 ,$57.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.59 ,95,,,$32.76 ,$57.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.68 ,75,,,$32.76 ,$57.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.63 ,85,,,$32.76 ,$57.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.78 ,97,,,$32.76 ,$57.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.76 ,55,,,$32.76 ,$57.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.61 ,90,,,$32.76 ,$57.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.78 ,97,,,$32.76 ,$57.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.78 ,97,,,$32.76 ,$57.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.78 ,97,,,$32.76 ,$57.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.63 ,85,,,$32.76 ,$57.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.61 ,90,,,$32.76 ,$57.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.76 ,55,,,$32.76 ,$57.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.59 ,90,,,$32.76 ,$57.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.76 ,55,,,$32.76 ,$57.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.40 ,93,,,$32.76 ,$57.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH,9519109,CDM,270,RC,1123,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CATH,9518969,CDM,270,RC,1122,HCPCS,outpatient,,,$46.78 ,$35.09 ,,$43.04 ,92,,,$25.73 ,$45.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.73 ,$45.38 ,other,,Not applicable. No negotiated rates per contract,$40.23 ,86,,,$25.73 ,$45.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.42 ,80,,,$25.73 ,$45.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.09 ,75,,,$25.73 ,$45.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.51 ,93,,,$25.73 ,$45.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH,10499227,CDM,272,RC,1166,HCPCS,outpatient,,,$116.17 ,$87.13 ,,$106.88 ,92,,,$63.89 ,$112.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.89 ,55,,,$63.89 ,$112.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.89 ,$112.68 ,other,,Not applicable. No negotiated rates per contract,$99.91 ,86,,,$63.89 ,$112.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.94 ,80,,,$63.89 ,$112.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.89 ,55,,,$63.89 ,$112.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.36 ,95,,,$63.89 ,$112.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.36 ,95,,,$63.89 ,$112.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.13 ,75,,,$63.89 ,$112.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$98.74 ,85,,,$63.89 ,$112.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.68 ,97,,,$63.89 ,$112.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.89 ,55,,,$63.89 ,$112.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.55 ,90,,,$63.89 ,$112.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.68 ,97,,,$63.89 ,$112.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.68 ,97,,,$63.89 ,$112.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.68 ,97,,,$63.89 ,$112.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.74 ,85,,,$63.89 ,$112.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.55 ,90,,,$63.89 ,$112.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.89 ,55,,,$63.89 ,$112.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.36 ,90,,,$63.89 ,$112.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.89 ,55,,,$63.89 ,$112.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.04 ,93,,,$63.89 ,$112.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. ALL SILICONE  20FR 5CC FOLEY,8785024,CDM,270,RC,,HCPCS,outpatient,,,$27.91 ,$20.93 ,,$25.68 ,92,,,$15.35 ,$27.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.35 ,55,,,$15.35 ,$27.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.35 ,$27.07 ,other,,Not applicable. No negotiated rates per contract,$24.00 ,86,,,$15.35 ,$27.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.33 ,80,,,$15.35 ,$27.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.35 ,55,,,$15.35 ,$27.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.51 ,95,,,$15.35 ,$27.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.51 ,95,,,$15.35 ,$27.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.93 ,75,,,$15.35 ,$27.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.72 ,85,,,$15.35 ,$27.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.07 ,97,,,$15.35 ,$27.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.35 ,55,,,$15.35 ,$27.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.12 ,90,,,$15.35 ,$27.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.07 ,97,,,$15.35 ,$27.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.07 ,97,,,$15.35 ,$27.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.07 ,97,,,$15.35 ,$27.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.72 ,85,,,$15.35 ,$27.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.12 ,90,,,$15.35 ,$27.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.35 ,55,,,$15.35 ,$27.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.51 ,90,,,$15.35 ,$27.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.35 ,55,,,$15.35 ,$27.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.96 ,93,,,$15.35 ,$27.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. COUDE  16FR 5CC FOLEY,8785143,CDM,270,RC,,HCPCS,outpatient,,,$79.86 ,$59.90 ,,$73.47 ,92,,,$43.92 ,$77.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.92 ,$77.46 ,other,,Not applicable. No negotiated rates per contract,$68.68 ,86,,,$43.92 ,$77.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.89 ,80,,,$43.92 ,$77.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.87 ,95,,,$43.92 ,$77.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.87 ,95,,,$43.92 ,$77.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.90 ,75,,,$43.92 ,$77.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.88 ,85,,,$43.92 ,$77.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.88 ,85,,,$43.92 ,$77.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.27 ,93,,,$43.92 ,$77.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. PED. 10FR 3CC FOLEY,8785146,CDM,270,RC,,HCPCS,outpatient,,,$109.51 ,$82.13 ,,$100.75 ,92,,,$60.23 ,$106.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.23 ,55,,,$60.23 ,$106.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.23 ,$106.22 ,other,,Not applicable. No negotiated rates per contract,$94.18 ,86,,,$60.23 ,$106.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$87.61 ,80,,,$60.23 ,$106.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.23 ,55,,,$60.23 ,$106.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.03 ,95,,,$60.23 ,$106.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.03 ,95,,,$60.23 ,$106.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.13 ,75,,,$60.23 ,$106.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.08 ,85,,,$60.23 ,$106.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.22 ,97,,,$60.23 ,$106.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.23 ,55,,,$60.23 ,$106.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.56 ,90,,,$60.23 ,$106.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.22 ,97,,,$60.23 ,$106.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.22 ,97,,,$60.23 ,$106.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.22 ,97,,,$60.23 ,$106.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.08 ,85,,,$60.23 ,$106.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.56 ,90,,,$60.23 ,$106.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.23 ,55,,,$60.23 ,$106.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.03 ,90,,,$60.23 ,$106.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.23 ,55,,,$60.23 ,$106.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.84 ,93,,,$60.23 ,$106.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. PED. 8FR 3CC FOLEY,8785431,CDM,270,RC,,HCPCS,outpatient,,,$138.11 ,$103.58 ,,$127.06 ,92,,,$75.96 ,$133.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$75.96 ,55,,,$75.96 ,$133.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$75.96 ,$133.97 ,other,,Not applicable. No negotiated rates per contract,$118.77 ,86,,,$75.96 ,$133.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$110.49 ,80,,,$75.96 ,$133.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$75.96 ,55,,,$75.96 ,$133.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.20 ,95,,,$75.96 ,$133.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.20 ,95,,,$75.96 ,$133.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.58 ,75,,,$75.96 ,$133.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$117.39 ,85,,,$75.96 ,$133.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.97 ,97,,,$75.96 ,$133.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.96 ,55,,,$75.96 ,$133.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.30 ,90,,,$75.96 ,$133.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.97 ,97,,,$75.96 ,$133.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.97 ,97,,,$75.96 ,$133.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.97 ,97,,,$75.96 ,$133.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.39 ,85,,,$75.96 ,$133.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.30 ,90,,,$75.96 ,$133.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.96 ,55,,,$75.96 ,$133.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.20 ,90,,,$75.96 ,$133.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.96 ,55,,,$75.96 ,$133.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.44 ,93,,,$75.96 ,$133.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. SIL. 18FR 30CC 3WAY,8785150,CDM,270,RC,,HCPCS,outpatient,,,$56.27 ,$42.20 ,,$51.77 ,92,,,$30.95 ,$54.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.95 ,$54.58 ,other,,Not applicable. No negotiated rates per contract,$48.39 ,86,,,$30.95 ,$54.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.02 ,80,,,$30.95 ,$54.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.46 ,95,,,$30.95 ,$54.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.46 ,95,,,$30.95 ,$54.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.20 ,75,,,$30.95 ,$54.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.83 ,85,,,$30.95 ,$54.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.64 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.83 ,85,,,$30.95 ,$54.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.64 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.46 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.33 ,93,,,$30.95 ,$54.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH. SIL. COUDE 18FR 30ML,9939001,CDM,272,RC,,HCPCS,outpatient,,,$135.16 ,$101.37 ,,$124.35 ,92,,,$74.34 ,$131.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.34 ,55,,,$74.34 ,$131.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$74.34 ,$131.11 ,other,,Not applicable. No negotiated rates per contract,$116.24 ,86,,,$74.34 ,$131.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$108.13 ,80,,,$74.34 ,$131.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.34 ,55,,,$74.34 ,$131.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.40 ,95,,,$74.34 ,$131.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.40 ,95,,,$74.34 ,$131.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.37 ,75,,,$74.34 ,$131.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$114.89 ,85,,,$74.34 ,$131.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.11 ,97,,,$74.34 ,$131.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.34 ,55,,,$74.34 ,$131.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.64 ,90,,,$74.34 ,$131.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.11 ,97,,,$74.34 ,$131.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.11 ,97,,,$74.34 ,$131.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.11 ,97,,,$74.34 ,$131.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.89 ,85,,,$74.34 ,$131.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.64 ,90,,,$74.34 ,$131.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.34 ,55,,,$74.34 ,$131.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.40 ,90,,,$74.34 ,$131.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.34 ,55,,,$74.34 ,$131.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.70 ,93,,,$74.34 ,$131.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH.SIL .COUDE 20FR 30ML,9939003,CDM,272,RC,,HCPCS,outpatient,,,$148.88 ,$111.66 ,,$136.97 ,92,,,$81.88 ,$144.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.88 ,55,,,$81.88 ,$144.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.88 ,$144.41 ,other,,Not applicable. No negotiated rates per contract,$128.04 ,86,,,$81.88 ,$144.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$119.10 ,80,,,$81.88 ,$144.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.88 ,55,,,$81.88 ,$144.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.44 ,95,,,$81.88 ,$144.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.44 ,95,,,$81.88 ,$144.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.66 ,75,,,$81.88 ,$144.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.55 ,85,,,$81.88 ,$144.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.41 ,97,,,$81.88 ,$144.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.88 ,55,,,$81.88 ,$144.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.99 ,90,,,$81.88 ,$144.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.41 ,97,,,$81.88 ,$144.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.41 ,97,,,$81.88 ,$144.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.41 ,97,,,$81.88 ,$144.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.55 ,85,,,$81.88 ,$144.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.99 ,90,,,$81.88 ,$144.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.88 ,55,,,$81.88 ,$144.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.44 ,90,,,$81.88 ,$144.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.88 ,55,,,$81.88 ,$144.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.46 ,93,,,$81.88 ,$144.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER  ALL SILICONE 12FR 5CC FOLEY,8785025,CDM,270,RC,,HCPCS,outpatient,,,$35.09 ,$26.32 ,,$32.28 ,92,,,$19.30 ,$34.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.30 ,$34.04 ,other,,Not applicable. No negotiated rates per contract,$30.18 ,86,,,$19.30 ,$34.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.07 ,80,,,$19.30 ,$34.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.34 ,95,,,$19.30 ,$34.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.34 ,95,,,$19.30 ,$34.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.32 ,75,,,$19.30 ,$34.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.83 ,85,,,$19.30 ,$34.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.58 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.83 ,85,,,$19.30 ,$34.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.58 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.34 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.63 ,93,,,$19.30 ,$34.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER  FOLEY 22FR 5CC BALLOON (0165L22),8785140,CDM,270,RC,,HCPCS,outpatient,,,$30.01 ,$22.51 ,,$27.61 ,92,,,$16.51 ,$29.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.51 ,$29.11 ,other,,Not applicable. No negotiated rates per contract,$25.81 ,86,,,$16.51 ,$29.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.01 ,80,,,$16.51 ,$29.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.51 ,75,,,$16.51 ,$29.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.91 ,93,,,$16.51 ,$29.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER  FOLEY 24FR 30CC BALLOON,8785142,CDM,270,RC,,HCPCS,outpatient,,,$32.90 ,$24.68 ,,$30.27 ,92,,,$18.10 ,$31.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.10 ,55,,,$18.10 ,$31.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.10 ,$31.91 ,other,,Not applicable. No negotiated rates per contract,$28.29 ,86,,,$18.10 ,$31.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.32 ,80,,,$18.10 ,$31.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.10 ,55,,,$18.10 ,$31.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.26 ,95,,,$18.10 ,$31.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.26 ,95,,,$18.10 ,$31.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.68 ,75,,,$18.10 ,$31.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.97 ,85,,,$18.10 ,$31.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.91 ,97,,,$18.10 ,$31.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.10 ,55,,,$18.10 ,$31.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.61 ,90,,,$18.10 ,$31.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.91 ,97,,,$18.10 ,$31.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.91 ,97,,,$18.10 ,$31.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.91 ,97,,,$18.10 ,$31.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.97 ,85,,,$18.10 ,$31.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.61 ,90,,,$18.10 ,$31.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.10 ,55,,,$18.10 ,$31.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.26 ,90,,,$18.10 ,$31.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.10 ,55,,,$18.10 ,$31.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.60 ,93,,,$18.10 ,$31.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 10FR URETHRAL (RED ROBIN),8785073,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 14 FR 5CC SILIC,8781936,CDM,270,RC,,HCPCS,outpatient,,,$34.04 ,$25.53 ,,$31.32 ,92,,,$18.72 ,$33.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.72 ,$33.02 ,other,,Not applicable. No negotiated rates per contract,$29.27 ,86,,,$18.72 ,$33.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.23 ,80,,,$18.72 ,$33.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.34 ,95,,,$18.72 ,$33.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.34 ,95,,,$18.72 ,$33.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.53 ,75,,,$18.72 ,$33.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.93 ,85,,,$18.72 ,$33.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.64 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.02 ,97,,,$18.72 ,$33.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.93 ,85,,,$18.72 ,$33.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.64 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.34 ,90,,,$18.72 ,$33.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.72 ,55,,,$18.72 ,$33.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.66 ,93,,,$18.72 ,$33.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 14FR 5CC FOLEY,8785432,CDM,270,RC,,HCPCS,outpatient,,,$78.74 ,$59.06 ,,$72.44 ,92,,,$43.31 ,$76.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.31 ,55,,,$43.31 ,$76.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.31 ,$76.38 ,other,,Not applicable. No negotiated rates per contract,$67.72 ,86,,,$43.31 ,$76.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.99 ,80,,,$43.31 ,$76.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.31 ,55,,,$43.31 ,$76.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.80 ,95,,,$43.31 ,$76.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.80 ,95,,,$43.31 ,$76.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.06 ,75,,,$43.31 ,$76.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.93 ,85,,,$43.31 ,$76.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.38 ,97,,,$43.31 ,$76.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.31 ,55,,,$43.31 ,$76.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.87 ,90,,,$43.31 ,$76.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.38 ,97,,,$43.31 ,$76.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.38 ,97,,,$43.31 ,$76.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.38 ,97,,,$43.31 ,$76.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,85,,,$43.31 ,$76.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.87 ,90,,,$43.31 ,$76.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.31 ,55,,,$43.31 ,$76.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.80 ,90,,,$43.31 ,$76.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.31 ,55,,,$43.31 ,$76.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.23 ,93,,,$43.31 ,$76.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 16FR 5CC FOLEY,8785144,CDM,270,RC,,HCPCS,outpatient,,,$33.08 ,$24.81 ,,$30.43 ,92,,,$18.19 ,$32.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.19 ,55,,,$18.19 ,$32.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.19 ,$32.09 ,other,,Not applicable. No negotiated rates per contract,$28.45 ,86,,,$18.19 ,$32.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.46 ,80,,,$18.19 ,$32.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.19 ,55,,,$18.19 ,$32.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.43 ,95,,,$18.19 ,$32.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.43 ,95,,,$18.19 ,$32.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.81 ,75,,,$18.19 ,$32.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.12 ,85,,,$18.19 ,$32.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.09 ,97,,,$18.19 ,$32.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.19 ,55,,,$18.19 ,$32.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.77 ,90,,,$18.19 ,$32.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.09 ,97,,,$18.19 ,$32.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.09 ,97,,,$18.19 ,$32.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.09 ,97,,,$18.19 ,$32.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.12 ,85,,,$18.19 ,$32.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.77 ,90,,,$18.19 ,$32.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.19 ,55,,,$18.19 ,$32.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.43 ,90,,,$18.19 ,$32.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.19 ,55,,,$18.19 ,$32.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.76 ,93,,,$18.19 ,$32.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 16FR URETHRAL CATHETER,8785075,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER 22FR 30CC 3-WAY,8785148,CDM,270,RC,,HCPCS,outpatient,,,$77.72 ,$58.29 ,,$71.50 ,92,,,$42.75 ,$75.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.75 ,55,,,$42.75 ,$75.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.75 ,$75.39 ,other,,Not applicable. No negotiated rates per contract,$66.84 ,86,,,$42.75 ,$75.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.18 ,80,,,$42.75 ,$75.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.75 ,55,,,$42.75 ,$75.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.83 ,95,,,$42.75 ,$75.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.83 ,95,,,$42.75 ,$75.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.29 ,75,,,$42.75 ,$75.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.06 ,85,,,$42.75 ,$75.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.39 ,97,,,$42.75 ,$75.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.75 ,55,,,$42.75 ,$75.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.95 ,90,,,$42.75 ,$75.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.39 ,97,,,$42.75 ,$75.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.39 ,97,,,$42.75 ,$75.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.39 ,97,,,$42.75 ,$75.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.06 ,85,,,$42.75 ,$75.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.95 ,90,,,$42.75 ,$75.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.75 ,55,,,$42.75 ,$75.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.83 ,90,,,$42.75 ,$75.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.75 ,55,,,$42.75 ,$75.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.28 ,93,,,$42.75 ,$75.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER CATH EXTERNAL LG,8785016,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER CATH PLUG,8785038,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER COUDE 18FR 5CC (FOLEY (0168L18),8785151,CDM,270,RC,,HCPCS,outpatient,,,$79.59 ,$59.69 ,,$73.22 ,92,,,$43.77 ,$77.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.77 ,55,,,$43.77 ,$77.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.77 ,$77.20 ,other,,Not applicable. No negotiated rates per contract,$68.45 ,86,,,$43.77 ,$77.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.67 ,80,,,$43.77 ,$77.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.77 ,55,,,$43.77 ,$77.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.61 ,95,,,$43.77 ,$77.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.61 ,95,,,$43.77 ,$77.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.69 ,75,,,$43.77 ,$77.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.65 ,85,,,$43.77 ,$77.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.20 ,97,,,$43.77 ,$77.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.77 ,55,,,$43.77 ,$77.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.63 ,90,,,$43.77 ,$77.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.20 ,97,,,$43.77 ,$77.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.20 ,97,,,$43.77 ,$77.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.20 ,97,,,$43.77 ,$77.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.65 ,85,,,$43.77 ,$77.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.63 ,90,,,$43.77 ,$77.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.77 ,55,,,$43.77 ,$77.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.61 ,90,,,$43.77 ,$77.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.77 ,55,,,$43.77 ,$77.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.02 ,93,,,$43.77 ,$77.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FEMALE CATH KIT,8785072,CDM,270,RC,,HCPCS,outpatient,,,$32.99 ,$24.74 ,,$30.35 ,92,,,$18.14 ,$32.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.14 ,55,,,$18.14 ,$32.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.14 ,$32.00 ,other,,Not applicable. No negotiated rates per contract,$28.37 ,86,,,$18.14 ,$32.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.39 ,80,,,$18.14 ,$32.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.14 ,55,,,$18.14 ,$32.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.34 ,95,,,$18.14 ,$32.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.34 ,95,,,$18.14 ,$32.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.74 ,75,,,$18.14 ,$32.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.04 ,85,,,$18.14 ,$32.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.00 ,97,,,$18.14 ,$32.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.14 ,55,,,$18.14 ,$32.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.69 ,90,,,$18.14 ,$32.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.00 ,97,,,$18.14 ,$32.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.00 ,97,,,$18.14 ,$32.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.00 ,97,,,$18.14 ,$32.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.04 ,85,,,$18.14 ,$32.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.69 ,90,,,$18.14 ,$32.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.14 ,55,,,$18.14 ,$32.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.34 ,90,,,$18.14 ,$32.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.14 ,55,,,$18.14 ,$32.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.68 ,93,,,$18.14 ,$32.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 14 FR 30CC,8785152,CDM,270,RC,,HCPCS,outpatient,,,$57.09 ,$42.82 ,,$52.52 ,92,,,$31.40 ,$55.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.40 ,55,,,$31.40 ,$55.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.40 ,$55.38 ,other,,Not applicable. No negotiated rates per contract,$49.10 ,86,,,$31.40 ,$55.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.67 ,80,,,$31.40 ,$55.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.40 ,55,,,$31.40 ,$55.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.24 ,95,,,$31.40 ,$55.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.24 ,95,,,$31.40 ,$55.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.82 ,75,,,$31.40 ,$55.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.53 ,85,,,$31.40 ,$55.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.38 ,97,,,$31.40 ,$55.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.40 ,55,,,$31.40 ,$55.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.38 ,90,,,$31.40 ,$55.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.38 ,97,,,$31.40 ,$55.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.38 ,97,,,$31.40 ,$55.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.38 ,97,,,$31.40 ,$55.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.53 ,85,,,$31.40 ,$55.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.38 ,90,,,$31.40 ,$55.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.40 ,55,,,$31.40 ,$55.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.24 ,90,,,$31.40 ,$55.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.40 ,55,,,$31.40 ,$55.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.09 ,93,,,$31.40 ,$55.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 16FR 30 CC 2WAY,8785418,CDM,270,RC,,HCPCS,outpatient,,,$26.78 ,$20.09 ,,$24.64 ,92,,,$14.73 ,$25.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.73 ,55,,,$14.73 ,$25.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.73 ,$25.98 ,other,,Not applicable. No negotiated rates per contract,$23.03 ,86,,,$14.73 ,$25.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.42 ,80,,,$14.73 ,$25.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.73 ,55,,,$14.73 ,$25.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.44 ,95,,,$14.73 ,$25.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.44 ,95,,,$14.73 ,$25.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.09 ,75,,,$14.73 ,$25.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.76 ,85,,,$14.73 ,$25.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.98 ,97,,,$14.73 ,$25.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.73 ,55,,,$14.73 ,$25.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.10 ,90,,,$14.73 ,$25.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.98 ,97,,,$14.73 ,$25.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.98 ,97,,,$14.73 ,$25.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.98 ,97,,,$14.73 ,$25.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.76 ,85,,,$14.73 ,$25.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.10 ,90,,,$14.73 ,$25.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.73 ,55,,,$14.73 ,$25.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.44 ,90,,,$14.73 ,$25.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.73 ,55,,,$14.73 ,$25.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.91 ,93,,,$14.73 ,$25.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 18FR 30CC (0166L18),8785014,CDM,270,RC,,HCPCS,outpatient,,,$66.83 ,$50.12 ,,$61.48 ,92,,,$36.76 ,$64.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.76 ,55,,,$36.76 ,$64.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.76 ,$64.83 ,other,,Not applicable. No negotiated rates per contract,$57.47 ,86,,,$36.76 ,$64.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.46 ,80,,,$36.76 ,$64.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.76 ,55,,,$36.76 ,$64.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.49 ,95,,,$36.76 ,$64.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.49 ,95,,,$36.76 ,$64.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.12 ,75,,,$36.76 ,$64.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.81 ,85,,,$36.76 ,$64.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.83 ,97,,,$36.76 ,$64.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.76 ,55,,,$36.76 ,$64.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.15 ,90,,,$36.76 ,$64.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.83 ,97,,,$36.76 ,$64.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.83 ,97,,,$36.76 ,$64.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.83 ,97,,,$36.76 ,$64.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.81 ,85,,,$36.76 ,$64.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.15 ,90,,,$36.76 ,$64.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.76 ,55,,,$36.76 ,$64.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.49 ,90,,,$36.76 ,$64.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.76 ,55,,,$36.76 ,$64.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.15 ,93,,,$36.76 ,$64.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 18FR 5CC BALLOO,8785145,CDM,270,RC,,HCPCS,outpatient,,,$31.76 ,$23.82 ,,$29.22 ,92,,,$17.47 ,$30.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.47 ,$30.81 ,other,,Not applicable. No negotiated rates per contract,$27.31 ,86,,,$17.47 ,$30.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.41 ,80,,,$17.47 ,$30.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.82 ,75,,,$17.47 ,$30.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.54 ,93,,,$17.47 ,$30.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 20FR 30CC  2WAY,8785147,CDM,270,RC,,HCPCS,outpatient,,,$36.66 ,$27.50 ,,$33.73 ,92,,,$20.16 ,$35.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.16 ,$35.56 ,other,,Not applicable. No negotiated rates per contract,$31.53 ,86,,,$20.16 ,$35.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.33 ,80,,,$20.16 ,$35.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.83 ,95,,,$20.16 ,$35.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.83 ,95,,,$20.16 ,$35.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.50 ,75,,,$20.16 ,$35.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.16 ,85,,,$20.16 ,$35.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.99 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.56 ,97,,,$20.16 ,$35.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.16 ,85,,,$20.16 ,$35.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.99 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.83 ,90,,,$20.16 ,$35.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.16 ,55,,,$20.16 ,$35.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.09 ,93,,,$20.16 ,$35.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 20FR 5CC BALLOON,8785417,CDM,270,RC,,HCPCS,outpatient,,,$32.55 ,$24.41 ,,$29.95 ,92,,,$17.90 ,$31.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.90 ,$31.57 ,other,,Not applicable. No negotiated rates per contract,$27.99 ,86,,,$17.90 ,$31.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.04 ,80,,,$17.90 ,$31.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.92 ,95,,,$17.90 ,$31.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.92 ,95,,,$17.90 ,$31.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.41 ,75,,,$17.90 ,$31.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.67 ,85,,,$17.90 ,$31.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.30 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.67 ,85,,,$17.90 ,$31.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.30 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.92 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.27 ,93,,,$17.90 ,$31.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 20FR C1758,8971130,CDM,270,RC,C1758,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$15.40 ,$27.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$15.40 ,$27.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$15.40 ,$27.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$15.40 ,$27.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.04 ,93,,,$15.40 ,$27.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 22FR 30CC BALLO,8785141,CDM,270,RC,,HCPCS,outpatient,,,$34.56 ,$25.92 ,,$31.80 ,92,,,$19.01 ,$33.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.01 ,55,,,$19.01 ,$33.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.01 ,$33.52 ,other,,Not applicable. No negotiated rates per contract,$29.72 ,86,,,$19.01 ,$33.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.65 ,80,,,$19.01 ,$33.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.01 ,55,,,$19.01 ,$33.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.83 ,95,,,$19.01 ,$33.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.83 ,95,,,$19.01 ,$33.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.92 ,75,,,$19.01 ,$33.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.38 ,85,,,$19.01 ,$33.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.52 ,97,,,$19.01 ,$33.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.01 ,55,,,$19.01 ,$33.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.10 ,90,,,$19.01 ,$33.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.52 ,97,,,$19.01 ,$33.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.52 ,97,,,$19.01 ,$33.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.52 ,97,,,$19.01 ,$33.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.38 ,85,,,$19.01 ,$33.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.10 ,90,,,$19.01 ,$33.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.01 ,55,,,$19.01 ,$33.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.83 ,90,,,$19.01 ,$33.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.01 ,55,,,$19.01 ,$33.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.14 ,93,,,$19.01 ,$33.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY ALL SILIC 2 WAY 20FR 5CC  LF TIEMANN,8785139,CDM,270,RC,,HCPCS,outpatient,,,$120.90 ,$90.68 ,,$111.23 ,92,,,$66.50 ,$117.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.50 ,$117.27 ,other,,Not applicable. No negotiated rates per contract,$103.97 ,86,,,$66.50 ,$117.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.72 ,80,,,$66.50 ,$117.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.86 ,95,,,$66.50 ,$117.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.86 ,95,,,$66.50 ,$117.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.68 ,75,,,$66.50 ,$117.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.77 ,85,,,$66.50 ,$117.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.81 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.77 ,85,,,$66.50 ,$117.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.81 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.86 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.44 ,93,,,$66.50 ,$117.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER LEG STRAP,8785348,CDM,270,RC,,HCPCS,outpatient,,,$37.45 ,$28.09 ,,$34.45 ,92,,,$20.60 ,$36.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.60 ,55,,,$20.60 ,$36.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.60 ,$36.33 ,other,,Not applicable. No negotiated rates per contract,$32.21 ,86,,,$20.60 ,$36.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.96 ,80,,,$20.60 ,$36.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.60 ,55,,,$20.60 ,$36.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.58 ,95,,,$20.60 ,$36.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.58 ,95,,,$20.60 ,$36.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.09 ,75,,,$20.60 ,$36.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.83 ,85,,,$20.60 ,$36.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.33 ,97,,,$20.60 ,$36.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.60 ,55,,,$20.60 ,$36.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.71 ,90,,,$20.60 ,$36.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.33 ,97,,,$20.60 ,$36.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.33 ,97,,,$20.60 ,$36.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.33 ,97,,,$20.60 ,$36.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.83 ,85,,,$20.60 ,$36.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.71 ,90,,,$20.60 ,$36.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.60 ,55,,,$20.60 ,$36.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.58 ,90,,,$20.60 ,$36.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.60 ,55,,,$20.60 ,$36.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.83 ,93,,,$20.60 ,$36.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER MED. EXTERNAL MALE,8785013,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER,8787012,CDM,270,RC,,HCPCS,outpatient,,,$72.52 ,$54.39 ,,$66.72 ,92,,,$39.89 ,$70.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.89 ,55,,,$39.89 ,$70.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.89 ,$70.34 ,other,,Not applicable. No negotiated rates per contract,$62.37 ,86,,,$39.89 ,$70.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$58.02 ,80,,,$39.89 ,$70.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.89 ,55,,,$39.89 ,$70.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.89 ,95,,,$39.89 ,$70.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.89 ,95,,,$39.89 ,$70.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.39 ,75,,,$39.89 ,$70.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.64 ,85,,,$39.89 ,$70.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.34 ,97,,,$39.89 ,$70.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.89 ,55,,,$39.89 ,$70.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.27 ,90,,,$39.89 ,$70.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.34 ,97,,,$39.89 ,$70.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.34 ,97,,,$39.89 ,$70.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.34 ,97,,,$39.89 ,$70.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.64 ,85,,,$39.89 ,$70.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.27 ,90,,,$39.89 ,$70.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.89 ,55,,,$39.89 ,$70.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.89 ,90,,,$39.89 ,$70.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.89 ,55,,,$39.89 ,$70.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.44 ,93,,,$39.89 ,$70.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER,10543651,CDM,270,RC,,HCPCS,outpatient,,,$66.91 ,$50.18 ,,$61.56 ,92,,,$36.80 ,$64.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.80 ,55,,,$36.80 ,$64.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.80 ,$64.90 ,other,,Not applicable. No negotiated rates per contract,$57.54 ,86,,,$36.80 ,$64.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.53 ,80,,,$36.80 ,$64.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.80 ,55,,,$36.80 ,$64.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.56 ,95,,,$36.80 ,$64.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.56 ,95,,,$36.80 ,$64.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.18 ,75,,,$36.80 ,$64.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.87 ,85,,,$36.80 ,$64.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.90 ,97,,,$36.80 ,$64.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.80 ,55,,,$36.80 ,$64.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.22 ,90,,,$36.80 ,$64.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,97,,,$36.80 ,$64.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,97,,,$36.80 ,$64.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,97,,,$36.80 ,$64.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.87 ,85,,,$36.80 ,$64.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.22 ,90,,,$36.80 ,$64.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.80 ,55,,,$36.80 ,$64.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.56 ,90,,,$36.80 ,$64.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.80 ,55,,,$36.80 ,$64.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.23 ,93,,,$36.80 ,$64.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CAUTERY EXTENSION  5"" (O",8784115,CDM,270,RC,,HCPCS,outpatient,,,$495.94 ,$371.96 ,,$456.26 ,92,,,$272.77 ,$481.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$272.77 ,55,,,$272.77 ,$481.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$272.77 ,$481.06 ,other,,Not applicable. No negotiated rates per contract,$426.51 ,86,,,$272.77 ,$481.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$396.75 ,80,,,$272.77 ,$481.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$272.77 ,55,,,$272.77 ,$481.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.14 ,95,,,$272.77 ,$481.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$471.14 ,95,,,$272.77 ,$481.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.96 ,75,,,$272.77 ,$481.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$421.55 ,85,,,$272.77 ,$481.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.06 ,97,,,$272.77 ,$481.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.77 ,55,,,$272.77 ,$481.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$446.35 ,90,,,$272.77 ,$481.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$481.06 ,97,,,$272.77 ,$481.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.06 ,97,,,$272.77 ,$481.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.06 ,97,,,$272.77 ,$481.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.55 ,85,,,$272.77 ,$481.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$446.35 ,90,,,$272.77 ,$481.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.77 ,55,,,$272.77 ,$481.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.14 ,90,,,$272.77 ,$481.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.77 ,55,,,$272.77 ,$481.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$461.22 ,93,,,$272.77 ,$481.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CAUTERY,8782512,CDM,270,RC,,HCPCS,outpatient,,,$70.70 ,$53.03 ,,$65.04 ,92,,,$38.89 ,$68.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.89 ,55,,,$38.89 ,$68.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.89 ,$68.58 ,other,,Not applicable. No negotiated rates per contract,$60.80 ,86,,,$38.89 ,$68.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.56 ,80,,,$38.89 ,$68.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.89 ,55,,,$38.89 ,$68.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.17 ,95,,,$38.89 ,$68.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.17 ,95,,,$38.89 ,$68.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.03 ,75,,,$38.89 ,$68.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$60.10 ,85,,,$38.89 ,$68.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.58 ,97,,,$38.89 ,$68.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.89 ,55,,,$38.89 ,$68.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.63 ,90,,,$38.89 ,$68.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.58 ,97,,,$38.89 ,$68.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.58 ,97,,,$38.89 ,$68.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.58 ,97,,,$38.89 ,$68.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.10 ,85,,,$38.89 ,$68.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.63 ,90,,,$38.89 ,$68.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.89 ,55,,,$38.89 ,$68.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.17 ,90,,,$38.89 ,$68.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.89 ,55,,,$38.89 ,$68.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.75 ,93,,,$38.89 ,$68.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CEMENT MIXING SYSTEM (OR,8787040,CDM,270,RC,,HCPCS,outpatient,,,"$1,381.25 ","$1,035.94 ",,"$1,270.75 ",92,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$759.69 ,"$1,339.81 ",other,,Not applicable. No negotiated rates per contract,"$1,187.88 ",86,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,105.00 ",80,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,312.19 ",95,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,312.19 ",95,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,035.94 ",75,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,174.06 ",85,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,243.13 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.06 ",85,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,243.13 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,312.19 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,284.56 ",93,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CERVICAL COLLAR L0120,8971132,CDM,270,RC,L0120,HCPCS,outpatient,,,$189.00 ,$141.75 ,,$173.88 ,92,,,$103.95 ,$183.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$103.95 ,$183.33 ,other,,Not applicable. No negotiated rates per contract,$162.54 ,86,,,$103.95 ,$183.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.20 ,80,,,$103.95 ,$183.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.55 ,95,,,$103.95 ,$183.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.75 ,75,,,$103.95 ,$183.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.33 ,97,,,$103.95 ,$183.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.65 ,85,,,$103.95 ,$183.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.10 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.55 ,90,,,$103.95 ,$183.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.95 ,55,,,$103.95 ,$183.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.77 ,93,,,$103.95 ,$183.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHART FLAGGS YELLOW  1 X,8782292,CDM,270,RC,,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHEMOLOCK CLOSED VIAL SPIKE W/SKIRT,8783711,CDM,270,RC,,HCPCS,outpatient,,,$35.96 ,$26.97 ,,$33.08 ,92,,,$19.78 ,$34.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.78 ,55,,,$19.78 ,$34.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.78 ,$34.88 ,other,,Not applicable. No negotiated rates per contract,$30.93 ,86,,,$19.78 ,$34.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.77 ,80,,,$19.78 ,$34.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.78 ,55,,,$19.78 ,$34.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.16 ,95,,,$19.78 ,$34.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.16 ,95,,,$19.78 ,$34.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.97 ,75,,,$19.78 ,$34.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.57 ,85,,,$19.78 ,$34.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.88 ,97,,,$19.78 ,$34.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.78 ,55,,,$19.78 ,$34.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.36 ,90,,,$19.78 ,$34.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.88 ,97,,,$19.78 ,$34.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.88 ,97,,,$19.78 ,$34.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.88 ,97,,,$19.78 ,$34.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.57 ,85,,,$19.78 ,$34.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.36 ,90,,,$19.78 ,$34.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.78 ,55,,,$19.78 ,$34.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.16 ,90,,,$19.78 ,$34.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.78 ,55,,,$19.78 ,$34.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.44 ,93,,,$19.78 ,$34.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHEST DRAINAGE UNIT  (THORA-SEAL),8785217,CDM,270,RC,,HCPCS,outpatient,,,$483.88 ,$362.91 ,,$445.17 ,92,,,$266.13 ,$469.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$266.13 ,55,,,$266.13 ,$469.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$266.13 ,$469.36 ,other,,Not applicable. No negotiated rates per contract,$416.14 ,86,,,$266.13 ,$469.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$387.10 ,80,,,$266.13 ,$469.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$266.13 ,55,,,$266.13 ,$469.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.69 ,95,,,$266.13 ,$469.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$459.69 ,95,,,$266.13 ,$469.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$362.91 ,75,,,$266.13 ,$469.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$411.30 ,85,,,$266.13 ,$469.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$469.36 ,97,,,$266.13 ,$469.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.13 ,55,,,$266.13 ,$469.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$435.49 ,90,,,$266.13 ,$469.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$469.36 ,97,,,$266.13 ,$469.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.36 ,97,,,$266.13 ,$469.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$469.36 ,97,,,$266.13 ,$469.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.30 ,85,,,$266.13 ,$469.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$435.49 ,90,,,$266.13 ,$469.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.13 ,55,,,$266.13 ,$469.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.69 ,90,,,$266.13 ,$469.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.13 ,55,,,$266.13 ,$469.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.01 ,93,,,$266.13 ,$469.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHLORAPREP 10.5ML APPLIC,8785568,CDM,270,RC,,HCPCS,outpatient,,,$30.19 ,$22.64 ,,$27.77 ,92,,,$16.60 ,$29.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.60 ,55,,,$16.60 ,$29.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.60 ,$29.28 ,other,,Not applicable. No negotiated rates per contract,$25.96 ,86,,,$16.60 ,$29.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.15 ,80,,,$16.60 ,$29.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.60 ,55,,,$16.60 ,$29.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.68 ,95,,,$16.60 ,$29.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.68 ,95,,,$16.60 ,$29.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.64 ,75,,,$16.60 ,$29.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.66 ,85,,,$16.60 ,$29.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.28 ,97,,,$16.60 ,$29.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.60 ,55,,,$16.60 ,$29.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.17 ,90,,,$16.60 ,$29.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.28 ,97,,,$16.60 ,$29.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.28 ,97,,,$16.60 ,$29.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.28 ,97,,,$16.60 ,$29.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.66 ,85,,,$16.60 ,$29.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.17 ,90,,,$16.60 ,$29.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.60 ,55,,,$16.60 ,$29.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.68 ,90,,,$16.60 ,$29.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.60 ,55,,,$16.60 ,$29.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.08 ,93,,,$16.60 ,$29.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHLORAPREP 26ML ORANGE APPLICAT,8785559,CDM,270,RC,,HCPCS,outpatient,,,$89.44 ,$67.08 ,,$82.28 ,92,,,$49.19 ,$86.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.19 ,55,,,$49.19 ,$86.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.19 ,$86.76 ,other,,Not applicable. No negotiated rates per contract,$76.92 ,86,,,$49.19 ,$86.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.55 ,80,,,$49.19 ,$86.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.19 ,55,,,$49.19 ,$86.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.97 ,95,,,$49.19 ,$86.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.97 ,95,,,$49.19 ,$86.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.08 ,75,,,$49.19 ,$86.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$76.02 ,85,,,$49.19 ,$86.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.76 ,97,,,$49.19 ,$86.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.19 ,55,,,$49.19 ,$86.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.50 ,90,,,$49.19 ,$86.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.76 ,97,,,$49.19 ,$86.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.76 ,97,,,$49.19 ,$86.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.76 ,97,,,$49.19 ,$86.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.02 ,85,,,$49.19 ,$86.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.50 ,90,,,$49.19 ,$86.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.19 ,55,,,$49.19 ,$86.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.97 ,90,,,$49.19 ,$86.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.19 ,55,,,$49.19 ,$86.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.18 ,93,,,$49.19 ,$86.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHLORAPREP 3ML  ONE-STEP,8785558,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CHLORAPREP ONE STEP/SINGLE SWABSTICKS,8785033,CDM,270,RC,,HCPCS,outpatient,,,$166.39 ,$124.79 ,,$153.08 ,92,,,$91.51 ,$161.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.51 ,55,,,$91.51 ,$161.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$91.51 ,$161.40 ,other,,Not applicable. No negotiated rates per contract,$143.10 ,86,,,$91.51 ,$161.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$133.11 ,80,,,$91.51 ,$161.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.51 ,55,,,$91.51 ,$161.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.07 ,95,,,$91.51 ,$161.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.07 ,95,,,$91.51 ,$161.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.79 ,75,,,$91.51 ,$161.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.43 ,85,,,$91.51 ,$161.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.40 ,97,,,$91.51 ,$161.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.51 ,55,,,$91.51 ,$161.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.75 ,90,,,$91.51 ,$161.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.40 ,97,,,$91.51 ,$161.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.40 ,97,,,$91.51 ,$161.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.40 ,97,,,$91.51 ,$161.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.43 ,85,,,$91.51 ,$161.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.75 ,90,,,$91.51 ,$161.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.51 ,55,,,$91.51 ,$161.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.07 ,90,,,$91.51 ,$161.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.51 ,55,,,$91.51 ,$161.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.74 ,93,,,$91.51 ,$161.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CIRCUIT ADULT UNIVERSAL,8942846,CDM,270,RC,,HCPCS,outpatient,,,$120.20 ,$90.15 ,,$110.58 ,92,,,$66.11 ,$116.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.11 ,55,,,$66.11 ,$116.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.11 ,$116.59 ,other,,Not applicable. No negotiated rates per contract,$103.37 ,86,,,$66.11 ,$116.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.16 ,80,,,$66.11 ,$116.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.11 ,55,,,$66.11 ,$116.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.19 ,95,,,$66.11 ,$116.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.19 ,95,,,$66.11 ,$116.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.15 ,75,,,$66.11 ,$116.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.17 ,85,,,$66.11 ,$116.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.59 ,97,,,$66.11 ,$116.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.11 ,55,,,$66.11 ,$116.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.18 ,90,,,$66.11 ,$116.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.59 ,97,,,$66.11 ,$116.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.59 ,97,,,$66.11 ,$116.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.59 ,97,,,$66.11 ,$116.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.17 ,85,,,$66.11 ,$116.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.18 ,90,,,$66.11 ,$116.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.11 ,55,,,$66.11 ,$116.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.19 ,90,,,$66.11 ,$116.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.11 ,55,,,$66.11 ,$116.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.79 ,93,,,$66.11 ,$116.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CIRCUIT ADULT UNIVERSAL  72"" FLEX F2 SAMPLE PORT ELBOW 3L BAG (NEW)(OR)",8785744,CDM,270,RC,,HCPCS,outpatient,,,$45.38 ,$34.04 ,,$41.75 ,92,,,$24.96 ,$44.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.96 ,55,,,$24.96 ,$44.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.96 ,$44.02 ,other,,Not applicable. No negotiated rates per contract,$39.03 ,86,,,$24.96 ,$44.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.30 ,80,,,$24.96 ,$44.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.96 ,55,,,$24.96 ,$44.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.11 ,95,,,$24.96 ,$44.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.11 ,95,,,$24.96 ,$44.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.04 ,75,,,$24.96 ,$44.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.57 ,85,,,$24.96 ,$44.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.02 ,97,,,$24.96 ,$44.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.96 ,55,,,$24.96 ,$44.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.84 ,90,,,$24.96 ,$44.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.02 ,97,,,$24.96 ,$44.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.02 ,97,,,$24.96 ,$44.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.02 ,97,,,$24.96 ,$44.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.57 ,85,,,$24.96 ,$44.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.84 ,90,,,$24.96 ,$44.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.96 ,55,,,$24.96 ,$44.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.11 ,90,,,$24.96 ,$44.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.96 ,55,,,$24.96 ,$44.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.20 ,93,,,$24.96 ,$44.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CIRCUIT ADULT UNIVERSAL F2 60"" KING SYSTEM (OR)",8785512,CDM,270,RC,,HCPCS,outpatient,,,$49.42 ,$37.07 ,,$45.47 ,92,,,$27.18 ,$47.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.18 ,55,,,$27.18 ,$47.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.18 ,$47.94 ,other,,Not applicable. No negotiated rates per contract,$42.50 ,86,,,$27.18 ,$47.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.54 ,80,,,$27.18 ,$47.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.18 ,55,,,$27.18 ,$47.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.95 ,95,,,$27.18 ,$47.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.95 ,95,,,$27.18 ,$47.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.07 ,75,,,$27.18 ,$47.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.01 ,85,,,$27.18 ,$47.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.94 ,97,,,$27.18 ,$47.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.18 ,55,,,$27.18 ,$47.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.48 ,90,,,$27.18 ,$47.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.94 ,97,,,$27.18 ,$47.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.94 ,97,,,$27.18 ,$47.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.94 ,97,,,$27.18 ,$47.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.01 ,85,,,$27.18 ,$47.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.48 ,90,,,$27.18 ,$47.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.18 ,55,,,$27.18 ,$47.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.95 ,90,,,$27.18 ,$47.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.18 ,55,,,$27.18 ,$47.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.96 ,93,,,$27.18 ,$47.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CIRCUIT PEDIATRIC UNIVER,8785519,CDM,270,RC,,HCPCS,outpatient,,,$87.34 ,$65.51 ,,$80.35 ,92,,,$48.04 ,$84.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.04 ,55,,,$48.04 ,$84.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.04 ,$84.72 ,other,,Not applicable. No negotiated rates per contract,$75.11 ,86,,,$48.04 ,$84.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.87 ,80,,,$48.04 ,$84.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.04 ,55,,,$48.04 ,$84.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.97 ,95,,,$48.04 ,$84.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.97 ,95,,,$48.04 ,$84.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.51 ,75,,,$48.04 ,$84.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.24 ,85,,,$48.04 ,$84.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.72 ,97,,,$48.04 ,$84.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.04 ,55,,,$48.04 ,$84.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.61 ,90,,,$48.04 ,$84.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.72 ,97,,,$48.04 ,$84.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.72 ,97,,,$48.04 ,$84.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.72 ,97,,,$48.04 ,$84.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.24 ,85,,,$48.04 ,$84.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.61 ,90,,,$48.04 ,$84.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.04 ,55,,,$48.04 ,$84.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.97 ,90,,,$48.04 ,$84.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.04 ,55,,,$48.04 ,$84.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.23 ,93,,,$48.04 ,$84.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CIRCUIT SINGLE LIMB ADUL,8785479,CDM,270,RC,,HCPCS,outpatient,,,$52.97 ,$39.73 ,,$48.73 ,92,,,$29.13 ,$51.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.13 ,$51.38 ,other,,Not applicable. No negotiated rates per contract,$45.55 ,86,,,$29.13 ,$51.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.38 ,80,,,$29.13 ,$51.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.32 ,95,,,$29.13 ,$51.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.32 ,95,,,$29.13 ,$51.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.73 ,75,,,$29.13 ,$51.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.02 ,85,,,$29.13 ,$51.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.67 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.02 ,85,,,$29.13 ,$51.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.67 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.32 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.26 ,93,,,$29.13 ,$51.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CISCO ASA5508 FIREPOWER A,8782003,CDM,270,RC,,HCPCS,outpatient,,,"$1,005.00 ",$753.75 ,,$924.60 ,92,,,$552.75 ,$974.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$552.75 ,55,,,$552.75 ,$974.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$552.75 ,$974.85 ,other,,Not applicable. No negotiated rates per contract,$864.30 ,86,,,$552.75 ,$974.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$804.00 ,80,,,$552.75 ,$974.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$552.75 ,55,,,$552.75 ,$974.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$954.75 ,95,,,$552.75 ,$974.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$954.75 ,95,,,$552.75 ,$974.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$753.75 ,75,,,$552.75 ,$974.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$854.25 ,85,,,$552.75 ,$974.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$974.85 ,97,,,$552.75 ,$974.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$552.75 ,55,,,$552.75 ,$974.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$904.50 ,90,,,$552.75 ,$974.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$974.85 ,97,,,$552.75 ,$974.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$974.85 ,97,,,$552.75 ,$974.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$974.85 ,97,,,$552.75 ,$974.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$854.25 ,85,,,$552.75 ,$974.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$904.50 ,90,,,$552.75 ,$974.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$552.75 ,55,,,$552.75 ,$974.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$954.75 ,90,,,$552.75 ,$974.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$552.75 ,55,,,$552.75 ,$974.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$934.65 ,93,,,$552.75 ,$974.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CIV FLEX TRANSDUCER COVE,8782538,CDM,270,RC,,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.80 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CLAMP STR. JAWS & HANDLE,8782740,CDM,270,RC,,HCPCS,outpatient,,,"$1,437.22 ","$1,077.92 ",,"$1,322.24 ",92,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$790.47 ,55,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$790.47 ,"$1,394.10 ",other,,Not applicable. No negotiated rates per contract,"$1,236.01 ",86,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,149.78 ",80,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$790.47 ,55,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.36 ",95,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,365.36 ",95,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,077.92 ",75,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,221.64 ",85,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,394.10 ",97,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$790.47 ,55,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,293.50 ",90,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,394.10 ",97,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,394.10 ",97,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,394.10 ",97,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,221.64 ",85,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,293.50 ",90,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.47 ,55,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,365.36 ",90,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$790.47 ,55,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,336.61 ",93,,,$790.47 ,"$1,394.10 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CLASSIC FLEXIBLE SPINE M,8786152,CDM,270,RC,,HCPCS,outpatient,,,$760.48 ,$570.36 ,,$699.64 ,92,,,$418.26 ,$737.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$418.26 ,55,,,$418.26 ,$737.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$418.26 ,$737.67 ,other,,Not applicable. No negotiated rates per contract,$654.01 ,86,,,$418.26 ,$737.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$608.38 ,80,,,$418.26 ,$737.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$418.26 ,55,,,$418.26 ,$737.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$722.46 ,95,,,$418.26 ,$737.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$722.46 ,95,,,$418.26 ,$737.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$570.36 ,75,,,$418.26 ,$737.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$646.41 ,85,,,$418.26 ,$737.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$737.67 ,97,,,$418.26 ,$737.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$418.26 ,55,,,$418.26 ,$737.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$684.43 ,90,,,$418.26 ,$737.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$737.67 ,97,,,$418.26 ,$737.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$737.67 ,97,,,$418.26 ,$737.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$737.67 ,97,,,$418.26 ,$737.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$646.41 ,85,,,$418.26 ,$737.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$684.43 ,90,,,$418.26 ,$737.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$418.26 ,55,,,$418.26 ,$737.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$722.46 ,90,,,$418.26 ,$737.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$418.26 ,55,,,$418.26 ,$737.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.25 ,93,,,$418.26 ,$737.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CLAVICLE STRAP,8971144,CDM,270,RC,L3660,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$64.90 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.90 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$101.48 ,86,,,$64.90 ,$114.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$94.40 ,80,,,$64.90 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$64.90 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$64.90 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$64.90 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$64.90 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$64.90 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$64.90 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CLAW GRASPER 10MM 36CM L,8782739,CDM,270,RC,,HCPCS,outpatient,,,"$3,283.81 ","$2,462.86 ",,"$3,021.11 ",92,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,806.10 ",55,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,806.10 ","$3,185.30 ",other,,Not applicable. No negotiated rates per contract,"$2,824.08 ",86,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,627.05 ",80,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,806.10 ",55,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,119.62 ",95,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,119.62 ",95,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,462.86 ",75,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,791.24 ",85,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,185.30 ",97,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,806.10 ",55,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,955.43 ",90,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,185.30 ",97,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,185.30 ",97,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,185.30 ",97,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,791.24 ",85,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,955.43 ",90,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,806.10 ",55,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,119.62 ",90,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,806.10 ",55,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,053.94 ",93,,,"$1,806.10 ","$3,185.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CLIP FIXING DEVICE (OR),8784773,CDM,270,RC,,HCPCS,outpatient,,,$465.75 ,$349.31 ,,$428.49 ,92,,,$256.16 ,$451.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$256.16 ,55,,,$256.16 ,$451.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$256.16 ,$451.78 ,other,,Not applicable. No negotiated rates per contract,$400.55 ,86,,,$256.16 ,$451.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$372.60 ,80,,,$256.16 ,$451.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$256.16 ,55,,,$256.16 ,$451.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.46 ,95,,,$256.16 ,$451.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$442.46 ,95,,,$256.16 ,$451.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$349.31 ,75,,,$256.16 ,$451.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$395.89 ,85,,,$256.16 ,$451.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$451.78 ,97,,,$256.16 ,$451.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.16 ,55,,,$256.16 ,$451.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$419.18 ,90,,,$256.16 ,$451.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$451.78 ,97,,,$256.16 ,$451.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$451.78 ,97,,,$256.16 ,$451.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$451.78 ,97,,,$256.16 ,$451.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$395.89 ,85,,,$256.16 ,$451.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.18 ,90,,,$256.16 ,$451.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.16 ,55,,,$256.16 ,$451.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.46 ,90,,,$256.16 ,$451.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.16 ,55,,,$256.16 ,$451.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.15 ,93,,,$256.16 ,$451.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CLOTH GLUCONATE 2% CHLORHEXIDINE,8785481,CDM,270,RC,,HCPCS,outpatient,,,$58.08 ,$43.56 ,,$53.43 ,92,,,$31.94 ,$56.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.94 ,$56.34 ,other,,Not applicable. No negotiated rates per contract,$49.95 ,86,,,$31.94 ,$56.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.46 ,80,,,$31.94 ,$56.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.18 ,95,,,$31.94 ,$56.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.18 ,95,,,$31.94 ,$56.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.56 ,75,,,$31.94 ,$56.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.37 ,85,,,$31.94 ,$56.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.27 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.37 ,85,,,$31.94 ,$56.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.27 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.18 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.01 ,93,,,$31.94 ,$56.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COBAN 2 LITE COMPRESSION SYSTEM,9452300,CDM,272,RC,,HCPCS,outpatient,,,$125.63 ,$94.22 ,,$115.58 ,92,,,$69.10 ,$121.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.10 ,55,,,$69.10 ,$121.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.10 ,$121.86 ,other,,Not applicable. No negotiated rates per contract,$108.04 ,86,,,$69.10 ,$121.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$100.50 ,80,,,$69.10 ,$121.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.10 ,55,,,$69.10 ,$121.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.35 ,95,,,$69.10 ,$121.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.35 ,95,,,$69.10 ,$121.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.22 ,75,,,$69.10 ,$121.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$106.79 ,85,,,$69.10 ,$121.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$121.86 ,97,,,$69.10 ,$121.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.10 ,55,,,$69.10 ,$121.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.07 ,90,,,$69.10 ,$121.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.86 ,97,,,$69.10 ,$121.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.86 ,97,,,$69.10 ,$121.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.86 ,97,,,$69.10 ,$121.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.79 ,85,,,$69.10 ,$121.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.07 ,90,,,$69.10 ,$121.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.10 ,55,,,$69.10 ,$121.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.35 ,90,,,$69.10 ,$121.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.10 ,55,,,$69.10 ,$121.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.84 ,93,,,$69.10 ,$121.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COBAN STERILE COBAN 4 X 5,8785485,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COBAN STERILE COBAN 6 X,8785470,CDM,270,RC,,HCPCS,outpatient,,,$80.93 ,$60.70 ,,$74.46 ,92,,,$44.51 ,$78.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.51 ,55,,,$44.51 ,$78.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.51 ,$78.50 ,other,,Not applicable. No negotiated rates per contract,$69.60 ,86,,,$44.51 ,$78.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.74 ,80,,,$44.51 ,$78.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.51 ,55,,,$44.51 ,$78.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.88 ,95,,,$44.51 ,$78.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.88 ,95,,,$44.51 ,$78.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.70 ,75,,,$44.51 ,$78.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.79 ,85,,,$44.51 ,$78.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.50 ,97,,,$44.51 ,$78.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.51 ,55,,,$44.51 ,$78.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.84 ,90,,,$44.51 ,$78.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.50 ,97,,,$44.51 ,$78.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.50 ,97,,,$44.51 ,$78.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.50 ,97,,,$44.51 ,$78.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.79 ,85,,,$44.51 ,$78.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.84 ,90,,,$44.51 ,$78.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.51 ,55,,,$44.51 ,$78.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.88 ,90,,,$44.51 ,$78.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.51 ,55,,,$44.51 ,$78.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.26 ,93,,,$44.51 ,$78.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"COBB ELEVATOR  1"" (28.0C",8783619,CDM,270,RC,,HCPCS,outpatient,,,$589.58 ,$442.19 ,,$542.41 ,92,,,$324.27 ,$571.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$324.27 ,55,,,$324.27 ,$571.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$324.27 ,$571.89 ,other,,Not applicable. No negotiated rates per contract,$507.04 ,86,,,$324.27 ,$571.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$471.66 ,80,,,$324.27 ,$571.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$324.27 ,55,,,$324.27 ,$571.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$560.10 ,95,,,$324.27 ,$571.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$560.10 ,95,,,$324.27 ,$571.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$442.19 ,75,,,$324.27 ,$571.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$501.14 ,85,,,$324.27 ,$571.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$571.89 ,97,,,$324.27 ,$571.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$324.27 ,55,,,$324.27 ,$571.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$530.62 ,90,,,$324.27 ,$571.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$571.89 ,97,,,$324.27 ,$571.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$571.89 ,97,,,$324.27 ,$571.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$571.89 ,97,,,$324.27 ,$571.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$501.14 ,85,,,$324.27 ,$571.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$530.62 ,90,,,$324.27 ,$571.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.27 ,55,,,$324.27 ,$571.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$560.10 ,90,,,$324.27 ,$571.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$324.27 ,55,,,$324.27 ,$571.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$548.31 ,93,,,$324.27 ,$571.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COBB ELEVATOR 25MM 1,8783618,CDM,270,RC,,HCPCS,outpatient,,,$403.44 ,$302.58 ,,$371.16 ,92,,,$221.89 ,$391.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$221.89 ,55,,,$221.89 ,$391.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$221.89 ,$391.34 ,other,,Not applicable. No negotiated rates per contract,$346.96 ,86,,,$221.89 ,$391.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$322.75 ,80,,,$221.89 ,$391.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$221.89 ,55,,,$221.89 ,$391.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.27 ,95,,,$221.89 ,$391.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$383.27 ,95,,,$221.89 ,$391.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.58 ,75,,,$221.89 ,$391.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$342.92 ,85,,,$221.89 ,$391.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.34 ,97,,,$221.89 ,$391.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.89 ,55,,,$221.89 ,$391.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.10 ,90,,,$221.89 ,$391.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.34 ,97,,,$221.89 ,$391.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.34 ,97,,,$221.89 ,$391.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.34 ,97,,,$221.89 ,$391.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$342.92 ,85,,,$221.89 ,$391.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$363.10 ,90,,,$221.89 ,$391.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.89 ,55,,,$221.89 ,$391.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.27 ,90,,,$221.89 ,$391.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$221.89 ,55,,,$221.89 ,$391.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.20 ,93,,,$221.89 ,$391.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CODE BLUE EASI-LAV,8783846,CDM,270,RC,,HCPCS,outpatient,,,$425.38 ,$319.04 ,,$391.35 ,92,,,$233.96 ,$412.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$233.96 ,55,,,$233.96 ,$412.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$233.96 ,$412.62 ,other,,Not applicable. No negotiated rates per contract,$365.83 ,86,,,$233.96 ,$412.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$340.30 ,80,,,$233.96 ,$412.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$233.96 ,55,,,$233.96 ,$412.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.11 ,95,,,$233.96 ,$412.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$404.11 ,95,,,$233.96 ,$412.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$319.04 ,75,,,$233.96 ,$412.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$361.57 ,85,,,$233.96 ,$412.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$412.62 ,97,,,$233.96 ,$412.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.96 ,55,,,$233.96 ,$412.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$382.84 ,90,,,$233.96 ,$412.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$412.62 ,97,,,$233.96 ,$412.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$412.62 ,97,,,$233.96 ,$412.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$412.62 ,97,,,$233.96 ,$412.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$361.57 ,85,,,$233.96 ,$412.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$382.84 ,90,,,$233.96 ,$412.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.96 ,55,,,$233.96 ,$412.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.11 ,90,,,$233.96 ,$412.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.96 ,55,,,$233.96 ,$412.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$395.60 ,93,,,$233.96 ,$412.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COMFORT CARE  CUFF,8786247,CDM,270,RC,,HCPCS,outpatient,,,$213.15 ,$159.86 ,,$196.10 ,92,,,$117.23 ,$206.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$117.23 ,55,,,$117.23 ,$206.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$117.23 ,$206.76 ,other,,Not applicable. No negotiated rates per contract,$183.31 ,86,,,$117.23 ,$206.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$170.52 ,80,,,$117.23 ,$206.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$117.23 ,55,,,$117.23 ,$206.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.49 ,95,,,$117.23 ,$206.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.49 ,95,,,$117.23 ,$206.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$159.86 ,75,,,$117.23 ,$206.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$181.18 ,85,,,$117.23 ,$206.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$206.76 ,97,,,$117.23 ,$206.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.23 ,55,,,$117.23 ,$206.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.84 ,90,,,$117.23 ,$206.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$206.76 ,97,,,$117.23 ,$206.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.76 ,97,,,$117.23 ,$206.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.76 ,97,,,$117.23 ,$206.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.18 ,85,,,$117.23 ,$206.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$191.84 ,90,,,$117.23 ,$206.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.23 ,55,,,$117.23 ,$206.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.49 ,90,,,$117.23 ,$206.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.23 ,55,,,$117.23 ,$206.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.23 ,93,,,$117.23 ,$206.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COMFORT SOFT PLUS CANNULA,8786523,CDM,270,RC,,HCPCS,outpatient,,,$31.94 ,$23.96 ,,$29.38 ,92,,,$17.57 ,$30.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.57 ,$30.98 ,other,,Not applicable. No negotiated rates per contract,$27.47 ,86,,,$17.57 ,$30.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.55 ,80,,,$17.57 ,$30.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.96 ,75,,,$17.57 ,$30.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,93,,,$17.57 ,$30.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COMFORT THUMB WRAP (5567,8786173,CDM,270,RC,,HCPCS,outpatient,,,$94.55 ,$70.91 ,,$86.99 ,92,,,$52.00 ,$91.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.00 ,55,,,$52.00 ,$91.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.00 ,$91.71 ,other,,Not applicable. No negotiated rates per contract,$81.31 ,86,,,$52.00 ,$91.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$75.64 ,80,,,$52.00 ,$91.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.00 ,55,,,$52.00 ,$91.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.82 ,95,,,$52.00 ,$91.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.82 ,95,,,$52.00 ,$91.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.91 ,75,,,$52.00 ,$91.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$80.37 ,85,,,$52.00 ,$91.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.71 ,97,,,$52.00 ,$91.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.00 ,55,,,$52.00 ,$91.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.10 ,90,,,$52.00 ,$91.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.71 ,97,,,$52.00 ,$91.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.71 ,97,,,$52.00 ,$91.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.71 ,97,,,$52.00 ,$91.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.37 ,85,,,$52.00 ,$91.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.10 ,90,,,$52.00 ,$91.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.00 ,55,,,$52.00 ,$91.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.82 ,90,,,$52.00 ,$91.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.00 ,55,,,$52.00 ,$91.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.93 ,93,,,$52.00 ,$91.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COMPRESSION EDEMA GLOVES 4 LEFT SMALL,8786157,CDM,270,RC,,HCPCS,outpatient,,,$48.02 ,$36.02 ,,$44.18 ,92,,,$26.41 ,$46.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.41 ,$46.58 ,other,,Not applicable. No negotiated rates per contract,$41.30 ,86,,,$26.41 ,$46.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.42 ,80,,,$26.41 ,$46.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.02 ,75,,,$26.41 ,$46.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.66 ,93,,,$26.41 ,$46.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COMPRESSION SYSYEM  (COB,8785264,CDM,270,RC,,HCPCS,outpatient,,,$86.65 ,$64.99 ,,$79.72 ,92,,,$47.66 ,$84.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.66 ,55,,,$47.66 ,$84.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.66 ,$84.05 ,other,,Not applicable. No negotiated rates per contract,$74.52 ,86,,,$47.66 ,$84.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.32 ,80,,,$47.66 ,$84.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.66 ,55,,,$47.66 ,$84.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.32 ,95,,,$47.66 ,$84.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.32 ,95,,,$47.66 ,$84.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.99 ,75,,,$47.66 ,$84.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.65 ,85,,,$47.66 ,$84.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.05 ,97,,,$47.66 ,$84.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.66 ,55,,,$47.66 ,$84.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.99 ,90,,,$47.66 ,$84.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.05 ,97,,,$47.66 ,$84.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.05 ,97,,,$47.66 ,$84.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.05 ,97,,,$47.66 ,$84.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.65 ,85,,,$47.66 ,$84.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.99 ,90,,,$47.66 ,$84.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.66 ,55,,,$47.66 ,$84.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.32 ,90,,,$47.66 ,$84.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.66 ,55,,,$47.66 ,$84.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.58 ,93,,,$47.66 ,$84.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"CONEXA 200 3"" X 3""",8786887,CDM,270,RC,,HCPCS,outpatient,,,"$6,771.00 ","$5,078.25 ",,"$6,229.32 ",92,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,724.05 ",55,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,724.05 ","$6,567.87 ",other,,Not applicable. No negotiated rates per contract,"$5,823.06 ",86,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,416.80 ",80,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,724.05 ",55,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,432.45 ",95,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,432.45 ",95,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,078.25 ",75,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,755.35 ",85,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,567.87 ",97,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,724.05 ",55,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,093.90 ",90,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,567.87 ",97,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,567.87 ",97,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,567.87 ",97,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,755.35 ",85,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,093.90 ",90,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,724.05 ",55,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,432.45 ",90,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,724.05 ",55,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,297.03 ",93,,,"$3,724.05 ","$6,567.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
CONTRAST,8782249,CDM,270,RC,,HCPCS,outpatient,,,$43.89 ,$32.92 ,,$40.38 ,92,,,$24.14 ,$42.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.14 ,$42.57 ,other,,Not applicable. No negotiated rates per contract,$37.75 ,86,,,$24.14 ,$42.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.11 ,80,,,$24.14 ,$42.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.70 ,95,,,$24.14 ,$42.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.70 ,95,,,$24.14 ,$42.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.92 ,75,,,$24.14 ,$42.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.31 ,85,,,$24.14 ,$42.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.50 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.31 ,85,,,$24.14 ,$42.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.50 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.70 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.82 ,93,,,$24.14 ,$42.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COOK BAKRI POSTPARTUM BA,8782896,CDM,270,RC,,HCPCS,outpatient,,,"$1,105.00 ",$828.75 ,,"$1,016.60 ",92,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$607.75 ,55,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$607.75 ,"$1,071.85 ",other,,Not applicable. No negotiated rates per contract,$950.30 ,86,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$884.00 ,80,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$607.75 ,55,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,049.75 ",95,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,049.75 ",95,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$828.75 ,75,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$939.25 ,85,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,071.85 ",97,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$607.75 ,55,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$994.50 ,90,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,071.85 ",97,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,071.85 ",97,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,071.85 ",97,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$939.25 ,85,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$994.50 ,90,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$607.75 ,55,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,049.75 ",90,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$607.75 ,55,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,027.65 ",93,,,$607.75 ,"$1,071.85 ",percent of total billed charges,,93% of total billed charges for outpatient setting
COOK ER PNEUMOTHORAX SET,8782893,CDM,270,RC,,HCPCS,outpatient,,,$667.49 ,$500.62 ,,$614.09 ,92,,,$367.12 ,$647.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.12 ,55,,,$367.12 ,$647.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$367.12 ,$647.47 ,other,,Not applicable. No negotiated rates per contract,$574.04 ,86,,,$367.12 ,$647.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$533.99 ,80,,,$367.12 ,$647.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.12 ,55,,,$367.12 ,$647.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$634.12 ,95,,,$367.12 ,$647.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$634.12 ,95,,,$367.12 ,$647.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$500.62 ,75,,,$367.12 ,$647.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$567.37 ,85,,,$367.12 ,$647.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$647.47 ,97,,,$367.12 ,$647.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.12 ,55,,,$367.12 ,$647.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$600.74 ,90,,,$367.12 ,$647.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$647.47 ,97,,,$367.12 ,$647.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$647.47 ,97,,,$367.12 ,$647.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$647.47 ,97,,,$367.12 ,$647.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$567.37 ,85,,,$367.12 ,$647.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$600.74 ,90,,,$367.12 ,$647.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.12 ,55,,,$367.12 ,$647.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$634.12 ,90,,,$367.12 ,$647.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.12 ,55,,,$367.12 ,$647.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$620.77 ,93,,,$367.12 ,$647.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COOK MELKER 5MM ID  EMERGENCY CUFFED,8782895,CDM,270,RC,,HCPCS,outpatient,,,"$1,227.83 ",$920.87 ,,"$1,129.60 ",92,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$675.31 ,55,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$675.31 ,"$1,191.00 ",other,,Not applicable. No negotiated rates per contract,"$1,055.93 ",86,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$982.26 ,80,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$675.31 ,55,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,166.44 ",95,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,166.44 ",95,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$920.87 ,75,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,043.66 ",85,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,191.00 ",97,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$675.31 ,55,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,105.05 ",90,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,191.00 ",97,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,191.00 ",97,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,191.00 ",97,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,043.66 ",85,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,105.05 ",90,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$675.31 ,55,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,166.44 ",90,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$675.31 ,55,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,141.88 ",93,,,$675.31 ,"$1,191.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
COOK MELKER EMERGENCY UNCUFFED CRICOTHYROTOMY  SET 3.8CM/3.5 ID,8782897,CDM,270,RC,,HCPCS,outpatient,,,$938.13 ,$703.60 ,,$863.08 ,92,,,$515.97 ,$909.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$515.97 ,55,,,$515.97 ,$909.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$515.97 ,$909.99 ,other,,Not applicable. No negotiated rates per contract,$806.79 ,86,,,$515.97 ,$909.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$750.50 ,80,,,$515.97 ,$909.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$515.97 ,55,,,$515.97 ,$909.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$891.22 ,95,,,$515.97 ,$909.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$891.22 ,95,,,$515.97 ,$909.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$703.60 ,75,,,$515.97 ,$909.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$797.41 ,85,,,$515.97 ,$909.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$909.99 ,97,,,$515.97 ,$909.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$515.97 ,55,,,$515.97 ,$909.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$844.32 ,90,,,$515.97 ,$909.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$909.99 ,97,,,$515.97 ,$909.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$909.99 ,97,,,$515.97 ,$909.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$909.99 ,97,,,$515.97 ,$909.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$797.41 ,85,,,$515.97 ,$909.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$844.32 ,90,,,$515.97 ,$909.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$515.97 ,55,,,$515.97 ,$909.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$891.22 ,90,,,$515.97 ,$909.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$515.97 ,55,,,$515.97 ,$909.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$872.46 ,93,,,$515.97 ,$909.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COOK MELKER EMERGENCY UNCUFFED CRICOTHYROTOMY  SET 4.2MM/4.0ID,8782898,CDM,270,RC,,HCPCS,outpatient,,,$758.86 ,$569.15 ,,$698.15 ,92,,,$417.37 ,$736.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.37 ,55,,,$417.37 ,$736.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.37 ,$736.09 ,other,,Not applicable. No negotiated rates per contract,$652.62 ,86,,,$417.37 ,$736.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.09 ,80,,,$417.37 ,$736.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.37 ,55,,,$417.37 ,$736.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$720.92 ,95,,,$417.37 ,$736.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$720.92 ,95,,,$417.37 ,$736.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.15 ,75,,,$417.37 ,$736.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.03 ,85,,,$417.37 ,$736.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.09 ,97,,,$417.37 ,$736.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.37 ,55,,,$417.37 ,$736.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$682.97 ,90,,,$417.37 ,$736.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.09 ,97,,,$417.37 ,$736.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.09 ,97,,,$417.37 ,$736.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.09 ,97,,,$417.37 ,$736.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.03 ,85,,,$417.37 ,$736.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$682.97 ,90,,,$417.37 ,$736.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.37 ,55,,,$417.37 ,$736.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$720.92 ,90,,,$417.37 ,$736.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.37 ,55,,,$417.37 ,$736.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.74 ,93,,,$417.37 ,$736.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COPRESSION EDEMA GLOVES 4  RIGHT SMALL,8786156,CDM,270,RC,,HCPCS,outpatient,,,$48.02 ,$36.02 ,,$44.18 ,92,,,$26.41 ,$46.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.41 ,$46.58 ,other,,Not applicable. No negotiated rates per contract,$41.30 ,86,,,$26.41 ,$46.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.42 ,80,,,$26.41 ,$46.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.02 ,75,,,$26.41 ,$46.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.66 ,93,,,$26.41 ,$46.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COPRESSION EDEMA GLOVES 4 RIGHT MEDIUM,8786158,CDM,270,RC,,HCPCS,outpatient,,,$48.02 ,$36.02 ,,$44.18 ,92,,,$26.41 ,$46.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.41 ,$46.58 ,other,,Not applicable. No negotiated rates per contract,$41.30 ,86,,,$26.41 ,$46.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.42 ,80,,,$26.41 ,$46.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.02 ,75,,,$26.41 ,$46.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.66 ,93,,,$26.41 ,$46.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COVER 6177 STERILE RF HE,8784137,CDM,270,RC,,HCPCS,outpatient,,,$116.25 ,$87.19 ,,$106.95 ,92,,,$63.94 ,$112.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.94 ,$112.76 ,other,,Not applicable. No negotiated rates per contract,$99.98 ,86,,,$63.94 ,$112.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$93.00 ,80,,,$63.94 ,$112.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.44 ,95,,,$63.94 ,$112.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.44 ,95,,,$63.94 ,$112.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.19 ,75,,,$63.94 ,$112.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$98.81 ,85,,,$63.94 ,$112.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.63 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.81 ,85,,,$63.94 ,$112.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.63 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.44 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.11 ,93,,,$63.94 ,$112.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
COVER BOOT XLARGE (OR),8785798,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CROWE- DAVIS MOUTH GAG,8786855,CDM,270,RC,,HCPCS,outpatient,,,$59.24 ,$44.43 ,,$54.50 ,92,,,$32.58 ,$57.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.58 ,55,,,$32.58 ,$57.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.58 ,$57.46 ,other,,Not applicable. No negotiated rates per contract,$50.95 ,86,,,$32.58 ,$57.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.39 ,80,,,$32.58 ,$57.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.58 ,55,,,$32.58 ,$57.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.28 ,95,,,$32.58 ,$57.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.28 ,95,,,$32.58 ,$57.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.43 ,75,,,$32.58 ,$57.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.35 ,85,,,$32.58 ,$57.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.46 ,97,,,$32.58 ,$57.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.58 ,55,,,$32.58 ,$57.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.32 ,90,,,$32.58 ,$57.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.46 ,97,,,$32.58 ,$57.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.46 ,97,,,$32.58 ,$57.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.46 ,97,,,$32.58 ,$57.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.35 ,85,,,$32.58 ,$57.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.32 ,90,,,$32.58 ,$57.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.58 ,55,,,$32.58 ,$57.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.28 ,90,,,$32.58 ,$57.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.58 ,55,,,$32.58 ,$57.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.09 ,93,,,$32.58 ,$57.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CT DUAL FLEX SYRINGE KIT W/ T-TUBIDUAL,8782133,CDM,270,RC,,HCPCS,outpatient,,,$101.00 ,$75.75 ,,$92.92 ,92,,,$55.55 ,$97.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.55 ,55,,,$55.55 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.55 ,$97.97 ,other,,Not applicable. No negotiated rates per contract,$86.86 ,86,,,$55.55 ,$97.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.80 ,80,,,$55.55 ,$97.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.55 ,55,,,$55.55 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,95,,,$55.55 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.95 ,95,,,$55.55 ,$97.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.75 ,75,,,$55.55 ,$97.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.85 ,85,,,$55.55 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.97 ,97,,,$55.55 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.55 ,55,,,$55.55 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.90 ,90,,,$55.55 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.97 ,97,,,$55.55 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$55.55 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.97 ,97,,,$55.55 ,$97.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.85 ,85,,,$55.55 ,$97.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.90 ,90,,,$55.55 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$55.55 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.95 ,90,,,$55.55 ,$97.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.55 ,55,,,$55.55 ,$97.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.93 ,93,,,$55.55 ,$97.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CULTURE TEST TUBES,8782605,CDM,270,RC,19020,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CURENT PROCEDURAL CODING,8784796,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CUSHION HEEL ANKLE PROTE,8785503,CDM,270,RC,,HCPCS,outpatient,,,$53.46 ,$40.10 ,,$49.18 ,92,,,$29.40 ,$51.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.40 ,55,,,$29.40 ,$51.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.40 ,$51.86 ,other,,Not applicable. No negotiated rates per contract,$45.98 ,86,,,$29.40 ,$51.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.77 ,80,,,$29.40 ,$51.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.40 ,55,,,$29.40 ,$51.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.79 ,95,,,$29.40 ,$51.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.79 ,95,,,$29.40 ,$51.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.10 ,75,,,$29.40 ,$51.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.44 ,85,,,$29.40 ,$51.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.86 ,97,,,$29.40 ,$51.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.40 ,55,,,$29.40 ,$51.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.11 ,90,,,$29.40 ,$51.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.86 ,97,,,$29.40 ,$51.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.86 ,97,,,$29.40 ,$51.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.86 ,97,,,$29.40 ,$51.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.44 ,85,,,$29.40 ,$51.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.11 ,90,,,$29.40 ,$51.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.40 ,55,,,$29.40 ,$51.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.79 ,90,,,$29.40 ,$51.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.40 ,55,,,$29.40 ,$51.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.72 ,93,,,$29.40 ,$51.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DARCO MEDIUM SLIMLINE CAST BOOT/SHOE,8786170,CDM,270,RC,,HCPCS,outpatient,,,$110.44 ,$82.83 ,,$101.60 ,92,,,$60.74 ,$107.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.74 ,$107.13 ,other,,Not applicable. No negotiated rates per contract,$94.98 ,86,,,$60.74 ,$107.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.35 ,80,,,$60.74 ,$107.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.83 ,75,,,$60.74 ,$107.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.71 ,93,,,$60.74 ,$107.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DARCO XLG SLIMLINE CAST BOOT/SHOES,8786123,CDM,270,RC,,HCPCS,outpatient,,,$110.44 ,$82.83 ,,$101.60 ,92,,,$60.74 ,$107.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.74 ,$107.13 ,other,,Not applicable. No negotiated rates per contract,$94.98 ,86,,,$60.74 ,$107.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.35 ,80,,,$60.74 ,$107.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.83 ,75,,,$60.74 ,$107.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.71 ,93,,,$60.74 ,$107.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DE-MAYO KNEE POSITIONER(,8783722,CDM,270,RC,,HCPCS,outpatient,,,"$15,803.00 ","$11,852.25 ",,"$14,538.76 ",92,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$8,691.65 ",55,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$8,691.65 ","$15,328.91 ",other,,Not applicable. No negotiated rates per contract,"$13,590.58 ",86,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$12,642.40 ",80,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$8,691.65 ",55,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$15,012.85 ",95,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$15,012.85 ",95,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$11,852.25 ",75,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$13,432.55 ",85,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$15,328.91 ",97,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,691.65 ",55,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$14,222.70 ",90,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$15,328.91 ",97,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$15,328.91 ",97,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$15,328.91 ",97,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$13,432.55 ",85,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$14,222.70 ",90,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$8,691.65 ",55,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$15,012.85 ",90,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$8,691.65 ",55,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$14,696.79 ",93,,,"$8,691.65 ","$15,328.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DE-MAYO KNEE POSITIONERS PAD,8783723,CDM,270,RC,,HCPCS,outpatient,,,$250.13 ,$187.60 ,,$230.12 ,92,,,$137.57 ,$242.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$137.57 ,$242.63 ,other,,Not applicable. No negotiated rates per contract,$215.11 ,86,,,$137.57 ,$242.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$200.10 ,80,,,$137.57 ,$242.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$187.60 ,75,,,$137.57 ,$242.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.62 ,93,,,$137.57 ,$242.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES (J&J)  PINNACLE ALTRX POLYETHYLENE ACETABULAR LINER NEUTRAL 36MM ID 56MM OD,9582849,CDM,278,RC,,HCPCS,both,,,"$4,165.00 ","$3,123.75 ",,"$3,831.80 ",92,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,290.75 ",55,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,290.75 ","$4,040.05 ",other,,Not applicable. No negotiated rates per contract,"$3,581.90 ",86,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,332.00 ",80,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,290.75 ",55,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,956.75 ",95,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,956.75 ",95,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,123.75 ",75,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,540.25 ",85,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,040.05 ",97,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,290.75 ",55,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,748.50 ",90,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,040.05 ",97,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,040.05 ",97,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,040.05 ",97,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,540.25 ",85,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,748.50 ",90,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,290.75 ",55,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,956.75 ",90,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,290.75 ",55,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,873.45 ",93,,,"$2,290.75 ","$4,040.05 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES (J&J) BIOLOX DELTA CERMAMIC FEMORAL HEAD +1.5 36MMDIA 12/14TAPER,9582855,CDM,278,RC,,HCPCS,both,,,"$2,762.50 ","$2,071.88 ",,"$2,541.50 ",92,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,519.38 ","$2,679.63 ",other,,Not applicable. No negotiated rates per contract,"$2,375.75 ",86,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,210.00 ",80,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,071.88 ",75,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,569.13 ",93,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES (J&J) FEMORAL STEM 12/14 TAPER ACTIS DUOFIX HIP PROTHESIS CEMENTLESS SZ 8 STD COLLAR,9582853,CDM,278,RC,,HCPCS,both,,,"$6,921.00 ","$5,190.75 ",,"$6,367.32 ",92,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,806.55 ",55,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,806.55 ","$6,713.37 ",other,,Not applicable. No negotiated rates per contract,"$5,952.06 ",86,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,536.80 ",80,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,806.55 ",55,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,574.95 ",95,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,574.95 ",95,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,190.75 ",75,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,882.85 ",85,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,713.37 ",97,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,806.55 ",55,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,228.90 ",90,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,713.37 ",97,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,713.37 ",97,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,713.37 ",97,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,882.85 ",85,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,228.90 ",90,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,806.55 ",55,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,574.95 ",90,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,806.55 ",55,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,436.53 ",93,,,"$3,806.55 ","$6,713.37 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES (J&J) PINNACLE GRIPTON ACETABULAR SHELL 60MM OD,9582851,CDM,278,RC,,HCPCS,both,,,"$4,410.00 ","$3,307.50 ",,"$4,057.20 ",92,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,425.50 ",55,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,425.50 ","$4,277.70 ",other,,Not applicable. No negotiated rates per contract,"$3,792.60 ",86,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,528.00 ",80,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,425.50 ",55,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,189.50 ",95,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,189.50 ",95,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,307.50 ",75,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,748.50 ",85,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,277.70 ",97,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,425.50 ",55,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,969.00 ",90,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,277.70 ",97,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,277.70 ",97,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,277.70 ",97,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,748.50 ",85,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,969.00 ",90,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,425.50 ",55,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,189.50 ",90,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,425.50 ",55,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,101.30 ",93,,,"$2,425.50 ","$4,277.70 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES,9612043,CDM,272,RC,,HCPCS,outpatient,,,$203.58 ,$152.69 ,,$187.29 ,92,,,$111.97 ,$197.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$111.97 ,$197.47 ,other,,Not applicable. No negotiated rates per contract,$175.08 ,86,,,$111.97 ,$197.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.86 ,80,,,$111.97 ,$197.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.40 ,95,,,$111.97 ,$197.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.40 ,95,,,$111.97 ,$197.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.69 ,75,,,$111.97 ,$197.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$173.04 ,85,,,$111.97 ,$197.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.22 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.47 ,97,,,$111.97 ,$197.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.04 ,85,,,$111.97 ,$197.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.22 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.40 ,90,,,$111.97 ,$197.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.97 ,55,,,$111.97 ,$197.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.33 ,93,,,$111.97 ,$197.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES,9612042,CDM,272,RC,,HCPCS,outpatient,,,"$1,769.45 ","$1,327.09 ",,"$1,627.89 ",92,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$973.20 ,55,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$973.20 ,"$1,716.37 ",other,,Not applicable. No negotiated rates per contract,"$1,521.73 ",86,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,415.56 ",80,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$973.20 ,55,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,680.98 ",95,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,680.98 ",95,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,327.09 ",75,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,504.03 ",85,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,716.37 ",97,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$973.20 ,55,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,592.51 ",90,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,716.37 ",97,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,716.37 ",97,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,716.37 ",97,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,504.03 ",85,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,592.51 ",90,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$973.20 ,55,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,680.98 ",90,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$973.20 ,55,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,645.59 ",93,,,$973.20 ,"$1,716.37 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DEPUY SYNTHES/J&J,9612041,CDM,278,RC,C1713,HCPCS,both,,,$823.37 ,$617.53 ,,$757.50 ,92,,,$452.85 ,$798.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$452.85 ,55,,,$452.85 ,$798.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$452.85 ,$798.67 ,other,,Not applicable. No negotiated rates per contract,$708.10 ,86,,,$452.85 ,$798.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$658.70 ,80,,,$452.85 ,$798.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$452.85 ,55,,,$452.85 ,$798.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$782.20 ,95,,,$452.85 ,$798.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$782.20 ,95,,,$452.85 ,$798.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$617.53 ,75,,,$452.85 ,$798.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$699.86 ,85,,,$452.85 ,$798.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$798.67 ,97,,,$452.85 ,$798.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.85 ,55,,,$452.85 ,$798.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$741.03 ,90,,,$452.85 ,$798.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$798.67 ,97,,,$452.85 ,$798.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$798.67 ,97,,,$452.85 ,$798.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$798.67 ,97,,,$452.85 ,$798.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$699.86 ,85,,,$452.85 ,$798.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$741.03 ,90,,,$452.85 ,$798.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.85 ,55,,,$452.85 ,$798.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$782.20 ,90,,,$452.85 ,$798.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.85 ,55,,,$452.85 ,$798.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$765.73 ,93,,,$452.85 ,$798.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DERMABOND PRINEO SKIN CL,8785198,CDM,270,RC,,HCPCS,outpatient,,,$455.81 ,$341.86 ,,$419.35 ,92,,,$250.70 ,$442.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$250.70 ,55,,,$250.70 ,$442.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$250.70 ,$442.14 ,other,,Not applicable. No negotiated rates per contract,$392.00 ,86,,,$250.70 ,$442.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$364.65 ,80,,,$250.70 ,$442.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$250.70 ,55,,,$250.70 ,$442.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.02 ,95,,,$250.70 ,$442.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$433.02 ,95,,,$250.70 ,$442.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$341.86 ,75,,,$250.70 ,$442.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$387.44 ,85,,,$250.70 ,$442.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.14 ,97,,,$250.70 ,$442.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.70 ,55,,,$250.70 ,$442.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.23 ,90,,,$250.70 ,$442.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$442.14 ,97,,,$250.70 ,$442.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.14 ,97,,,$250.70 ,$442.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.14 ,97,,,$250.70 ,$442.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.44 ,85,,,$250.70 ,$442.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$410.23 ,90,,,$250.70 ,$442.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.70 ,55,,,$250.70 ,$442.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.02 ,90,,,$250.70 ,$442.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.70 ,55,,,$250.70 ,$442.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$423.90 ,93,,,$250.70 ,$442.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DEV-O-LOOP DEOV MINI RED,8785344,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIAMOND RASP 45 DEGREE,8786667,CDM,270,RC,,HCPCS,outpatient,,,"$1,962.31 ","$1,471.73 ",,"$1,805.33 ",92,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,079.27 ",55,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,079.27 ","$1,903.44 ",other,,Not applicable. No negotiated rates per contract,"$1,687.59 ",86,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,569.85 ",80,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,079.27 ",55,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,864.19 ",95,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,864.19 ",95,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,471.73 ",75,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,667.96 ",85,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,903.44 ",97,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,079.27 ",55,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,766.08 ",90,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,903.44 ",97,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,903.44 ",97,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,903.44 ",97,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,667.96 ",85,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,766.08 ",90,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,079.27 ",55,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,864.19 ",90,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,079.27 ",55,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,824.95 ",93,,,"$1,079.27 ","$1,903.44 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DIAMOND RASP 90  DEGREE,8786668,CDM,270,RC,,HCPCS,outpatient,,,"$1,012.90 ",$759.68 ,,$931.87 ,92,,,$557.10 ,$982.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$557.10 ,55,,,$557.10 ,$982.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$557.10 ,$982.51 ,other,,Not applicable. No negotiated rates per contract,$871.09 ,86,,,$557.10 ,$982.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$810.32 ,80,,,$557.10 ,$982.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$557.10 ,55,,,$557.10 ,$982.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.26 ,95,,,$557.10 ,$982.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$962.26 ,95,,,$557.10 ,$982.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$759.68 ,75,,,$557.10 ,$982.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$860.97 ,85,,,$557.10 ,$982.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$982.51 ,97,,,$557.10 ,$982.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.10 ,55,,,$557.10 ,$982.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$911.61 ,90,,,$557.10 ,$982.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$982.51 ,97,,,$557.10 ,$982.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.51 ,97,,,$557.10 ,$982.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$982.51 ,97,,,$557.10 ,$982.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$860.97 ,85,,,$557.10 ,$982.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$911.61 ,90,,,$557.10 ,$982.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.10 ,55,,,$557.10 ,$982.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$962.26 ,90,,,$557.10 ,$982.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.10 ,55,,,$557.10 ,$982.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.00 ,93,,,$557.10 ,$982.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIDGITAL FINGER  SPLINT,8787057,CDM,270,RC,51587,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
DIGITAL FINGER  SPLINT,8787055,CDM,270,RC,51585,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIGITAL FINGER  SPLINT,8787059,CDM,270,RC,51589,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIGITAL FINGER  SPLINT,8787060,CDM,270,RC,52557,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIGITAL FINGER SPLINT,8787054,CDM,270,RC,51584,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
DIGITAL FINGER SPLINT,8787056,CDM,270,RC,51586,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DILATION BALLOON18-19-20,8784169,CDM,270,RC,,HCPCS,outpatient,,,$677.25 ,$507.94 ,,$623.07 ,92,,,$372.49 ,$656.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$372.49 ,55,,,$372.49 ,$656.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$372.49 ,$656.93 ,other,,Not applicable. No negotiated rates per contract,$582.44 ,86,,,$372.49 ,$656.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$541.80 ,80,,,$372.49 ,$656.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$372.49 ,55,,,$372.49 ,$656.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$643.39 ,95,,,$372.49 ,$656.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$643.39 ,95,,,$372.49 ,$656.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$507.94 ,75,,,$372.49 ,$656.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$575.66 ,85,,,$372.49 ,$656.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$656.93 ,97,,,$372.49 ,$656.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$372.49 ,55,,,$372.49 ,$656.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$609.53 ,90,,,$372.49 ,$656.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$656.93 ,97,,,$372.49 ,$656.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$656.93 ,97,,,$372.49 ,$656.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$656.93 ,97,,,$372.49 ,$656.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$575.66 ,85,,,$372.49 ,$656.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$609.53 ,90,,,$372.49 ,$656.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$372.49 ,55,,,$372.49 ,$656.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$643.39 ,90,,,$372.49 ,$656.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$372.49 ,55,,,$372.49 ,$656.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.84 ,93,,,$372.49 ,$656.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DIP TUBE FOR SAFE-T PUMP,8782566,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISP. MEDIUM LEG ABDUCTION PILLOW,9181736,CDM,272,RC,,HCPCS,outpatient,,,$308.41 ,$231.31 ,,$283.74 ,92,,,$169.63 ,$299.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$169.63 ,$299.16 ,other,,Not applicable. No negotiated rates per contract,$265.23 ,86,,,$169.63 ,$299.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$246.73 ,80,,,$169.63 ,$299.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.99 ,95,,,$169.63 ,$299.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$292.99 ,95,,,$169.63 ,$299.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.31 ,75,,,$169.63 ,$299.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$262.15 ,85,,,$169.63 ,$299.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.57 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.15 ,85,,,$169.63 ,$299.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.57 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.99 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.82 ,93,,,$169.63 ,$299.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISPENSING PIN,8785739,CDM,270,RC,51732,HCPCS,outpatient,,,$30.45 ,$22.84 ,,$28.01 ,92,,,$16.75 ,$29.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.75 ,$29.54 ,other,,Not applicable. No negotiated rates per contract,$26.19 ,86,,,$16.75 ,$29.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.36 ,80,,,$16.75 ,$29.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.93 ,95,,,$16.75 ,$29.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.93 ,95,,,$16.75 ,$29.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.84 ,75,,,$16.75 ,$29.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.88 ,85,,,$16.75 ,$29.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.41 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.88 ,85,,,$16.75 ,$29.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.41 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.93 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.32 ,93,,,$16.75 ,$29.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISPOSABLE ABDOMINAL BEL,8786266,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISPOSABLE SNARE (OR),8784770,CDM,270,RC,,HCPCS,outpatient,,,$83.16 ,$62.37 ,,$76.51 ,92,,,$45.74 ,$80.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.74 ,55,,,$45.74 ,$80.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.74 ,$80.67 ,other,,Not applicable. No negotiated rates per contract,$71.52 ,86,,,$45.74 ,$80.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$66.53 ,80,,,$45.74 ,$80.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.74 ,55,,,$45.74 ,$80.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.00 ,95,,,$45.74 ,$80.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.00 ,95,,,$45.74 ,$80.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.37 ,75,,,$45.74 ,$80.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$70.69 ,85,,,$45.74 ,$80.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.67 ,97,,,$45.74 ,$80.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.74 ,55,,,$45.74 ,$80.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.84 ,90,,,$45.74 ,$80.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.67 ,97,,,$45.74 ,$80.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.67 ,97,,,$45.74 ,$80.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.67 ,97,,,$45.74 ,$80.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.69 ,85,,,$45.74 ,$80.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.84 ,90,,,$45.74 ,$80.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.74 ,55,,,$45.74 ,$80.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.00 ,90,,,$45.74 ,$80.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.74 ,55,,,$45.74 ,$80.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.34 ,93,,,$45.74 ,$80.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISPOSABLE SUCTION FILTE,8785510,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DISPSABLES KIT FOR DX FI,8942847,CDM,270,RC,,HCPCS,outpatient,,,"$1,302.80 ",$977.10 ,,"$1,198.58 ",92,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$716.54 ,55,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$716.54 ,"$1,263.72 ",other,,Not applicable. No negotiated rates per contract,"$1,120.41 ",86,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,042.24 ",80,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$716.54 ,55,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,237.66 ",95,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,237.66 ",95,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$977.10 ,75,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,107.38 ",85,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,263.72 ",97,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$716.54 ,55,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,172.52 ",90,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,263.72 ",97,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,263.72 ",97,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,263.72 ",97,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,107.38 ",85,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,172.52 ",90,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$716.54 ,55,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,237.66 ",90,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$716.54 ,55,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,211.60 ",93,,,$716.54 ,"$1,263.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DJO,10057489,CDM,270,RC,55659,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
DOCK FOR SURFACE PRO 3,8786030,CDM,270,RC,,HCPCS,outpatient,,,$497.00 ,$372.75 ,,$457.24 ,92,,,$273.35 ,$482.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.35 ,55,,,$273.35 ,$482.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.35 ,$482.09 ,other,,Not applicable. No negotiated rates per contract,$427.42 ,86,,,$273.35 ,$482.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.60 ,80,,,$273.35 ,$482.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.35 ,55,,,$273.35 ,$482.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.15 ,95,,,$273.35 ,$482.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.15 ,95,,,$273.35 ,$482.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.75 ,75,,,$273.35 ,$482.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.45 ,85,,,$273.35 ,$482.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.09 ,97,,,$273.35 ,$482.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.35 ,55,,,$273.35 ,$482.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.30 ,90,,,$273.35 ,$482.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$482.09 ,97,,,$273.35 ,$482.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.09 ,97,,,$273.35 ,$482.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.09 ,97,,,$273.35 ,$482.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.45 ,85,,,$273.35 ,$482.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.30 ,90,,,$273.35 ,$482.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.35 ,55,,,$273.35 ,$482.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.15 ,90,,,$273.35 ,$482.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.35 ,55,,,$273.35 ,$482.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.21 ,93,,,$273.35 ,$482.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAIN 1/4 PENROSE DRAIN,8781941,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAIN FLAT HUBLESS SILIC,8782335,CDM,270,RC,,HCPCS,outpatient,,,$42.96 ,$32.22 ,,$39.52 ,92,,,$23.63 ,$41.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.63 ,$41.67 ,other,,Not applicable. No negotiated rates per contract,$36.95 ,86,,,$23.63 ,$41.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.37 ,80,,,$23.63 ,$41.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.81 ,95,,,$23.63 ,$41.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.81 ,95,,,$23.63 ,$41.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.22 ,75,,,$23.63 ,$41.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.52 ,85,,,$23.63 ,$41.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.66 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.67 ,97,,,$23.63 ,$41.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.52 ,85,,,$23.63 ,$41.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.66 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.81 ,90,,,$23.63 ,$41.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.63 ,55,,,$23.63 ,$41.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.95 ,93,,,$23.63 ,$41.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAINAGE BAG CONTINOUS I,8785021,CDM,270,RC,,HCPCS,outpatient,,,$34.65 ,$25.99 ,,$31.88 ,92,,,$19.06 ,$33.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.06 ,$33.61 ,other,,Not applicable. No negotiated rates per contract,$29.80 ,86,,,$19.06 ,$33.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.72 ,80,,,$19.06 ,$33.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.92 ,95,,,$19.06 ,$33.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.92 ,95,,,$19.06 ,$33.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.99 ,75,,,$19.06 ,$33.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.45 ,85,,,$19.06 ,$33.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.19 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.45 ,85,,,$19.06 ,$33.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.19 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.92 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.22 ,93,,,$19.06 ,$33.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE ARTHOSCOPY W/FLD P,8785338,CDM,270,RC,,HCPCS,outpatient,,,$149.64 ,$112.23 ,,$137.67 ,92,,,$82.30 ,$145.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.30 ,55,,,$82.30 ,$145.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.30 ,$145.15 ,other,,Not applicable. No negotiated rates per contract,$128.69 ,86,,,$82.30 ,$145.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$119.71 ,80,,,$82.30 ,$145.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.30 ,55,,,$82.30 ,$145.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.16 ,95,,,$82.30 ,$145.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.16 ,95,,,$82.30 ,$145.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.23 ,75,,,$82.30 ,$145.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$127.19 ,85,,,$82.30 ,$145.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.15 ,97,,,$82.30 ,$145.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.30 ,55,,,$82.30 ,$145.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.68 ,90,,,$82.30 ,$145.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.15 ,97,,,$82.30 ,$145.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.15 ,97,,,$82.30 ,$145.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.15 ,97,,,$82.30 ,$145.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.19 ,85,,,$82.30 ,$145.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.68 ,90,,,$82.30 ,$145.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.30 ,55,,,$82.30 ,$145.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.16 ,90,,,$82.30 ,$145.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.30 ,55,,,$82.30 ,$145.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.17 ,93,,,$82.30 ,$145.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE C-ARM IMAGE (OR),8785339,CDM,270,RC,,HCPCS,outpatient,,,$59.07 ,$44.30 ,,$54.34 ,92,,,$32.49 ,$57.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.49 ,55,,,$32.49 ,$57.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.49 ,$57.30 ,other,,Not applicable. No negotiated rates per contract,$50.80 ,86,,,$32.49 ,$57.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.26 ,80,,,$32.49 ,$57.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.49 ,55,,,$32.49 ,$57.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.12 ,95,,,$32.49 ,$57.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.12 ,95,,,$32.49 ,$57.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.30 ,75,,,$32.49 ,$57.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.21 ,85,,,$32.49 ,$57.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.30 ,97,,,$32.49 ,$57.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.49 ,55,,,$32.49 ,$57.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.16 ,90,,,$32.49 ,$57.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.30 ,97,,,$32.49 ,$57.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.30 ,97,,,$32.49 ,$57.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.30 ,97,,,$32.49 ,$57.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.21 ,85,,,$32.49 ,$57.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.16 ,90,,,$32.49 ,$57.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.49 ,55,,,$32.49 ,$57.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.12 ,90,,,$32.49 ,$57.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.49 ,55,,,$32.49 ,$57.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.94 ,93,,,$32.49 ,$57.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE INCISE IOBAN  2 (13X13),8785363,CDM,270,RC,,HCPCS,outpatient,,,$30.54 ,$22.91 ,,$28.10 ,92,,,$16.80 ,$29.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.80 ,55,,,$16.80 ,$29.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.80 ,$29.62 ,other,,Not applicable. No negotiated rates per contract,$26.26 ,86,,,$16.80 ,$29.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.43 ,80,,,$16.80 ,$29.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.80 ,55,,,$16.80 ,$29.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.01 ,95,,,$16.80 ,$29.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.01 ,95,,,$16.80 ,$29.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.91 ,75,,,$16.80 ,$29.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.96 ,85,,,$16.80 ,$29.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.62 ,97,,,$16.80 ,$29.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.80 ,55,,,$16.80 ,$29.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.49 ,90,,,$16.80 ,$29.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.62 ,97,,,$16.80 ,$29.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.62 ,97,,,$16.80 ,$29.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.62 ,97,,,$16.80 ,$29.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.96 ,85,,,$16.80 ,$29.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.49 ,90,,,$16.80 ,$29.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.80 ,55,,,$16.80 ,$29.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.01 ,90,,,$16.80 ,$29.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.80 ,55,,,$16.80 ,$29.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.40 ,93,,,$16.80 ,$29.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE INCISE IOBAN 2 ( 23 X 33 in),8785365,CDM,270,RC,,HCPCS,outpatient,,,$77.63 ,$58.22 ,,$71.42 ,92,,,$42.70 ,$75.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.70 ,55,,,$42.70 ,$75.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.70 ,$75.30 ,other,,Not applicable. No negotiated rates per contract,$66.76 ,86,,,$42.70 ,$75.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.10 ,80,,,$42.70 ,$75.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.70 ,55,,,$42.70 ,$75.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.75 ,95,,,$42.70 ,$75.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.75 ,95,,,$42.70 ,$75.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.22 ,75,,,$42.70 ,$75.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.99 ,85,,,$42.70 ,$75.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.30 ,97,,,$42.70 ,$75.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.70 ,55,,,$42.70 ,$75.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.87 ,90,,,$42.70 ,$75.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.30 ,97,,,$42.70 ,$75.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.30 ,97,,,$42.70 ,$75.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.30 ,97,,,$42.70 ,$75.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.99 ,85,,,$42.70 ,$75.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.87 ,90,,,$42.70 ,$75.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.70 ,55,,,$42.70 ,$75.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.75 ,90,,,$42.70 ,$75.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.70 ,55,,,$42.70 ,$75.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,93,,,$42.70 ,$75.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE INCISE IOBAN II 23 X17,8785364,CDM,270,RC,,HCPCS,outpatient,,,$75.32 ,$56.49 ,,$69.29 ,92,,,$41.43 ,$73.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.43 ,$73.06 ,other,,Not applicable. No negotiated rates per contract,$64.78 ,86,,,$41.43 ,$73.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.26 ,80,,,$41.43 ,$73.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.55 ,95,,,$41.43 ,$73.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.55 ,95,,,$41.43 ,$73.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.49 ,75,,,$41.43 ,$73.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.02 ,85,,,$41.43 ,$73.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.79 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,85,,,$41.43 ,$73.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.79 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.55 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.05 ,93,,,$41.43 ,$73.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE INSTRUMENT POUCH 1,8785791,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE LAP STERILE FENSTD,8785475,CDM,270,RC,,HCPCS,outpatient,,,$45.87 ,$34.40 ,,$42.20 ,92,,,$25.23 ,$44.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.23 ,55,,,$25.23 ,$44.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.23 ,$44.49 ,other,,Not applicable. No negotiated rates per contract,$39.45 ,86,,,$25.23 ,$44.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.70 ,80,,,$25.23 ,$44.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.23 ,55,,,$25.23 ,$44.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.58 ,95,,,$25.23 ,$44.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.58 ,95,,,$25.23 ,$44.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.40 ,75,,,$25.23 ,$44.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.99 ,85,,,$25.23 ,$44.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.49 ,97,,,$25.23 ,$44.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.23 ,55,,,$25.23 ,$44.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.28 ,90,,,$25.23 ,$44.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.49 ,97,,,$25.23 ,$44.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.49 ,97,,,$25.23 ,$44.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.49 ,97,,,$25.23 ,$44.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.99 ,85,,,$25.23 ,$44.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.28 ,90,,,$25.23 ,$44.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.23 ,55,,,$25.23 ,$44.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.58 ,90,,,$25.23 ,$44.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.23 ,55,,,$25.23 ,$44.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.66 ,93,,,$25.23 ,$44.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE OR TOWELS,8785516,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE SHEET 3/4,8785313,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE SHEET SPLIT IMPERV,8785658,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE SHOULDER BEACH CHA,8784116,CDM,270,RC,,HCPCS,outpatient,,,$119.04 ,$89.28 ,,$109.52 ,92,,,$65.47 ,$115.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.47 ,55,,,$65.47 ,$115.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.47 ,$115.47 ,other,,Not applicable. No negotiated rates per contract,$102.37 ,86,,,$65.47 ,$115.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.23 ,80,,,$65.47 ,$115.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.47 ,55,,,$65.47 ,$115.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.09 ,95,,,$65.47 ,$115.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.09 ,95,,,$65.47 ,$115.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.28 ,75,,,$65.47 ,$115.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.18 ,85,,,$65.47 ,$115.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.47 ,97,,,$65.47 ,$115.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.47 ,55,,,$65.47 ,$115.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.14 ,90,,,$65.47 ,$115.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.47 ,97,,,$65.47 ,$115.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.47 ,97,,,$65.47 ,$115.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.47 ,97,,,$65.47 ,$115.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.18 ,85,,,$65.47 ,$115.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.14 ,90,,,$65.47 ,$115.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.47 ,55,,,$65.47 ,$115.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.09 ,90,,,$65.47 ,$115.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.47 ,55,,,$65.47 ,$115.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.71 ,93,,,$65.47 ,$115.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE STERI U-DRAPE SURG,8785340,CDM,270,RC,,HCPCS,outpatient,,,$27.21 ,$20.41 ,,$25.03 ,92,,,$14.97 ,$26.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.97 ,$26.39 ,other,,Not applicable. No negotiated rates per contract,$23.40 ,86,,,$14.97 ,$26.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.77 ,80,,,$14.97 ,$26.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.41 ,75,,,$14.97 ,$26.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.31 ,93,,,$14.97 ,$26.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE THYROID  T-DRAPE STERILE  WITH ARMBOARD,8785337,CDM,270,RC,,HCPCS,outpatient,,,$46.78 ,$35.09 ,,$43.04 ,92,,,$25.73 ,$45.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.73 ,$45.38 ,other,,Not applicable. No negotiated rates per contract,$40.23 ,86,,,$25.73 ,$45.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.42 ,80,,,$25.73 ,$45.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.09 ,75,,,$25.73 ,$45.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.51 ,93,,,$25.73 ,$45.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE U SHEET 76 X 120(O,8785482,CDM,270,RC,,HCPCS,outpatient,,,$52.55 ,$39.41 ,,$48.35 ,92,,,$28.90 ,$50.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.90 ,55,,,$28.90 ,$50.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.90 ,$50.97 ,other,,Not applicable. No negotiated rates per contract,$45.19 ,86,,,$28.90 ,$50.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.04 ,80,,,$28.90 ,$50.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.90 ,55,,,$28.90 ,$50.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.92 ,95,,,$28.90 ,$50.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.92 ,95,,,$28.90 ,$50.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.41 ,75,,,$28.90 ,$50.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.67 ,85,,,$28.90 ,$50.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.97 ,97,,,$28.90 ,$50.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.90 ,55,,,$28.90 ,$50.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.30 ,90,,,$28.90 ,$50.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.97 ,97,,,$28.90 ,$50.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.97 ,97,,,$28.90 ,$50.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.97 ,97,,,$28.90 ,$50.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.67 ,85,,,$28.90 ,$50.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.30 ,90,,,$28.90 ,$50.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.90 ,55,,,$28.90 ,$50.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.92 ,90,,,$28.90 ,$50.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.90 ,55,,,$28.90 ,$50.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.87 ,93,,,$28.90 ,$50.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE UTILITY STERILE 26,8785790,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRAPE- UNIV. EXTREMITY,8785476,CDM,270,RC,,HCPCS,outpatient,,,$82.00 ,$61.50 ,,$75.44 ,92,,,$45.10 ,$79.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.10 ,$79.54 ,other,,Not applicable. No negotiated rates per contract,$70.52 ,86,,,$45.10 ,$79.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.60 ,80,,,$45.10 ,$79.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.50 ,75,,,$45.10 ,$79.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.26 ,93,,,$45.10 ,$79.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8786126,CDM,270,RC,,HCPCS,outpatient,,,$81.38 ,$61.04 ,,$74.87 ,92,,,$44.76 ,$78.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.76 ,$78.94 ,other,,Not applicable. No negotiated rates per contract,$69.99 ,86,,,$44.76 ,$78.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.10 ,80,,,$44.76 ,$78.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.31 ,95,,,$44.76 ,$78.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.31 ,95,,,$44.76 ,$78.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.04 ,75,,,$44.76 ,$78.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.17 ,85,,,$44.76 ,$78.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.24 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.94 ,97,,,$44.76 ,$78.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.17 ,85,,,$44.76 ,$78.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.24 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.31 ,90,,,$44.76 ,$78.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.76 ,55,,,$44.76 ,$78.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.68 ,93,,,$44.76 ,$78.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1 IODOFORM GAUZE,8785042,CDM,270,RC,,HCPCS,outpatient,,,$28.09 ,$21.07 ,,$25.84 ,92,,,$15.45 ,$27.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.45 ,$27.25 ,other,,Not applicable. No negotiated rates per contract,$24.16 ,86,,,$15.45 ,$27.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.47 ,80,,,$15.45 ,$27.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.07 ,75,,,$15.45 ,$27.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.12 ,93,,,$15.45 ,$27.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1 PLAIN NUGAUZE,8785031,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1 X 8 VASELINE (23180),8785699,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1 X 8 XEROFORM,8785697,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1/2 IODOFORM GA,8785041,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1/2 PLAIN NUGAUZE,8785030,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"DRESSING 1/2"" IODOFORM GAUZE (MEDLINE)",8942807,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1/4 IODOFORM GA,8785032,CDM,270,RC,,HCPCS,outpatient,,,$32.73 ,$24.55 ,,$30.11 ,92,,,$18.00 ,$31.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.00 ,$31.75 ,other,,Not applicable. No negotiated rates per contract,$28.15 ,86,,,$18.00 ,$31.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.18 ,80,,,$18.00 ,$31.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.09 ,95,,,$18.00 ,$31.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.09 ,95,,,$18.00 ,$31.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.55 ,75,,,$18.00 ,$31.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.82 ,85,,,$18.00 ,$31.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.46 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.75 ,97,,,$18.00 ,$31.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.82 ,85,,,$18.00 ,$31.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.46 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.09 ,90,,,$18.00 ,$31.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.00 ,55,,,$18.00 ,$31.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.44 ,93,,,$18.00 ,$31.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1/4 IODOFORM GAUZE (MEDLINE),8942805,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 1/4 PLAIN NUGAUZE,8785029,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 2 X 2.75 COMFEEL(33530),8785315,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 3 ELASTOPLAST (02595002),8785133,CDM,270,RC,,HCPCS,outpatient,,,$58.33 ,$43.75 ,,$53.66 ,92,,,$32.08 ,$56.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.08 ,55,,,$32.08 ,$56.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.08 ,$56.58 ,other,,Not applicable. No negotiated rates per contract,$50.16 ,86,,,$32.08 ,$56.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.66 ,80,,,$32.08 ,$56.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.08 ,55,,,$32.08 ,$56.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.41 ,95,,,$32.08 ,$56.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.41 ,95,,,$32.08 ,$56.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.75 ,75,,,$32.08 ,$56.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.58 ,85,,,$32.08 ,$56.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.58 ,97,,,$32.08 ,$56.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.08 ,55,,,$32.08 ,$56.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.50 ,90,,,$32.08 ,$56.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.58 ,97,,,$32.08 ,$56.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.58 ,97,,,$32.08 ,$56.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.58 ,97,,,$32.08 ,$56.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.58 ,85,,,$32.08 ,$56.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.50 ,90,,,$32.08 ,$56.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.08 ,55,,,$32.08 ,$56.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.41 ,90,,,$32.08 ,$56.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.08 ,55,,,$32.08 ,$56.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.25 ,93,,,$32.08 ,$56.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 3 X 8 ADAPTIC,8785596,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 4 X 4 DUODERM,8785501,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 4 X 4 TEGADERM,8785754,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 4 X 5 ISLAND,8785543,CDM,270,RC,,HCPCS,outpatient,,,$28.53 ,$21.40 ,,$26.25 ,92,,,$15.69 ,$27.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.69 ,55,,,$15.69 ,$27.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.69 ,$27.67 ,other,,Not applicable. No negotiated rates per contract,$24.54 ,86,,,$15.69 ,$27.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.82 ,80,,,$15.69 ,$27.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.69 ,55,,,$15.69 ,$27.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.10 ,95,,,$15.69 ,$27.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.10 ,95,,,$15.69 ,$27.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.40 ,75,,,$15.69 ,$27.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.25 ,85,,,$15.69 ,$27.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.67 ,97,,,$15.69 ,$27.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.69 ,55,,,$15.69 ,$27.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.68 ,90,,,$15.69 ,$27.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.67 ,97,,,$15.69 ,$27.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.67 ,97,,,$15.69 ,$27.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.67 ,97,,,$15.69 ,$27.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,85,,,$15.69 ,$27.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.68 ,90,,,$15.69 ,$27.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.69 ,55,,,$15.69 ,$27.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.10 ,90,,,$15.69 ,$27.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.69 ,55,,,$15.69 ,$27.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.53 ,93,,,$15.69 ,$27.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 4 X4 COMFEEL,8785316,CDM,270,RC,,HCPCS,outpatient,,,$25.81 ,$19.36 ,,$23.75 ,92,,,$14.20 ,$25.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.20 ,$25.04 ,other,,Not applicable. No negotiated rates per contract,$22.20 ,86,,,$14.20 ,$25.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.65 ,80,,,$14.20 ,$25.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.36 ,75,,,$14.20 ,$25.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.00 ,93,,,$14.20 ,$25.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 4.5 KERLIX,8785789,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 5 X 9 XEROFORM,8784926,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 5X9 XEROFLO GAU,8785428,CDM,270,RC,,HCPCS,outpatient,,,$30.01 ,$22.51 ,,$27.61 ,92,,,$16.51 ,$29.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.51 ,$29.11 ,other,,Not applicable. No negotiated rates per contract,$25.81 ,86,,,$16.51 ,$29.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.01 ,80,,,$16.51 ,$29.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.51 ,75,,,$16.51 ,$29.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.91 ,93,,,$16.51 ,$29.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 6 ELASTOPLAST TENSOPLAST,8785134,CDM,270,RC,,HCPCS,outpatient,,,$100.83 ,$75.62 ,,$92.76 ,92,,,$55.46 ,$97.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.46 ,$97.81 ,other,,Not applicable. No negotiated rates per contract,$86.71 ,86,,,$55.46 ,$97.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.66 ,80,,,$55.46 ,$97.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.79 ,95,,,$55.46 ,$97.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.79 ,95,,,$55.46 ,$97.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.62 ,75,,,$55.46 ,$97.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.71 ,85,,,$55.46 ,$97.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.75 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.71 ,85,,,$55.46 ,$97.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.75 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.79 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.77 ,93,,,$55.46 ,$97.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 6 X 36 VASELINE (8884416600),8785467,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 6 X 8 TEGADERM,8785306,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING 8 X 12 TEGADERM,8785307,CDM,270,RC,,HCPCS,outpatient,,,$28.79 ,$21.59 ,,$26.49 ,92,,,$15.83 ,$27.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.83 ,$27.93 ,other,,Not applicable. No negotiated rates per contract,$24.76 ,86,,,$15.83 ,$27.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.03 ,80,,,$15.83 ,$27.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.35 ,95,,,$15.83 ,$27.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.35 ,95,,,$15.83 ,$27.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.59 ,75,,,$15.83 ,$27.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.47 ,85,,,$15.83 ,$27.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.91 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.47 ,85,,,$15.83 ,$27.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.91 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.35 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.77 ,93,,,$15.83 ,$27.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING ACTICOAT FLEX 7 RIBBON 1 X24,9144064,CDM,270,RC,,HCPCS,outpatient,,,$175.02 ,$131.27 ,,$161.02 ,92,,,$96.26 ,$169.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.26 ,$169.77 ,other,,Not applicable. No negotiated rates per contract,$150.52 ,86,,,$96.26 ,$169.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.02 ,80,,,$96.26 ,$169.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.27 ,75,,,$96.26 ,$169.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.77 ,93,,,$96.26 ,$169.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING ACTICOAT FLEX/7 (66800403),8784072,CDM,270,RC,,HCPCS,outpatient,,,$145.39 ,$109.04 ,,$133.76 ,92,,,$79.96 ,$141.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.96 ,55,,,$79.96 ,$141.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$79.96 ,$141.03 ,other,,Not applicable. No negotiated rates per contract,$125.04 ,86,,,$79.96 ,$141.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.31 ,80,,,$79.96 ,$141.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.96 ,55,,,$79.96 ,$141.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.12 ,95,,,$79.96 ,$141.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.12 ,95,,,$79.96 ,$141.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.04 ,75,,,$79.96 ,$141.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$123.58 ,85,,,$79.96 ,$141.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.03 ,97,,,$79.96 ,$141.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.96 ,55,,,$79.96 ,$141.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$130.85 ,90,,,$79.96 ,$141.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.03 ,97,,,$79.96 ,$141.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.03 ,97,,,$79.96 ,$141.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.03 ,97,,,$79.96 ,$141.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.58 ,85,,,$79.96 ,$141.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$130.85 ,90,,,$79.96 ,$141.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.96 ,55,,,$79.96 ,$141.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.12 ,90,,,$79.96 ,$141.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.96 ,55,,,$79.96 ,$141.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.21 ,93,,,$79.96 ,$141.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING ADAPTIC NON- ADHERING DRESSING,8785534,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING ALLEVYN HEEL CUP 4 1/2 X 5 1/2 INCH,8942849,CDM,270,RC,,HCPCS,outpatient,,,$63.53 ,$47.65 ,,$58.45 ,92,,,$34.94 ,$61.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.94 ,55,,,$34.94 ,$61.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$34.94 ,$61.62 ,other,,Not applicable. No negotiated rates per contract,$54.64 ,86,,,$34.94 ,$61.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$50.82 ,80,,,$34.94 ,$61.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.94 ,55,,,$34.94 ,$61.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.35 ,95,,,$34.94 ,$61.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.35 ,95,,,$34.94 ,$61.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.65 ,75,,,$34.94 ,$61.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$54.00 ,85,,,$34.94 ,$61.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.62 ,97,,,$34.94 ,$61.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.94 ,55,,,$34.94 ,$61.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.18 ,90,,,$34.94 ,$61.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.62 ,97,,,$34.94 ,$61.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.62 ,97,,,$34.94 ,$61.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.62 ,97,,,$34.94 ,$61.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.00 ,85,,,$34.94 ,$61.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.18 ,90,,,$34.94 ,$61.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.94 ,55,,,$34.94 ,$61.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.35 ,90,,,$34.94 ,$61.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.94 ,55,,,$34.94 ,$61.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.08 ,93,,,$34.94 ,$61.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"DRESSING ALLEVYN LIFE 5 3/4"" X 5 3/4""",8785346,CDM,270,RC,,HCPCS,outpatient,,,$33.43 ,$25.07 ,,$30.76 ,92,,,$18.39 ,$32.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.39 ,55,,,$18.39 ,$32.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.39 ,$32.43 ,other,,Not applicable. No negotiated rates per contract,$28.75 ,86,,,$18.39 ,$32.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.74 ,80,,,$18.39 ,$32.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.39 ,55,,,$18.39 ,$32.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.76 ,95,,,$18.39 ,$32.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.76 ,95,,,$18.39 ,$32.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.07 ,75,,,$18.39 ,$32.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.42 ,85,,,$18.39 ,$32.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.43 ,97,,,$18.39 ,$32.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.39 ,55,,,$18.39 ,$32.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.09 ,90,,,$18.39 ,$32.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.43 ,97,,,$18.39 ,$32.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.43 ,97,,,$18.39 ,$32.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.43 ,97,,,$18.39 ,$32.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.42 ,85,,,$18.39 ,$32.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.09 ,90,,,$18.39 ,$32.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.39 ,55,,,$18.39 ,$32.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.76 ,90,,,$18.39 ,$32.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.39 ,55,,,$18.39 ,$32.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.09 ,93,,,$18.39 ,$32.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING AQUACEL AG SILVER HYDROFIBER 3/4 X 18INCH,9087622,CDM,270,RC,,HCPCS,outpatient,,,$79.45 ,$59.59 ,,$73.09 ,92,,,$43.70 ,$77.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.70 ,55,,,$43.70 ,$77.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.70 ,$77.07 ,other,,Not applicable. No negotiated rates per contract,$68.33 ,86,,,$43.70 ,$77.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.56 ,80,,,$43.70 ,$77.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.70 ,55,,,$43.70 ,$77.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.48 ,95,,,$43.70 ,$77.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.48 ,95,,,$43.70 ,$77.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.59 ,75,,,$43.70 ,$77.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.53 ,85,,,$43.70 ,$77.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.07 ,97,,,$43.70 ,$77.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.70 ,55,,,$43.70 ,$77.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.51 ,90,,,$43.70 ,$77.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.07 ,97,,,$43.70 ,$77.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.07 ,97,,,$43.70 ,$77.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.07 ,97,,,$43.70 ,$77.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.53 ,85,,,$43.70 ,$77.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.51 ,90,,,$43.70 ,$77.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.70 ,55,,,$43.70 ,$77.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.48 ,90,,,$43.70 ,$77.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.70 ,55,,,$43.70 ,$77.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.89 ,93,,,$43.70 ,$77.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING AQUACEL AG SURGICAL,8785318,CDM,270,RC,,HCPCS,outpatient,,,$278.76 ,$209.07 ,,$256.46 ,92,,,$153.32 ,$270.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.32 ,55,,,$153.32 ,$270.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.32 ,$270.40 ,other,,Not applicable. No negotiated rates per contract,$239.73 ,86,,,$153.32 ,$270.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.01 ,80,,,$153.32 ,$270.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.32 ,55,,,$153.32 ,$270.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.82 ,95,,,$153.32 ,$270.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.82 ,95,,,$153.32 ,$270.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.07 ,75,,,$153.32 ,$270.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$236.95 ,85,,,$153.32 ,$270.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$270.40 ,97,,,$153.32 ,$270.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.32 ,55,,,$153.32 ,$270.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.88 ,90,,,$153.32 ,$270.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.40 ,97,,,$153.32 ,$270.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.40 ,97,,,$153.32 ,$270.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.40 ,97,,,$153.32 ,$270.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.95 ,85,,,$153.32 ,$270.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.88 ,90,,,$153.32 ,$270.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.32 ,55,,,$153.32 ,$270.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.82 ,90,,,$153.32 ,$270.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.32 ,55,,,$153.32 ,$270.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.25 ,93,,,$153.32 ,$270.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING AQUACEL EXTRA AG,8785320,CDM,270,RC,,HCPCS,outpatient,,,$84.01 ,$63.01 ,,$77.29 ,92,,,$46.21 ,$81.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.21 ,55,,,$46.21 ,$81.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.21 ,$81.49 ,other,,Not applicable. No negotiated rates per contract,$72.25 ,86,,,$46.21 ,$81.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$67.21 ,80,,,$46.21 ,$81.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.21 ,55,,,$46.21 ,$81.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.81 ,95,,,$46.21 ,$81.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.81 ,95,,,$46.21 ,$81.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.01 ,75,,,$46.21 ,$81.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$71.41 ,85,,,$46.21 ,$81.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.49 ,97,,,$46.21 ,$81.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.21 ,55,,,$46.21 ,$81.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.61 ,90,,,$46.21 ,$81.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.49 ,97,,,$46.21 ,$81.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.49 ,97,,,$46.21 ,$81.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.49 ,97,,,$46.21 ,$81.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.41 ,85,,,$46.21 ,$81.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.61 ,90,,,$46.21 ,$81.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.21 ,55,,,$46.21 ,$81.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.81 ,90,,,$46.21 ,$81.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.21 ,55,,,$46.21 ,$81.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.13 ,93,,,$46.21 ,$81.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING AQUACEL EXTRA H,8785319,CDM,270,RC,,HCPCS,outpatient,,,$63.36 ,$47.52 ,,$58.29 ,92,,,$34.85 ,$61.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.85 ,55,,,$34.85 ,$61.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$34.85 ,$61.46 ,other,,Not applicable. No negotiated rates per contract,$54.49 ,86,,,$34.85 ,$61.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$50.69 ,80,,,$34.85 ,$61.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.85 ,55,,,$34.85 ,$61.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.19 ,95,,,$34.85 ,$61.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.19 ,95,,,$34.85 ,$61.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.52 ,75,,,$34.85 ,$61.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$53.86 ,85,,,$34.85 ,$61.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.46 ,97,,,$34.85 ,$61.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.85 ,55,,,$34.85 ,$61.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.02 ,90,,,$34.85 ,$61.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.46 ,97,,,$34.85 ,$61.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.46 ,97,,,$34.85 ,$61.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.46 ,97,,,$34.85 ,$61.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.86 ,85,,,$34.85 ,$61.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.02 ,90,,,$34.85 ,$61.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.85 ,55,,,$34.85 ,$61.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.19 ,90,,,$34.85 ,$61.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.85 ,55,,,$34.85 ,$61.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.92 ,93,,,$34.85 ,$61.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING BIOPATCH (DISC) WHITE 1 INCH DISK W/ 4.0MM,8961858,CDM,270,RC,,HCPCS,outpatient,,,$37.36 ,$28.02 ,,$34.37 ,92,,,$20.55 ,$36.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.55 ,$36.24 ,other,,Not applicable. No negotiated rates per contract,$32.13 ,86,,,$20.55 ,$36.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.89 ,80,,,$20.55 ,$36.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.49 ,95,,,$20.55 ,$36.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.49 ,95,,,$20.55 ,$36.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.02 ,75,,,$20.55 ,$36.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.76 ,85,,,$20.55 ,$36.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.62 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.76 ,85,,,$20.55 ,$36.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.62 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.49 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.74 ,93,,,$20.55 ,$36.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING BORDER MEPILEX 3 X 3 ADH THIN (HH),8785220,CDM,270,RC,,HCPCS,outpatient,,,$89.82 ,$67.37 ,,$82.63 ,92,,,$49.40 ,$87.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.40 ,55,,,$49.40 ,$87.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.40 ,$87.13 ,other,,Not applicable. No negotiated rates per contract,$77.25 ,86,,,$49.40 ,$87.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.86 ,80,,,$49.40 ,$87.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.40 ,55,,,$49.40 ,$87.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.33 ,95,,,$49.40 ,$87.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.33 ,95,,,$49.40 ,$87.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.37 ,75,,,$49.40 ,$87.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$76.35 ,85,,,$49.40 ,$87.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.13 ,97,,,$49.40 ,$87.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.40 ,55,,,$49.40 ,$87.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.84 ,90,,,$49.40 ,$87.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.13 ,97,,,$49.40 ,$87.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.13 ,97,,,$49.40 ,$87.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.13 ,97,,,$49.40 ,$87.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.35 ,85,,,$49.40 ,$87.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.84 ,90,,,$49.40 ,$87.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.40 ,55,,,$49.40 ,$87.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.33 ,90,,,$49.40 ,$87.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.40 ,55,,,$49.40 ,$87.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.53 ,93,,,$49.40 ,$87.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING BORDER MEPILEX 4 X4 (HH),8785222,CDM,270,RC,,HCPCS,outpatient,,,$41.83 ,$31.37 ,,$38.48 ,92,,,$23.01 ,$40.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.01 ,55,,,$23.01 ,$40.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.01 ,$40.58 ,other,,Not applicable. No negotiated rates per contract,$35.97 ,86,,,$23.01 ,$40.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.46 ,80,,,$23.01 ,$40.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.01 ,55,,,$23.01 ,$40.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.74 ,95,,,$23.01 ,$40.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.74 ,95,,,$23.01 ,$40.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.37 ,75,,,$23.01 ,$40.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.56 ,85,,,$23.01 ,$40.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.58 ,97,,,$23.01 ,$40.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.01 ,55,,,$23.01 ,$40.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.65 ,90,,,$23.01 ,$40.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.58 ,97,,,$23.01 ,$40.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.58 ,97,,,$23.01 ,$40.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.58 ,97,,,$23.01 ,$40.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.56 ,85,,,$23.01 ,$40.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.65 ,90,,,$23.01 ,$40.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.01 ,55,,,$23.01 ,$40.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.74 ,90,,,$23.01 ,$40.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.01 ,55,,,$23.01 ,$40.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.90 ,93,,,$23.01 ,$40.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING CURITY   SINGLE SHEET  3 X8 NON- ADHERING DRESSING,9570455,CDM,272,RC,,HCPCS,outpatient,,,$26.00 ,$19.50 ,,$23.92 ,92,,,$14.30 ,$25.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.30 ,55,,,$14.30 ,$25.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.30 ,$25.22 ,other,,Not applicable. No negotiated rates per contract,$22.36 ,86,,,$14.30 ,$25.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.80 ,80,,,$14.30 ,$25.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.30 ,55,,,$14.30 ,$25.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,95,,,$14.30 ,$25.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.70 ,95,,,$14.30 ,$25.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.50 ,75,,,$14.30 ,$25.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.10 ,85,,,$14.30 ,$25.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.22 ,97,,,$14.30 ,$25.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.30 ,55,,,$14.30 ,$25.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.40 ,90,,,$14.30 ,$25.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.22 ,97,,,$14.30 ,$25.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$14.30 ,$25.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.22 ,97,,,$14.30 ,$25.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.10 ,85,,,$14.30 ,$25.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.40 ,90,,,$14.30 ,$25.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.30 ,55,,,$14.30 ,$25.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.70 ,90,,,$14.30 ,$25.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.30 ,55,,,$14.30 ,$25.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.18 ,93,,,$14.30 ,$25.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING CURITY NON-ADHESIVE,8785595,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING DUODERM EXTRA T,8785317,CDM,270,RC,,HCPCS,outpatient,,,$41.99 ,$31.49 ,,$38.63 ,92,,,$23.09 ,$40.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.09 ,$40.73 ,other,,Not applicable. No negotiated rates per contract,$36.11 ,86,,,$23.09 ,$40.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.59 ,80,,,$23.09 ,$40.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.89 ,95,,,$23.09 ,$40.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.89 ,95,,,$23.09 ,$40.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.49 ,75,,,$23.09 ,$40.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.69 ,85,,,$23.09 ,$40.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.79 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.69 ,85,,,$23.09 ,$40.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.79 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.89 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.05 ,93,,,$23.09 ,$40.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING EXU-DRY 4 X6 (5999004120),8782515,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING FOAM STERILE 5,8782517,CDM,270,RC,,HCPCS,outpatient,,,$79.67 ,$59.75 ,,$73.30 ,92,,,$43.82 ,$77.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.82 ,55,,,$43.82 ,$77.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.82 ,$77.28 ,other,,Not applicable. No negotiated rates per contract,$68.52 ,86,,,$43.82 ,$77.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.74 ,80,,,$43.82 ,$77.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.82 ,55,,,$43.82 ,$77.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.69 ,95,,,$43.82 ,$77.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.69 ,95,,,$43.82 ,$77.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.75 ,75,,,$43.82 ,$77.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.72 ,85,,,$43.82 ,$77.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.28 ,97,,,$43.82 ,$77.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.82 ,55,,,$43.82 ,$77.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.70 ,90,,,$43.82 ,$77.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.28 ,97,,,$43.82 ,$77.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.28 ,97,,,$43.82 ,$77.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.28 ,97,,,$43.82 ,$77.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.72 ,85,,,$43.82 ,$77.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.70 ,90,,,$43.82 ,$77.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.82 ,55,,,$43.82 ,$77.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.69 ,90,,,$43.82 ,$77.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.82 ,55,,,$43.82 ,$77.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.09 ,93,,,$43.82 ,$77.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING FOAM TEGADERM HIGH PED,8784075,CDM,270,RC,,HCPCS,outpatient,,,$39.38 ,$29.54 ,,$36.23 ,92,,,$21.66 ,$38.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.66 ,55,,,$21.66 ,$38.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.66 ,$38.20 ,other,,Not applicable. No negotiated rates per contract,$33.87 ,86,,,$21.66 ,$38.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.50 ,80,,,$21.66 ,$38.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.66 ,55,,,$21.66 ,$38.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.41 ,95,,,$21.66 ,$38.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.41 ,95,,,$21.66 ,$38.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.54 ,75,,,$21.66 ,$38.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.47 ,85,,,$21.66 ,$38.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.20 ,97,,,$21.66 ,$38.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.66 ,55,,,$21.66 ,$38.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.44 ,90,,,$21.66 ,$38.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.20 ,97,,,$21.66 ,$38.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.20 ,97,,,$21.66 ,$38.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.20 ,97,,,$21.66 ,$38.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.47 ,85,,,$21.66 ,$38.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.44 ,90,,,$21.66 ,$38.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.66 ,55,,,$21.66 ,$38.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.41 ,90,,,$21.66 ,$38.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.66 ,55,,,$21.66 ,$38.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.62 ,93,,,$21.66 ,$38.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING LIGHT BORDER ME,8785300,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING MEPILEX FOAM AG,8785221,CDM,270,RC,,HCPCS,outpatient,,,$123.92 ,$92.94 ,,$114.01 ,92,,,$68.16 ,$120.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.16 ,55,,,$68.16 ,$120.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.16 ,$120.20 ,other,,Not applicable. No negotiated rates per contract,$106.57 ,86,,,$68.16 ,$120.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$99.14 ,80,,,$68.16 ,$120.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.16 ,55,,,$68.16 ,$120.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.72 ,95,,,$68.16 ,$120.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.72 ,95,,,$68.16 ,$120.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.94 ,75,,,$68.16 ,$120.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.33 ,85,,,$68.16 ,$120.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.20 ,97,,,$68.16 ,$120.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.16 ,55,,,$68.16 ,$120.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.53 ,90,,,$68.16 ,$120.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.20 ,97,,,$68.16 ,$120.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.20 ,97,,,$68.16 ,$120.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.20 ,97,,,$68.16 ,$120.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.33 ,85,,,$68.16 ,$120.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.53 ,90,,,$68.16 ,$120.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.16 ,55,,,$68.16 ,$120.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.72 ,90,,,$68.16 ,$120.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.16 ,55,,,$68.16 ,$120.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.25 ,93,,,$68.16 ,$120.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING MEPILEX FOAM AG ANTI. 6 X6(287300),8942801,CDM,270,RC,,HCPCS,outpatient,,,$143.92 ,$107.94 ,,$132.41 ,92,,,$79.16 ,$139.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.16 ,55,,,$79.16 ,$139.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$79.16 ,$139.60 ,other,,Not applicable. No negotiated rates per contract,$123.77 ,86,,,$79.16 ,$139.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$115.14 ,80,,,$79.16 ,$139.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.16 ,55,,,$79.16 ,$139.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.72 ,95,,,$79.16 ,$139.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$136.72 ,95,,,$79.16 ,$139.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$107.94 ,75,,,$79.16 ,$139.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.33 ,85,,,$79.16 ,$139.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.60 ,97,,,$79.16 ,$139.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.16 ,55,,,$79.16 ,$139.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.53 ,90,,,$79.16 ,$139.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.60 ,97,,,$79.16 ,$139.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.60 ,97,,,$79.16 ,$139.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.60 ,97,,,$79.16 ,$139.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.33 ,85,,,$79.16 ,$139.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.53 ,90,,,$79.16 ,$139.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.16 ,55,,,$79.16 ,$139.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.72 ,90,,,$79.16 ,$139.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.16 ,55,,,$79.16 ,$139.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.85 ,93,,,$79.16 ,$139.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING OPTIFOAM ADHESI,8785361,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING OPTIFOAM GENTLE,8784119,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING PRISMA MATRIX 4,8785381,CDM,270,RC,,HCPCS,outpatient,,,$70.04 ,$52.53 ,,$64.44 ,92,,,$38.52 ,$67.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.52 ,$67.94 ,other,,Not applicable. No negotiated rates per contract,$60.23 ,86,,,$38.52 ,$67.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.03 ,80,,,$38.52 ,$67.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.54 ,95,,,$38.52 ,$67.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.54 ,95,,,$38.52 ,$67.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.53 ,75,,,$38.52 ,$67.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.53 ,85,,,$38.52 ,$67.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.04 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.53 ,85,,,$38.52 ,$67.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.04 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.54 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.14 ,93,,,$38.52 ,$67.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING PRISMA MATRIX 4.75 SQ INCH,8785382,CDM,270,RC,,HCPCS,outpatient,,,$70.04 ,$52.53 ,,$64.44 ,92,,,$38.52 ,$67.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.52 ,$67.94 ,other,,Not applicable. No negotiated rates per contract,$60.23 ,86,,,$38.52 ,$67.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.03 ,80,,,$38.52 ,$67.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.54 ,95,,,$38.52 ,$67.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.54 ,95,,,$38.52 ,$67.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.53 ,75,,,$38.52 ,$67.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.53 ,85,,,$38.52 ,$67.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.04 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.94 ,97,,,$38.52 ,$67.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.53 ,85,,,$38.52 ,$67.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.04 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.54 ,90,,,$38.52 ,$67.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.52 ,55,,,$38.52 ,$67.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.14 ,93,,,$38.52 ,$67.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING SORBAVIEW 2000,8782479,CDM,270,RC,,HCPCS,outpatient,,,$46.20 ,$34.65 ,,$42.50 ,92,,,$25.41 ,$44.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.41 ,$44.81 ,other,,Not applicable. No negotiated rates per contract,$39.73 ,86,,,$25.41 ,$44.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.96 ,80,,,$25.41 ,$44.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,95,,,$25.41 ,$44.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.89 ,95,,,$25.41 ,$44.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.65 ,75,,,$25.41 ,$44.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.27 ,85,,,$25.41 ,$44.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.58 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.27 ,85,,,$25.41 ,$44.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.58 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.97 ,93,,,$25.41 ,$44.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING TIELLE MAX 4-1/,8785761,CDM,270,RC,,HCPCS,outpatient,,,$41.33 ,$31.00 ,,$38.02 ,92,,,$22.73 ,$40.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.73 ,55,,,$22.73 ,$40.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.73 ,$40.09 ,other,,Not applicable. No negotiated rates per contract,$35.54 ,86,,,$22.73 ,$40.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.06 ,80,,,$22.73 ,$40.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.73 ,55,,,$22.73 ,$40.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.26 ,95,,,$22.73 ,$40.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.26 ,95,,,$22.73 ,$40.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.00 ,75,,,$22.73 ,$40.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.13 ,85,,,$22.73 ,$40.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.09 ,97,,,$22.73 ,$40.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.73 ,55,,,$22.73 ,$40.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.20 ,90,,,$22.73 ,$40.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.09 ,97,,,$22.73 ,$40.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.09 ,97,,,$22.73 ,$40.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.09 ,97,,,$22.73 ,$40.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.13 ,85,,,$22.73 ,$40.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.20 ,90,,,$22.73 ,$40.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.73 ,55,,,$22.73 ,$40.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.26 ,90,,,$22.73 ,$40.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.73 ,55,,,$22.73 ,$40.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.44 ,93,,,$22.73 ,$40.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"DRESSING TRAUMA 10"" x 30""",8783012,CDM,270,RC,,HCPCS,outpatient,,,$28.18 ,$21.14 ,,$25.93 ,92,,,$15.50 ,$27.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.50 ,55,,,$15.50 ,$27.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.50 ,$27.33 ,other,,Not applicable. No negotiated rates per contract,$24.23 ,86,,,$15.50 ,$27.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.54 ,80,,,$15.50 ,$27.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.50 ,55,,,$15.50 ,$27.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.77 ,95,,,$15.50 ,$27.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.77 ,95,,,$15.50 ,$27.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.14 ,75,,,$15.50 ,$27.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.95 ,85,,,$15.50 ,$27.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.33 ,97,,,$15.50 ,$27.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.50 ,55,,,$15.50 ,$27.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.36 ,90,,,$15.50 ,$27.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.33 ,97,,,$15.50 ,$27.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.33 ,97,,,$15.50 ,$27.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.33 ,97,,,$15.50 ,$27.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.95 ,85,,,$15.50 ,$27.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.36 ,90,,,$15.50 ,$27.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.50 ,55,,,$15.50 ,$27.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.77 ,90,,,$15.50 ,$27.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.50 ,55,,,$15.50 ,$27.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.21 ,93,,,$15.50 ,$27.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING UNNABOOT ( FLEX,8783594,CDM,270,RC,,HCPCS,outpatient,,,$47.77 ,$35.83 ,,$43.95 ,92,,,$26.27 ,$46.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.27 ,55,,,$26.27 ,$46.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.27 ,$46.34 ,other,,Not applicable. No negotiated rates per contract,$41.08 ,86,,,$26.27 ,$46.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.22 ,80,,,$26.27 ,$46.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.27 ,55,,,$26.27 ,$46.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.38 ,95,,,$26.27 ,$46.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.38 ,95,,,$26.27 ,$46.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.83 ,75,,,$26.27 ,$46.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.60 ,85,,,$26.27 ,$46.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.34 ,97,,,$26.27 ,$46.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.27 ,55,,,$26.27 ,$46.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.99 ,90,,,$26.27 ,$46.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.34 ,97,,,$26.27 ,$46.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.34 ,97,,,$26.27 ,$46.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.34 ,97,,,$26.27 ,$46.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.60 ,85,,,$26.27 ,$46.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.99 ,90,,,$26.27 ,$46.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.27 ,55,,,$26.27 ,$46.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.38 ,90,,,$26.27 ,$46.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.27 ,55,,,$26.27 ,$46.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.43 ,93,,,$26.27 ,$46.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING WOUND ENLUXTRA 4 x 4,8784073,CDM,270,RC,,HCPCS,outpatient,,,$82.62 ,$61.97 ,,$76.01 ,92,,,$45.44 ,$80.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.44 ,55,,,$45.44 ,$80.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.44 ,$80.14 ,other,,Not applicable. No negotiated rates per contract,$71.05 ,86,,,$45.44 ,$80.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$66.10 ,80,,,$45.44 ,$80.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.44 ,55,,,$45.44 ,$80.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.49 ,95,,,$45.44 ,$80.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.49 ,95,,,$45.44 ,$80.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.97 ,75,,,$45.44 ,$80.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$70.23 ,85,,,$45.44 ,$80.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.14 ,97,,,$45.44 ,$80.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.44 ,55,,,$45.44 ,$80.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.36 ,90,,,$45.44 ,$80.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.14 ,97,,,$45.44 ,$80.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.14 ,97,,,$45.44 ,$80.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.14 ,97,,,$45.44 ,$80.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.23 ,85,,,$45.44 ,$80.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.36 ,90,,,$45.44 ,$80.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.44 ,55,,,$45.44 ,$80.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.49 ,90,,,$45.44 ,$80.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.44 ,55,,,$45.44 ,$80.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.84 ,93,,,$45.44 ,$80.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785496,CDM,270,RC,,HCPCS,outpatient,,,$124.62 ,$93.47 ,,$114.65 ,92,,,$68.54 ,$120.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.54 ,55,,,$68.54 ,$120.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.54 ,$120.88 ,other,,Not applicable. No negotiated rates per contract,$107.17 ,86,,,$68.54 ,$120.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$99.70 ,80,,,$68.54 ,$120.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.54 ,55,,,$68.54 ,$120.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.39 ,95,,,$68.54 ,$120.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$118.39 ,95,,,$68.54 ,$120.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.47 ,75,,,$68.54 ,$120.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.93 ,85,,,$68.54 ,$120.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.88 ,97,,,$68.54 ,$120.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.54 ,55,,,$68.54 ,$120.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.16 ,90,,,$68.54 ,$120.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.88 ,97,,,$68.54 ,$120.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.88 ,97,,,$68.54 ,$120.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.88 ,97,,,$68.54 ,$120.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.93 ,85,,,$68.54 ,$120.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.16 ,90,,,$68.54 ,$120.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.54 ,55,,,$68.54 ,$120.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.39 ,90,,,$68.54 ,$120.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.54 ,55,,,$68.54 ,$120.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.90 ,93,,,$68.54 ,$120.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8784069,CDM,270,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
DRESSING,8785301,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785511,CDM,270,RC,,HCPCS,outpatient,,,$72.35 ,$54.26 ,,$66.56 ,92,,,$39.79 ,$70.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.79 ,55,,,$39.79 ,$70.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.79 ,$70.18 ,other,,Not applicable. No negotiated rates per contract,$62.22 ,86,,,$39.79 ,$70.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.88 ,80,,,$39.79 ,$70.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.79 ,55,,,$39.79 ,$70.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.73 ,95,,,$39.79 ,$70.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.73 ,95,,,$39.79 ,$70.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.26 ,75,,,$39.79 ,$70.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.50 ,85,,,$39.79 ,$70.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.18 ,97,,,$39.79 ,$70.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.79 ,55,,,$39.79 ,$70.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.12 ,90,,,$39.79 ,$70.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.18 ,97,,,$39.79 ,$70.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.18 ,97,,,$39.79 ,$70.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.18 ,97,,,$39.79 ,$70.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.50 ,85,,,$39.79 ,$70.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$65.12 ,90,,,$39.79 ,$70.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.79 ,55,,,$39.79 ,$70.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.73 ,90,,,$39.79 ,$70.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.79 ,55,,,$39.79 ,$70.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.29 ,93,,,$39.79 ,$70.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785302,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8784074,CDM,270,RC,,HCPCS,outpatient,,,$65.92 ,$49.44 ,,$60.65 ,92,,,$36.26 ,$63.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.26 ,55,,,$36.26 ,$63.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.26 ,$63.94 ,other,,Not applicable. No negotiated rates per contract,$56.69 ,86,,,$36.26 ,$63.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$52.74 ,80,,,$36.26 ,$63.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.26 ,55,,,$36.26 ,$63.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.62 ,95,,,$36.26 ,$63.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$62.62 ,95,,,$36.26 ,$63.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.44 ,75,,,$36.26 ,$63.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.03 ,85,,,$36.26 ,$63.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.94 ,97,,,$36.26 ,$63.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.26 ,55,,,$36.26 ,$63.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.33 ,90,,,$36.26 ,$63.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.94 ,97,,,$36.26 ,$63.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.94 ,97,,,$36.26 ,$63.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.94 ,97,,,$36.26 ,$63.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.03 ,85,,,$36.26 ,$63.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$59.33 ,90,,,$36.26 ,$63.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.26 ,55,,,$36.26 ,$63.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.62 ,90,,,$36.26 ,$63.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.26 ,55,,,$36.26 ,$63.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.31 ,93,,,$36.26 ,$63.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785226,CDM,270,RC,,HCPCS,outpatient,,,$29.49 ,$22.12 ,,$27.13 ,92,,,$16.22 ,$28.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.22 ,55,,,$16.22 ,$28.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.22 ,$28.61 ,other,,Not applicable. No negotiated rates per contract,$25.36 ,86,,,$16.22 ,$28.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.59 ,80,,,$16.22 ,$28.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.22 ,55,,,$16.22 ,$28.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.02 ,95,,,$16.22 ,$28.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.02 ,95,,,$16.22 ,$28.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.12 ,75,,,$16.22 ,$28.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.07 ,85,,,$16.22 ,$28.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.61 ,97,,,$16.22 ,$28.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.22 ,55,,,$16.22 ,$28.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.54 ,90,,,$16.22 ,$28.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.61 ,97,,,$16.22 ,$28.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.61 ,97,,,$16.22 ,$28.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.61 ,97,,,$16.22 ,$28.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.07 ,85,,,$16.22 ,$28.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.54 ,90,,,$16.22 ,$28.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.22 ,55,,,$16.22 ,$28.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.02 ,90,,,$16.22 ,$28.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.22 ,55,,,$16.22 ,$28.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.43 ,93,,,$16.22 ,$28.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785383,CDM,270,RC,,HCPCS,outpatient,,,$58.00 ,$43.50 ,,$53.36 ,92,,,$31.90 ,$56.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.90 ,$56.26 ,other,,Not applicable. No negotiated rates per contract,$49.88 ,86,,,$31.90 ,$56.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.40 ,80,,,$31.90 ,$56.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,95,,,$31.90 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.10 ,95,,,$31.90 ,$56.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,75,,,$31.90 ,$56.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.26 ,97,,,$31.90 ,$56.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.30 ,85,,,$31.90 ,$56.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.20 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.10 ,90,,,$31.90 ,$56.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.90 ,55,,,$31.90 ,$56.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.94 ,93,,,$31.90 ,$56.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8942850,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8957452,CDM,270,RC,,HCPCS,outpatient,,,$85.41 ,$64.06 ,,$78.58 ,92,,,$46.98 ,$82.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.98 ,55,,,$46.98 ,$82.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.98 ,$82.85 ,other,,Not applicable. No negotiated rates per contract,$73.45 ,86,,,$46.98 ,$82.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.33 ,80,,,$46.98 ,$82.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.98 ,55,,,$46.98 ,$82.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.14 ,95,,,$46.98 ,$82.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.14 ,95,,,$46.98 ,$82.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.06 ,75,,,$46.98 ,$82.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.60 ,85,,,$46.98 ,$82.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.85 ,97,,,$46.98 ,$82.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.98 ,55,,,$46.98 ,$82.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.87 ,90,,,$46.98 ,$82.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.85 ,97,,,$46.98 ,$82.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.85 ,97,,,$46.98 ,$82.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.85 ,97,,,$46.98 ,$82.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.60 ,85,,,$46.98 ,$82.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.87 ,90,,,$46.98 ,$82.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.98 ,55,,,$46.98 ,$82.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.14 ,90,,,$46.98 ,$82.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.98 ,55,,,$46.98 ,$82.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.43 ,93,,,$46.98 ,$82.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785360,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8784120,CDM,270,RC,,HCPCS,outpatient,,,$39.81 ,$29.86 ,,$36.63 ,92,,,$21.90 ,$38.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.90 ,55,,,$21.90 ,$38.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.90 ,$38.62 ,other,,Not applicable. No negotiated rates per contract,$34.24 ,86,,,$21.90 ,$38.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.85 ,80,,,$21.90 ,$38.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.90 ,55,,,$21.90 ,$38.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.82 ,95,,,$21.90 ,$38.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.82 ,95,,,$21.90 ,$38.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.86 ,75,,,$21.90 ,$38.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.84 ,85,,,$21.90 ,$38.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.62 ,97,,,$21.90 ,$38.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.90 ,55,,,$21.90 ,$38.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.83 ,90,,,$21.90 ,$38.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.62 ,97,,,$21.90 ,$38.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.62 ,97,,,$21.90 ,$38.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.62 ,97,,,$21.90 ,$38.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.84 ,85,,,$21.90 ,$38.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.83 ,90,,,$21.90 ,$38.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.90 ,55,,,$21.90 ,$38.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.82 ,90,,,$21.90 ,$38.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.90 ,55,,,$21.90 ,$38.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.02 ,93,,,$21.90 ,$38.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8784079,CDM,270,RC,,HCPCS,outpatient,,,$71.53 ,$53.65 ,,$65.81 ,92,,,$39.34 ,$69.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.34 ,55,,,$39.34 ,$69.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.34 ,$69.38 ,other,,Not applicable. No negotiated rates per contract,$61.52 ,86,,,$39.34 ,$69.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.22 ,80,,,$39.34 ,$69.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.34 ,55,,,$39.34 ,$69.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.95 ,95,,,$39.34 ,$69.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.95 ,95,,,$39.34 ,$69.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.65 ,75,,,$39.34 ,$69.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$60.80 ,85,,,$39.34 ,$69.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.38 ,97,,,$39.34 ,$69.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.34 ,55,,,$39.34 ,$69.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.38 ,90,,,$39.34 ,$69.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.38 ,97,,,$39.34 ,$69.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.38 ,97,,,$39.34 ,$69.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.38 ,97,,,$39.34 ,$69.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.80 ,85,,,$39.34 ,$69.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.38 ,90,,,$39.34 ,$69.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.34 ,55,,,$39.34 ,$69.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.95 ,90,,,$39.34 ,$69.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.34 ,55,,,$39.34 ,$69.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.52 ,93,,,$39.34 ,$69.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785229,CDM,270,RC,,HCPCS,outpatient,,,$110.44 ,$82.83 ,,$101.60 ,92,,,$60.74 ,$107.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.74 ,$107.13 ,other,,Not applicable. No negotiated rates per contract,$94.98 ,86,,,$60.74 ,$107.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.35 ,80,,,$60.74 ,$107.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.92 ,95,,,$60.74 ,$107.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.83 ,75,,,$60.74 ,$107.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.13 ,97,,,$60.74 ,$107.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.87 ,85,,,$60.74 ,$107.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.40 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.92 ,90,,,$60.74 ,$107.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.74 ,55,,,$60.74 ,$107.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.71 ,93,,,$60.74 ,$107.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRESSING,8785259,CDM,270,RC,,HCPCS,outpatient,,,$164.50 ,$123.38 ,,$151.34 ,92,,,$90.48 ,$159.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$90.48 ,$159.57 ,other,,Not applicable. No negotiated rates per contract,$141.47 ,86,,,$90.48 ,$159.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$131.60 ,80,,,$90.48 ,$159.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.28 ,95,,,$90.48 ,$159.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.28 ,95,,,$90.48 ,$159.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.38 ,75,,,$90.48 ,$159.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.83 ,85,,,$90.48 ,$159.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.05 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.83 ,85,,,$90.48 ,$159.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.05 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.28 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.99 ,93,,,$90.48 ,$159.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRILL GUIDE CROWN TIP RE,8786663,CDM,270,RC,,HCPCS,outpatient,,,"$1,381.25 ","$1,035.94 ",,"$1,270.75 ",92,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$759.69 ,"$1,339.81 ",other,,Not applicable. No negotiated rates per contract,"$1,187.88 ",86,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,105.00 ",80,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,312.19 ",95,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,312.19 ",95,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,035.94 ",75,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,174.06 ",85,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,243.13 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,339.81 ",97,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.06 ",85,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,243.13 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,312.19 ",90,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$759.69 ,55,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,284.56 ",93,,,$759.69 ,"$1,339.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DRILL L BIT,8786862,CDM,270,RC,,HCPCS,outpatient,,,"$1,596.73 ","$1,197.55 ",,"$1,468.99 ",92,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$878.20 ,55,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$878.20 ,"$1,548.83 ",other,,Not applicable. No negotiated rates per contract,"$1,373.19 ",86,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,277.38 ",80,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$878.20 ,55,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,516.89 ",95,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,516.89 ",95,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,197.55 ",75,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,357.22 ",85,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,548.83 ",97,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$878.20 ,55,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,437.06 ",90,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,548.83 ",97,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,548.83 ",97,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,548.83 ",97,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,357.22 ",85,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,437.06 ",90,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.20 ,55,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,516.89 ",90,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.20 ,55,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,484.96 ",93,,,$878.20 ,"$1,548.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
DRILL L BIT,8786865,CDM,270,RC,,HCPCS,outpatient,,,$699.56 ,$524.67 ,,$643.60 ,92,,,$384.76 ,$678.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$384.76 ,55,,,$384.76 ,$678.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$384.76 ,$678.57 ,other,,Not applicable. No negotiated rates per contract,$601.62 ,86,,,$384.76 ,$678.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$559.65 ,80,,,$384.76 ,$678.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$384.76 ,55,,,$384.76 ,$678.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.58 ,95,,,$384.76 ,$678.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$664.58 ,95,,,$384.76 ,$678.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$524.67 ,75,,,$384.76 ,$678.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$594.63 ,85,,,$384.76 ,$678.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$678.57 ,97,,,$384.76 ,$678.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.76 ,55,,,$384.76 ,$678.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$629.60 ,90,,,$384.76 ,$678.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$678.57 ,97,,,$384.76 ,$678.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.57 ,97,,,$384.76 ,$678.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$678.57 ,97,,,$384.76 ,$678.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$594.63 ,85,,,$384.76 ,$678.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$629.60 ,90,,,$384.76 ,$678.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.76 ,55,,,$384.76 ,$678.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$664.58 ,90,,,$384.76 ,$678.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.76 ,55,,,$384.76 ,$678.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$650.59 ,93,,,$384.76 ,$678.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRILL PIN TIGHTROPE (OR),8782087,CDM,270,RC,,HCPCS,outpatient,,,$850.25 ,$637.69 ,,$782.23 ,92,,,$467.64 ,$824.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$467.64 ,$824.74 ,other,,Not applicable. No negotiated rates per contract,$731.22 ,86,,,$467.64 ,$824.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$680.20 ,80,,,$467.64 ,$824.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$807.74 ,95,,,$467.64 ,$824.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$807.74 ,95,,,$467.64 ,$824.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$637.69 ,75,,,$467.64 ,$824.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$722.71 ,85,,,$467.64 ,$824.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$765.23 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.71 ,85,,,$467.64 ,$824.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$765.23 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$807.74 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$790.73 ,93,,,$467.64 ,$824.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRILLL BIT,8786873,CDM,270,RC,,HCPCS,outpatient,,,$414.38 ,$310.79 ,,$381.23 ,92,,,$227.91 ,$401.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$227.91 ,55,,,$227.91 ,$401.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$227.91 ,$401.95 ,other,,Not applicable. No negotiated rates per contract,$356.37 ,86,,,$227.91 ,$401.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$331.50 ,80,,,$227.91 ,$401.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$227.91 ,55,,,$227.91 ,$401.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.66 ,95,,,$227.91 ,$401.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$393.66 ,95,,,$227.91 ,$401.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$310.79 ,75,,,$227.91 ,$401.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$352.22 ,85,,,$227.91 ,$401.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$401.95 ,97,,,$227.91 ,$401.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.91 ,55,,,$227.91 ,$401.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$372.94 ,90,,,$227.91 ,$401.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$401.95 ,97,,,$227.91 ,$401.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.95 ,97,,,$227.91 ,$401.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.95 ,97,,,$227.91 ,$401.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$352.22 ,85,,,$227.91 ,$401.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$372.94 ,90,,,$227.91 ,$401.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.91 ,55,,,$227.91 ,$401.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$393.66 ,90,,,$227.91 ,$401.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.91 ,55,,,$227.91 ,$401.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$385.37 ,93,,,$227.91 ,$401.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRILLL BIT,8786866,CDM,270,RC,,HCPCS,outpatient,,,$430.63 ,$322.97 ,,$396.18 ,92,,,$236.85 ,$417.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$236.85 ,55,,,$236.85 ,$417.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$236.85 ,$417.71 ,other,,Not applicable. No negotiated rates per contract,$370.34 ,86,,,$236.85 ,$417.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$344.50 ,80,,,$236.85 ,$417.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$236.85 ,55,,,$236.85 ,$417.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$409.10 ,95,,,$236.85 ,$417.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$409.10 ,95,,,$236.85 ,$417.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$322.97 ,75,,,$236.85 ,$417.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$366.04 ,85,,,$236.85 ,$417.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$417.71 ,97,,,$236.85 ,$417.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.85 ,55,,,$236.85 ,$417.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$387.57 ,90,,,$236.85 ,$417.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.71 ,97,,,$236.85 ,$417.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.71 ,97,,,$236.85 ,$417.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.71 ,97,,,$236.85 ,$417.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.04 ,85,,,$236.85 ,$417.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.57 ,90,,,$236.85 ,$417.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.85 ,55,,,$236.85 ,$417.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$409.10 ,90,,,$236.85 ,$417.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.85 ,55,,,$236.85 ,$417.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$400.49 ,93,,,$236.85 ,$417.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRY DOC CANNULA 7.0 X 95,8782881,CDM,270,RC,,HCPCS,outpatient,,,$253.90 ,$190.43 ,,$233.59 ,92,,,$139.65 ,$246.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.65 ,55,,,$139.65 ,$246.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.65 ,$246.28 ,other,,Not applicable. No negotiated rates per contract,$218.35 ,86,,,$139.65 ,$246.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.12 ,80,,,$139.65 ,$246.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.65 ,55,,,$139.65 ,$246.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.21 ,95,,,$139.65 ,$246.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.21 ,95,,,$139.65 ,$246.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.43 ,75,,,$139.65 ,$246.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.82 ,85,,,$139.65 ,$246.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.28 ,97,,,$139.65 ,$246.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.65 ,55,,,$139.65 ,$246.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.51 ,90,,,$139.65 ,$246.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.28 ,97,,,$139.65 ,$246.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.28 ,97,,,$139.65 ,$246.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.28 ,97,,,$139.65 ,$246.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.82 ,85,,,$139.65 ,$246.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.51 ,90,,,$139.65 ,$246.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.65 ,55,,,$139.65 ,$246.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.21 ,90,,,$139.65 ,$246.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.65 ,55,,,$139.65 ,$246.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.13 ,93,,,$139.65 ,$246.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DRY DOC CANNULA W/ DISP,8782880,CDM,270,RC,,HCPCS,outpatient,,,$235.99 ,$176.99 ,,$217.11 ,92,,,$129.79 ,$228.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.79 ,55,,,$129.79 ,$228.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$129.79 ,$228.91 ,other,,Not applicable. No negotiated rates per contract,$202.95 ,86,,,$129.79 ,$228.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$188.79 ,80,,,$129.79 ,$228.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.79 ,55,,,$129.79 ,$228.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.19 ,95,,,$129.79 ,$228.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.19 ,95,,,$129.79 ,$228.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.99 ,75,,,$129.79 ,$228.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$200.59 ,85,,,$129.79 ,$228.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.91 ,97,,,$129.79 ,$228.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.79 ,55,,,$129.79 ,$228.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.39 ,90,,,$129.79 ,$228.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.91 ,97,,,$129.79 ,$228.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.91 ,97,,,$129.79 ,$228.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.91 ,97,,,$129.79 ,$228.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.59 ,85,,,$129.79 ,$228.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.39 ,90,,,$129.79 ,$228.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.79 ,55,,,$129.79 ,$228.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.19 ,90,,,$129.79 ,$228.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.79 ,55,,,$129.79 ,$228.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.47 ,93,,,$129.79 ,$228.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DURAPREP 26ML APPLICATOR,8785509,CDM,270,RC,,HCPCS,outpatient,,,$56.27 ,$42.20 ,,$51.77 ,92,,,$30.95 ,$54.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.95 ,$54.58 ,other,,Not applicable. No negotiated rates per contract,$48.39 ,86,,,$30.95 ,$54.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.02 ,80,,,$30.95 ,$54.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.46 ,95,,,$30.95 ,$54.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.46 ,95,,,$30.95 ,$54.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.20 ,75,,,$30.95 ,$54.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.83 ,85,,,$30.95 ,$54.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.64 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.58 ,97,,,$30.95 ,$54.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.83 ,85,,,$30.95 ,$54.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.64 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.46 ,90,,,$30.95 ,$54.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.95 ,55,,,$30.95 ,$54.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.33 ,93,,,$30.95 ,$54.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
DX FIBERTAK SUTURE ANCHO,8942851,CDM,270,RC,,HCPCS,outpatient,,,"$2,204.48 ","$1,653.36 ",,"$2,028.12 ",92,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,212.46 ",55,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,212.46 ","$2,138.35 ",other,,Not applicable. No negotiated rates per contract,"$1,895.85 ",86,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,763.58 ",80,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,212.46 ",55,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,094.26 ",95,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,094.26 ",95,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,653.36 ",75,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,873.81 ",85,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,138.35 ",97,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,212.46 ",55,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,984.03 ",90,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,138.35 ",97,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,138.35 ",97,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,138.35 ",97,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,873.81 ",85,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,984.03 ",90,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,212.46 ",55,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,094.26 ",90,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,212.46 ",55,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,050.17 ",93,,,"$1,212.46 ","$2,138.35 ",percent of total billed charges,,93% of total billed charges for outpatient setting
EAR WICK 9 X 15MM,8983457,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EATON 9PX 9PX1500RT - UPS - 1350 WATT - 1500 VA,10931968,CDM,270,RC,,HCPCS,outpatient,,,$998.00 ,$748.50 ,,$918.16 ,92,,,$548.90 ,$968.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$548.90 ,55,,,$548.90 ,$968.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$548.90 ,$968.06 ,other,,Not applicable. No negotiated rates per contract,$858.28 ,86,,,$548.90 ,$968.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$798.40 ,80,,,$548.90 ,$968.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$548.90 ,55,,,$548.90 ,$968.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$948.10 ,95,,,$548.90 ,$968.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$948.10 ,95,,,$548.90 ,$968.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$748.50 ,75,,,$548.90 ,$968.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$848.30 ,85,,,$548.90 ,$968.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$968.06 ,97,,,$548.90 ,$968.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$548.90 ,55,,,$548.90 ,$968.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.20 ,90,,,$548.90 ,$968.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$968.06 ,97,,,$548.90 ,$968.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$968.06 ,97,,,$548.90 ,$968.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$968.06 ,97,,,$548.90 ,$968.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$848.30 ,85,,,$548.90 ,$968.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$898.20 ,90,,,$548.90 ,$968.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$548.90 ,55,,,$548.90 ,$968.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$948.10 ,90,,,$548.90 ,$968.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$548.90 ,55,,,$548.90 ,$968.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$928.14 ,93,,,$548.90 ,$968.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ECG PATIENT MONITORING C,8782347,CDM,270,RC,,HCPCS,outpatient,,,$668.00 ,$501.00 ,,$614.56 ,92,,,$367.40 ,$647.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$367.40 ,55,,,$367.40 ,$647.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$367.40 ,$647.96 ,other,,Not applicable. No negotiated rates per contract,$574.48 ,86,,,$367.40 ,$647.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$534.40 ,80,,,$367.40 ,$647.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$367.40 ,55,,,$367.40 ,$647.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$634.60 ,95,,,$367.40 ,$647.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$634.60 ,95,,,$367.40 ,$647.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$501.00 ,75,,,$367.40 ,$647.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$567.80 ,85,,,$367.40 ,$647.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$647.96 ,97,,,$367.40 ,$647.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.40 ,55,,,$367.40 ,$647.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$601.20 ,90,,,$367.40 ,$647.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$647.96 ,97,,,$367.40 ,$647.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$647.96 ,97,,,$367.40 ,$647.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$647.96 ,97,,,$367.40 ,$647.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$567.80 ,85,,,$367.40 ,$647.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$601.20 ,90,,,$367.40 ,$647.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.40 ,55,,,$367.40 ,$647.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$634.60 ,90,,,$367.40 ,$647.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$367.40 ,55,,,$367.40 ,$647.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$621.24 ,93,,,$367.40 ,$647.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EDEMA GLOVES 4 RIGHT LAR,8786164,CDM,270,RC,,HCPCS,outpatient,,,$48.02 ,$36.02 ,,$44.18 ,92,,,$26.41 ,$46.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.41 ,$46.58 ,other,,Not applicable. No negotiated rates per contract,$41.30 ,86,,,$26.41 ,$46.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.42 ,80,,,$26.41 ,$46.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.62 ,95,,,$26.41 ,$46.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.02 ,75,,,$26.41 ,$46.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.58 ,97,,,$26.41 ,$46.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,85,,,$26.41 ,$46.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.22 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.62 ,90,,,$26.41 ,$46.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.41 ,55,,,$26.41 ,$46.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.66 ,93,,,$26.41 ,$46.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EGG BUR (4.0 MM) S 1607-002-035,8786803,CDM,270,RC,,HCPCS,outpatient,,,$393.53 ,$295.15 ,,$362.05 ,92,,,$216.44 ,$381.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.44 ,$381.72 ,other,,Not applicable. No negotiated rates per contract,$338.44 ,86,,,$216.44 ,$381.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$314.82 ,80,,,$216.44 ,$381.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.85 ,95,,,$216.44 ,$381.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.85 ,95,,,$216.44 ,$381.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$295.15 ,75,,,$216.44 ,$381.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.50 ,85,,,$216.44 ,$381.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.18 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.50 ,85,,,$216.44 ,$381.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.18 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.85 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.98 ,93,,,$216.44 ,$381.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EKG MACHINE,8784228,CDM,270,RC,,HCPCS,outpatient,,,"$7,958.00 ","$5,968.50 ",,"$7,321.36 ",92,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$4,376.90 ",55,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$4,376.90 ","$7,719.26 ",other,,Not applicable. No negotiated rates per contract,"$6,843.88 ",86,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$6,366.40 ",80,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$4,376.90 ",55,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,560.10 ",95,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,560.10 ",95,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,968.50 ",75,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,764.30 ",85,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,719.26 ",97,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,376.90 ",55,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,162.20 ",90,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,719.26 ",97,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,719.26 ",97,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,719.26 ",97,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,764.30 ",85,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,162.20 ",90,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,376.90 ",55,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,560.10 ",90,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,376.90 ",55,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,400.94 ",93,,,"$4,376.90 ","$7,719.26 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ELBOW SUPPORT,8786889,CDM,270,RC,,HCPCS,outpatient,,,$99.90 ,$74.93 ,,$91.91 ,92,,,$54.95 ,$96.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$54.95 ,55,,,$54.95 ,$96.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$54.95 ,$96.90 ,other,,Not applicable. No negotiated rates per contract,$85.91 ,86,,,$54.95 ,$96.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$79.92 ,80,,,$54.95 ,$96.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$54.95 ,55,,,$54.95 ,$96.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.91 ,95,,,$54.95 ,$96.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.91 ,95,,,$54.95 ,$96.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.93 ,75,,,$54.95 ,$96.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$84.92 ,85,,,$54.95 ,$96.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$96.90 ,97,,,$54.95 ,$96.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.95 ,55,,,$54.95 ,$96.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.91 ,90,,,$54.95 ,$96.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.90 ,97,,,$54.95 ,$96.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.90 ,97,,,$54.95 ,$96.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.90 ,97,,,$54.95 ,$96.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.92 ,85,,,$54.95 ,$96.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.91 ,90,,,$54.95 ,$96.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.95 ,55,,,$54.95 ,$96.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.91 ,90,,,$54.95 ,$96.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.95 ,55,,,$54.95 ,$96.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.91 ,93,,,$54.95 ,$96.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELBOW WORKHARD PROTECTOR,8783076,CDM,270,RC,,HCPCS,outpatient,,,$117.41 ,$88.06 ,,$108.02 ,92,,,$64.58 ,$113.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.58 ,55,,,$64.58 ,$113.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.58 ,$113.89 ,other,,Not applicable. No negotiated rates per contract,$100.97 ,86,,,$64.58 ,$113.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$93.93 ,80,,,$64.58 ,$113.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.58 ,55,,,$64.58 ,$113.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.54 ,95,,,$64.58 ,$113.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.54 ,95,,,$64.58 ,$113.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.06 ,75,,,$64.58 ,$113.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$99.80 ,85,,,$64.58 ,$113.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.89 ,97,,,$64.58 ,$113.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.58 ,55,,,$64.58 ,$113.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.67 ,90,,,$64.58 ,$113.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.89 ,97,,,$64.58 ,$113.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.89 ,97,,,$64.58 ,$113.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.89 ,97,,,$64.58 ,$113.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.80 ,85,,,$64.58 ,$113.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.67 ,90,,,$64.58 ,$113.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.58 ,55,,,$64.58 ,$113.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.54 ,90,,,$64.58 ,$113.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.58 ,55,,,$64.58 ,$113.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.19 ,93,,,$64.58 ,$113.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODE LAPAROSCOPIC WIRE L-HOOK,8782918,CDM,270,RC,,HCPCS,outpatient,,,$288.99 ,$216.74 ,,$265.87 ,92,,,$158.94 ,$280.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$158.94 ,55,,,$158.94 ,$280.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$158.94 ,$280.32 ,other,,Not applicable. No negotiated rates per contract,$248.53 ,86,,,$158.94 ,$280.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$231.19 ,80,,,$158.94 ,$280.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$158.94 ,55,,,$158.94 ,$280.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.54 ,95,,,$158.94 ,$280.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$274.54 ,95,,,$158.94 ,$280.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$216.74 ,75,,,$158.94 ,$280.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$245.64 ,85,,,$158.94 ,$280.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.32 ,97,,,$158.94 ,$280.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.94 ,55,,,$158.94 ,$280.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.09 ,90,,,$158.94 ,$280.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$280.32 ,97,,,$158.94 ,$280.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.32 ,97,,,$158.94 ,$280.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.32 ,97,,,$158.94 ,$280.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.64 ,85,,,$158.94 ,$280.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.09 ,90,,,$158.94 ,$280.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.94 ,55,,,$158.94 ,$280.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.54 ,90,,,$158.94 ,$280.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.94 ,55,,,$158.94 ,$280.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.76 ,93,,,$158.94 ,$280.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODE PEDIATRIC QUIK-COMBO (11996-000093),8786289,CDM,270,RC,,HCPCS,outpatient,,,$165.66 ,$124.25 ,,$152.41 ,92,,,$91.11 ,$160.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.11 ,55,,,$91.11 ,$160.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$91.11 ,$160.69 ,other,,Not applicable. No negotiated rates per contract,$142.47 ,86,,,$91.11 ,$160.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.53 ,80,,,$91.11 ,$160.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.11 ,55,,,$91.11 ,$160.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.38 ,95,,,$91.11 ,$160.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.38 ,95,,,$91.11 ,$160.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.25 ,75,,,$91.11 ,$160.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.81 ,85,,,$91.11 ,$160.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.69 ,97,,,$91.11 ,$160.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.11 ,55,,,$91.11 ,$160.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.09 ,90,,,$91.11 ,$160.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.69 ,97,,,$91.11 ,$160.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.69 ,97,,,$91.11 ,$160.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.69 ,97,,,$91.11 ,$160.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.81 ,85,,,$91.11 ,$160.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.09 ,90,,,$91.11 ,$160.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.11 ,55,,,$91.11 ,$160.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.38 ,90,,,$91.11 ,$160.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.11 ,55,,,$91.11 ,$160.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.06 ,93,,,$91.11 ,$160.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES  REM POLYHESIVE ADULT PATIENT RETURN PAD,8785752,CDM,270,RC,,HCPCS,outpatient,,,$80.68 ,$60.51 ,,$74.23 ,92,,,$44.37 ,$78.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.37 ,55,,,$44.37 ,$78.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.37 ,$78.26 ,other,,Not applicable. No negotiated rates per contract,$69.38 ,86,,,$44.37 ,$78.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.54 ,80,,,$44.37 ,$78.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.37 ,55,,,$44.37 ,$78.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.65 ,95,,,$44.37 ,$78.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.65 ,95,,,$44.37 ,$78.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.51 ,75,,,$44.37 ,$78.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.58 ,85,,,$44.37 ,$78.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.26 ,97,,,$44.37 ,$78.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.37 ,55,,,$44.37 ,$78.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.61 ,90,,,$44.37 ,$78.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.26 ,97,,,$44.37 ,$78.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.26 ,97,,,$44.37 ,$78.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.26 ,97,,,$44.37 ,$78.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.58 ,85,,,$44.37 ,$78.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.61 ,90,,,$44.37 ,$78.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.37 ,55,,,$44.37 ,$78.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.65 ,90,,,$44.37 ,$78.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.37 ,55,,,$44.37 ,$78.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.03 ,93,,,$44.37 ,$78.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES 3M,8785508,CDM,270,RC,,HCPCS,outpatient,,,$38.33 ,$28.75 ,,$35.26 ,92,,,$21.08 ,$37.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.08 ,$37.18 ,other,,Not applicable. No negotiated rates per contract,$32.96 ,86,,,$21.08 ,$37.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.66 ,80,,,$21.08 ,$37.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.41 ,95,,,$21.08 ,$37.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.41 ,95,,,$21.08 ,$37.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.75 ,75,,,$21.08 ,$37.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.58 ,85,,,$21.08 ,$37.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.50 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.18 ,97,,,$21.08 ,$37.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.58 ,85,,,$21.08 ,$37.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.50 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.41 ,90,,,$21.08 ,$37.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.08 ,55,,,$21.08 ,$37.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.65 ,93,,,$21.08 ,$37.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES 3M SENSITIVE,8785507,CDM,270,RC,,HCPCS,outpatient,,,$37.01 ,$27.76 ,,$34.05 ,92,,,$20.36 ,$35.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.36 ,55,,,$20.36 ,$35.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.36 ,$35.90 ,other,,Not applicable. No negotiated rates per contract,$31.83 ,86,,,$20.36 ,$35.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.61 ,80,,,$20.36 ,$35.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.36 ,55,,,$20.36 ,$35.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.16 ,95,,,$20.36 ,$35.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.16 ,95,,,$20.36 ,$35.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.76 ,75,,,$20.36 ,$35.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.46 ,85,,,$20.36 ,$35.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.90 ,97,,,$20.36 ,$35.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.36 ,55,,,$20.36 ,$35.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.31 ,90,,,$20.36 ,$35.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.90 ,97,,,$20.36 ,$35.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.90 ,97,,,$20.36 ,$35.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.90 ,97,,,$20.36 ,$35.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.46 ,85,,,$20.36 ,$35.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.31 ,90,,,$20.36 ,$35.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.36 ,55,,,$20.36 ,$35.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.16 ,90,,,$20.36 ,$35.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.36 ,55,,,$20.36 ,$35.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.42 ,93,,,$20.36 ,$35.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES ADULT QUICK COMBO(11996-000091),8786288,CDM,270,RC,,HCPCS,outpatient,,,$141.05 ,$105.79 ,,$129.77 ,92,,,$77.58 ,$136.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$77.58 ,55,,,$77.58 ,$136.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$77.58 ,$136.82 ,other,,Not applicable. No negotiated rates per contract,$121.30 ,86,,,$77.58 ,$136.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$112.84 ,80,,,$77.58 ,$136.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$77.58 ,55,,,$77.58 ,$136.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.00 ,95,,,$77.58 ,$136.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.00 ,95,,,$77.58 ,$136.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.79 ,75,,,$77.58 ,$136.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$119.89 ,85,,,$77.58 ,$136.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.82 ,97,,,$77.58 ,$136.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.58 ,55,,,$77.58 ,$136.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.95 ,90,,,$77.58 ,$136.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$136.82 ,97,,,$77.58 ,$136.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.82 ,97,,,$77.58 ,$136.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$136.82 ,97,,,$77.58 ,$136.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.89 ,85,,,$77.58 ,$136.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.95 ,90,,,$77.58 ,$136.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.58 ,55,,,$77.58 ,$136.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.00 ,90,,,$77.58 ,$136.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.58 ,55,,,$77.58 ,$136.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.18 ,93,,,$77.58 ,$136.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES CARDIOSENS/UL,8782478,CDM,270,RC,,HCPCS,outpatient,,,$497.15 ,$372.86 ,,$457.38 ,92,,,$273.43 ,$482.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.43 ,55,,,$273.43 ,$482.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.43 ,$482.24 ,other,,Not applicable. No negotiated rates per contract,$427.55 ,86,,,$273.43 ,$482.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.72 ,80,,,$273.43 ,$482.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.43 ,55,,,$273.43 ,$482.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.29 ,95,,,$273.43 ,$482.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.29 ,95,,,$273.43 ,$482.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.86 ,75,,,$273.43 ,$482.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.58 ,85,,,$273.43 ,$482.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.24 ,97,,,$273.43 ,$482.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.43 ,55,,,$273.43 ,$482.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.44 ,90,,,$273.43 ,$482.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$482.24 ,97,,,$273.43 ,$482.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.24 ,97,,,$273.43 ,$482.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.24 ,97,,,$273.43 ,$482.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.58 ,85,,,$273.43 ,$482.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.44 ,90,,,$273.43 ,$482.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.43 ,55,,,$273.43 ,$482.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.29 ,90,,,$273.43 ,$482.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.43 ,55,,,$273.43 ,$482.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.35 ,93,,,$273.43 ,$482.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES ECL 5400 Q-TRACE,8782495,CDM,270,RC,,HCPCS,outpatient,,,$175.09 ,$131.32 ,,$161.08 ,92,,,$96.30 ,$169.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.30 ,$169.84 ,other,,Not applicable. No negotiated rates per contract,$150.58 ,86,,,$96.30 ,$169.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.07 ,80,,,$96.30 ,$169.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.34 ,95,,,$96.30 ,$169.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.34 ,95,,,$96.30 ,$169.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.32 ,75,,,$96.30 ,$169.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.83 ,85,,,$96.30 ,$169.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.58 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.83 ,85,,,$96.30 ,$169.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.58 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.34 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.83 ,93,,,$96.30 ,$169.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES EKG NEONATE,8782552,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES PEDIATRIC 3/P,8783050,CDM,270,RC,,HCPCS,outpatient,,,$27.21 ,$20.41 ,,$25.03 ,92,,,$14.97 ,$26.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.97 ,$26.39 ,other,,Not applicable. No negotiated rates per contract,$23.40 ,86,,,$14.97 ,$26.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.77 ,80,,,$14.97 ,$26.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.85 ,95,,,$14.97 ,$26.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.41 ,75,,,$14.97 ,$26.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.39 ,97,,,$14.97 ,$26.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.13 ,85,,,$14.97 ,$26.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.49 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.85 ,90,,,$14.97 ,$26.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.97 ,55,,,$14.97 ,$26.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.31 ,93,,,$14.97 ,$26.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES RED DOT,8785812,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES SPIRAL PURPLE,8786246,CDM,270,RC,,HCPCS,outpatient,,,$30.63 ,$22.97 ,,$28.18 ,92,,,$16.85 ,$29.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.85 ,$29.71 ,other,,Not applicable. No negotiated rates per contract,$26.34 ,86,,,$16.85 ,$29.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.50 ,80,,,$16.85 ,$29.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.10 ,95,,,$16.85 ,$29.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.10 ,95,,,$16.85 ,$29.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.97 ,75,,,$16.85 ,$29.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.04 ,85,,,$16.85 ,$29.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.57 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.71 ,97,,,$16.85 ,$29.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.04 ,85,,,$16.85 ,$29.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.57 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.10 ,90,,,$16.85 ,$29.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.85 ,55,,,$16.85 ,$29.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.49 ,93,,,$16.85 ,$29.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ELECTRODES,8783727,CDM,270,RC,,HCPCS,outpatient,,,$49.09 ,$36.82 ,,$45.16 ,92,,,$27.00 ,$47.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.00 ,55,,,$27.00 ,$47.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.00 ,$47.62 ,other,,Not applicable. No negotiated rates per contract,$42.22 ,86,,,$27.00 ,$47.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.27 ,80,,,$27.00 ,$47.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.00 ,55,,,$27.00 ,$47.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.64 ,95,,,$27.00 ,$47.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.64 ,95,,,$27.00 ,$47.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.82 ,75,,,$27.00 ,$47.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.73 ,85,,,$27.00 ,$47.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.62 ,97,,,$27.00 ,$47.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.00 ,55,,,$27.00 ,$47.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.18 ,90,,,$27.00 ,$47.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.62 ,97,,,$27.00 ,$47.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.62 ,97,,,$27.00 ,$47.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.62 ,97,,,$27.00 ,$47.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.73 ,85,,,$27.00 ,$47.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.18 ,90,,,$27.00 ,$47.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.00 ,55,,,$27.00 ,$47.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.64 ,90,,,$27.00 ,$47.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.00 ,55,,,$27.00 ,$47.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.65 ,93,,,$27.00 ,$47.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENCORE,8784081,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDO RETRACT 10MM (INSTR,8785243,CDM,270,RC,,HCPCS,outpatient,,,$871.89 ,$653.92 ,,$802.14 ,92,,,$479.54 ,$845.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$479.54 ,55,,,$479.54 ,$845.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$479.54 ,$845.73 ,other,,Not applicable. No negotiated rates per contract,$749.83 ,86,,,$479.54 ,$845.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$697.51 ,80,,,$479.54 ,$845.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$479.54 ,55,,,$479.54 ,$845.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$828.30 ,95,,,$479.54 ,$845.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$828.30 ,95,,,$479.54 ,$845.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$653.92 ,75,,,$479.54 ,$845.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$741.11 ,85,,,$479.54 ,$845.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$845.73 ,97,,,$479.54 ,$845.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.54 ,55,,,$479.54 ,$845.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$784.70 ,90,,,$479.54 ,$845.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$845.73 ,97,,,$479.54 ,$845.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.73 ,97,,,$479.54 ,$845.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.73 ,97,,,$479.54 ,$845.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$741.11 ,85,,,$479.54 ,$845.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$784.70 ,90,,,$479.54 ,$845.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.54 ,55,,,$479.54 ,$845.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$828.30 ,90,,,$479.54 ,$845.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.54 ,55,,,$479.54 ,$845.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.86 ,93,,,$479.54 ,$845.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDO TACH TUBE HI-LO CUF,8786519,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDO TRACH GUIDE  PEDIATRIC 8FR,8783041,CDM,270,RC,,HCPCS,outpatient,,,$39.99 ,$29.99 ,,$36.79 ,92,,,$21.99 ,$38.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.99 ,$38.79 ,other,,Not applicable. No negotiated rates per contract,$34.39 ,86,,,$21.99 ,$38.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.99 ,80,,,$21.99 ,$38.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.99 ,95,,,$21.99 ,$38.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.99 ,95,,,$21.99 ,$38.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.99 ,75,,,$21.99 ,$38.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.99 ,85,,,$21.99 ,$38.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.99 ,85,,,$21.99 ,$38.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.19 ,93,,,$21.99 ,$38.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDO TRACH TUBE W/CUFF L,8787013,CDM,270,RC,,HCPCS,outpatient,,,$33.60 ,$25.20 ,,$30.91 ,92,,,$18.48 ,$32.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.48 ,$32.59 ,other,,Not applicable. No negotiated rates per contract,$28.90 ,86,,,$18.48 ,$32.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.88 ,80,,,$18.48 ,$32.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.92 ,95,,,$18.48 ,$32.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.92 ,95,,,$18.48 ,$32.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.20 ,75,,,$18.48 ,$32.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.56 ,85,,,$18.48 ,$32.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.24 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.59 ,97,,,$18.48 ,$32.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.56 ,85,,,$18.48 ,$32.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.24 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.92 ,90,,,$18.48 ,$32.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.48 ,55,,,$18.48 ,$32.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.25 ,93,,,$18.48 ,$32.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDOBUTTON CL ULTRA 20MM,9168194,CDM,278,RC,,HCPCS,both,,,"$1,242.74 ",$932.06 ,,"$1,143.32 ",92,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.51 ,"$1,205.46 ",other,,Not applicable. No negotiated rates per contract,"$1,068.76 ",86,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$994.19 ,80,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,180.60 ",95,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,180.60 ",95,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$932.06 ,75,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,056.33 ",85,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,118.47 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,056.33 ",85,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,118.47 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,180.60 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.75 ",93,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ENDOBUTTON CL ULTRA 25MM,9121064,CDM,278,RC,,HCPCS,both,,,"$1,242.74 ",$932.06 ,,"$1,143.32 ",92,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.51 ,"$1,205.46 ",other,,Not applicable. No negotiated rates per contract,"$1,068.76 ",86,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$994.19 ,80,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,180.60 ",95,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,180.60 ",95,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$932.06 ,75,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,056.33 ",85,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,118.47 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.46 ",97,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,056.33 ",85,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,118.47 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,180.60 ",90,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.51 ,55,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.75 ",93,,,$683.51 ,"$1,205.46 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ENDOBUTTON CL ULTRA PAC 1.2,9121063,CDM,278,RC,,HCPCS,both,,,"$2,023.00 ","$1,517.25 ",,"$1,861.16 ",92,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,112.65 ",55,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,112.65 ","$1,962.31 ",other,,Not applicable. No negotiated rates per contract,"$1,739.78 ",86,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,618.40 ",80,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,112.65 ",55,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,921.85 ",95,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,921.85 ",95,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,517.25 ",75,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,719.55 ",85,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,962.31 ",97,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,112.65 ",55,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,820.70 ",90,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,962.31 ",97,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,962.31 ",97,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,962.31 ",97,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,719.55 ",85,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,820.70 ",90,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,112.65 ",55,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,921.85 ",90,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,112.65 ",55,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,881.39 ",93,,,"$1,112.65 ","$1,962.31 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ENDOPATH RELOAD (WHITE V,8785437,CDM,270,RC,,HCPCS,outpatient,,,$560.75 ,$420.56 ,,$515.89 ,92,,,$308.41 ,$543.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$308.41 ,$543.93 ,other,,Not applicable. No negotiated rates per contract,$482.25 ,86,,,$308.41 ,$543.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$448.60 ,80,,,$308.41 ,$543.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.71 ,95,,,$308.41 ,$543.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.71 ,95,,,$308.41 ,$543.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.56 ,75,,,$308.41 ,$543.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$476.64 ,85,,,$308.41 ,$543.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.68 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$476.64 ,85,,,$308.41 ,$543.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.68 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.71 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$521.50 ,93,,,$308.41 ,$543.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENDOPOUCH RETRIEVER SPEC,8785256,CDM,270,RC,,HCPCS,outpatient,,,$377.46 ,$283.10 ,,$347.26 ,92,,,$207.60 ,$366.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$207.60 ,55,,,$207.60 ,$366.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$207.60 ,$366.14 ,other,,Not applicable. No negotiated rates per contract,$324.62 ,86,,,$207.60 ,$366.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$301.97 ,80,,,$207.60 ,$366.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$207.60 ,55,,,$207.60 ,$366.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.59 ,95,,,$207.60 ,$366.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$358.59 ,95,,,$207.60 ,$366.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$283.10 ,75,,,$207.60 ,$366.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$320.84 ,85,,,$207.60 ,$366.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$366.14 ,97,,,$207.60 ,$366.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.60 ,55,,,$207.60 ,$366.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.71 ,90,,,$207.60 ,$366.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$366.14 ,97,,,$207.60 ,$366.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.14 ,97,,,$207.60 ,$366.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$366.14 ,97,,,$207.60 ,$366.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$320.84 ,85,,,$207.60 ,$366.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$339.71 ,90,,,$207.60 ,$366.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.60 ,55,,,$207.60 ,$366.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.59 ,90,,,$207.60 ,$366.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$207.60 ,55,,,$207.60 ,$366.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.04 ,93,,,$207.60 ,$366.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENEMA RING FLUID COLLECT,8784159,CDM,270,RC,,HCPCS,outpatient,,,$36.84 ,$27.63 ,,$33.89 ,92,,,$20.26 ,$35.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.26 ,$35.73 ,other,,Not applicable. No negotiated rates per contract,$31.68 ,86,,,$20.26 ,$35.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.47 ,80,,,$20.26 ,$35.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.00 ,95,,,$20.26 ,$35.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.00 ,95,,,$20.26 ,$35.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.63 ,75,,,$20.26 ,$35.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.31 ,85,,,$20.26 ,$35.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.31 ,85,,,$20.26 ,$35.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.16 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.00 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.26 ,93,,,$20.26 ,$35.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ENSEAL G2 TISSUE SEALER,8783812,CDM,270,RC,,HCPCS,outpatient,,,"$2,975.00 ","$2,231.25 ",,"$2,737.00 ",92,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,636.25 ",55,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,636.25 ","$2,885.75 ",other,,Not applicable. No negotiated rates per contract,"$2,558.50 ",86,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,380.00 ",80,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,636.25 ",55,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,826.25 ",95,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,826.25 ",95,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,231.25 ",75,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,528.75 ",85,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,885.75 ",97,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,636.25 ",55,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,677.50 ",90,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,885.75 ",97,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,885.75 ",97,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,885.75 ",97,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,528.75 ",85,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,677.50 ",90,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,636.25 ",55,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,826.25 ",90,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,636.25 ",55,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,766.75 ",93,,,"$1,636.25 ","$2,885.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ET TUBE HOLDER ADULT,8783043,CDM,270,RC,,HCPCS,outpatient,,,$37.19 ,$27.89 ,,$34.21 ,92,,,$20.45 ,$36.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.45 ,55,,,$20.45 ,$36.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.45 ,$36.07 ,other,,Not applicable. No negotiated rates per contract,$31.98 ,86,,,$20.45 ,$36.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.75 ,80,,,$20.45 ,$36.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.45 ,55,,,$20.45 ,$36.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.33 ,95,,,$20.45 ,$36.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.33 ,95,,,$20.45 ,$36.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.89 ,75,,,$20.45 ,$36.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.61 ,85,,,$20.45 ,$36.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.07 ,97,,,$20.45 ,$36.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.45 ,55,,,$20.45 ,$36.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.47 ,90,,,$20.45 ,$36.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.07 ,97,,,$20.45 ,$36.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.07 ,97,,,$20.45 ,$36.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.07 ,97,,,$20.45 ,$36.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.61 ,85,,,$20.45 ,$36.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.47 ,90,,,$20.45 ,$36.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.45 ,55,,,$20.45 ,$36.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.33 ,90,,,$20.45 ,$36.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.45 ,55,,,$20.45 ,$36.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.59 ,93,,,$20.45 ,$36.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ET TUBE HOLDER PED.,8783044,CDM,270,RC,,HCPCS,outpatient,,,$38.94 ,$29.21 ,,$35.82 ,92,,,$21.42 ,$37.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.42 ,$37.77 ,other,,Not applicable. No negotiated rates per contract,$33.49 ,86,,,$21.42 ,$37.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.15 ,80,,,$21.42 ,$37.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.99 ,95,,,$21.42 ,$37.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.99 ,95,,,$21.42 ,$37.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.21 ,75,,,$21.42 ,$37.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.10 ,85,,,$21.42 ,$37.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.05 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.10 ,85,,,$21.42 ,$37.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.05 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.99 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.21 ,93,,,$21.42 ,$37.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ET/I-GEL  HOLDER,8942803,CDM,270,RC,,HCPCS,outpatient,,,$41.99 ,$31.49 ,,$38.63 ,92,,,$23.09 ,$40.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.09 ,$40.73 ,other,,Not applicable. No negotiated rates per contract,$36.11 ,86,,,$23.09 ,$40.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.59 ,80,,,$23.09 ,$40.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.89 ,95,,,$23.09 ,$40.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.89 ,95,,,$23.09 ,$40.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.49 ,75,,,$23.09 ,$40.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.69 ,85,,,$23.09 ,$40.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.79 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.73 ,97,,,$23.09 ,$40.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.69 ,85,,,$23.09 ,$40.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.79 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.89 ,90,,,$23.09 ,$40.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.09 ,55,,,$23.09 ,$40.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.05 ,93,,,$23.09 ,$40.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EVACUATED CONTAINER,8785248,CDM,270,RC,,HCPCS,outpatient,,,$79.86 ,$59.90 ,,$73.47 ,92,,,$43.92 ,$77.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.92 ,$77.46 ,other,,Not applicable. No negotiated rates per contract,$68.68 ,86,,,$43.92 ,$77.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.89 ,80,,,$43.92 ,$77.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.87 ,95,,,$43.92 ,$77.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.87 ,95,,,$43.92 ,$77.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.90 ,75,,,$43.92 ,$77.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.88 ,85,,,$43.92 ,$77.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.46 ,97,,,$43.92 ,$77.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.88 ,85,,,$43.92 ,$77.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.87 ,90,,,$43.92 ,$77.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.92 ,55,,,$43.92 ,$77.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.27 ,93,,,$43.92 ,$77.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EVACUTED CONTAINER (PLASTIC),8783823,CDM,270,RC,,HCPCS,outpatient,,,$86.80 ,$65.10 ,,$79.86 ,92,,,$47.74 ,$84.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.74 ,$84.20 ,other,,Not applicable. No negotiated rates per contract,$74.65 ,86,,,$47.74 ,$84.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.44 ,80,,,$47.74 ,$84.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.10 ,75,,,$47.74 ,$84.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.72 ,93,,,$47.74 ,$84.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EVERST TUMBLER FOOD & NU,8786342,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EVICEL FIBRIN SEALANT HU,8783800,CDM,270,RC,,HCPCS,outpatient,,,"$3,139.18 ","$2,354.39 ",,"$2,888.05 ",92,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,726.55 ",55,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,726.55 ","$3,045.00 ",other,,Not applicable. No negotiated rates per contract,"$2,699.69 ",86,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,511.34 ",80,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,726.55 ",55,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,982.22 ",95,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,982.22 ",95,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,354.39 ",75,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,668.30 ",85,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,045.00 ",97,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,726.55 ",55,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,825.26 ",90,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,045.00 ",97,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,045.00 ",97,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,045.00 ",97,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,668.30 ",85,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,825.26 ",90,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,726.55 ",55,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,982.22 ",90,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,726.55 ",55,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,919.44 ",93,,,"$1,726.55 ","$3,045.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
EXAM TABLE BASE ONLY MOD,8785047,CDM,270,RC,,HCPCS,outpatient,,,"$1,478.00 ","$1,108.50 ",,"$1,359.76 ",92,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$812.90 ,55,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$812.90 ,"$1,433.66 ",other,,Not applicable. No negotiated rates per contract,"$1,271.08 ",86,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,182.40 ",80,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$812.90 ,55,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,404.10 ",95,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,404.10 ",95,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,108.50 ",75,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,256.30 ",85,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,433.66 ",97,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$812.90 ,55,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,330.20 ",90,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,433.66 ",97,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,433.66 ",97,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,433.66 ",97,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,256.30 ",85,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,330.20 ",90,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$812.90 ,55,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,404.10 ",90,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$812.90 ,55,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,374.54 ",93,,,$812.90 ,"$1,433.66 ",percent of total billed charges,,93% of total billed charges for outpatient setting
EXOSOFT GAUNLET SZ XL,8989066,CDM,270,RC,,HCPCS,outpatient,,,$282.69 ,$212.02 ,,$260.07 ,92,,,$155.48 ,$274.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.48 ,55,,,$155.48 ,$274.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$155.48 ,$274.21 ,other,,Not applicable. No negotiated rates per contract,$243.11 ,86,,,$155.48 ,$274.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$226.15 ,80,,,$155.48 ,$274.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.48 ,55,,,$155.48 ,$274.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.56 ,95,,,$155.48 ,$274.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$268.56 ,95,,,$155.48 ,$274.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.02 ,75,,,$155.48 ,$274.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$240.29 ,85,,,$155.48 ,$274.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.21 ,97,,,$155.48 ,$274.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.48 ,55,,,$155.48 ,$274.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.42 ,90,,,$155.48 ,$274.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$274.21 ,97,,,$155.48 ,$274.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.21 ,97,,,$155.48 ,$274.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.21 ,97,,,$155.48 ,$274.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.29 ,85,,,$155.48 ,$274.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.42 ,90,,,$155.48 ,$274.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.48 ,55,,,$155.48 ,$274.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.56 ,90,,,$155.48 ,$274.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.48 ,55,,,$155.48 ,$274.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.90 ,93,,,$155.48 ,$274.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EXPRESSEW III FLEXIBLE SUTURE P,8783775,CDM,270,RC,,HCPCS,outpatient,,,$560.57 ,$420.43 ,,$515.72 ,92,,,$308.31 ,$543.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$308.31 ,55,,,$308.31 ,$543.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$308.31 ,$543.75 ,other,,Not applicable. No negotiated rates per contract,$482.09 ,86,,,$308.31 ,$543.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$448.46 ,80,,,$308.31 ,$543.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$308.31 ,55,,,$308.31 ,$543.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.54 ,95,,,$308.31 ,$543.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.54 ,95,,,$308.31 ,$543.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.43 ,75,,,$308.31 ,$543.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$476.48 ,85,,,$308.31 ,$543.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.75 ,97,,,$308.31 ,$543.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.31 ,55,,,$308.31 ,$543.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.51 ,90,,,$308.31 ,$543.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$543.75 ,97,,,$308.31 ,$543.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.75 ,97,,,$308.31 ,$543.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.75 ,97,,,$308.31 ,$543.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$476.48 ,85,,,$308.31 ,$543.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.51 ,90,,,$308.31 ,$543.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.31 ,55,,,$308.31 ,$543.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.54 ,90,,,$308.31 ,$543.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.31 ,55,,,$308.31 ,$543.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$521.33 ,93,,,$308.31 ,$543.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EXTENSION SET,8785742,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EYE SHIELD PLASTIC VENTE,8785420,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EYE SHIELDS CLEAR CHOICE (LENSES) (SDN100) OR,8786526,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EYE SHIELDS CLEAR CHOICE W/ FRAMES (SN1025) OR,8786513,CDM,270,RC,,HCPCS,outpatient,,,$216.05 ,$162.04 ,,$198.77 ,92,,,$118.83 ,$209.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.83 ,55,,,$118.83 ,$209.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$118.83 ,$209.57 ,other,,Not applicable. No negotiated rates per contract,$185.80 ,86,,,$118.83 ,$209.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$172.84 ,80,,,$118.83 ,$209.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.83 ,55,,,$118.83 ,$209.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.25 ,95,,,$118.83 ,$209.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$205.25 ,95,,,$118.83 ,$209.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.04 ,75,,,$118.83 ,$209.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$183.64 ,85,,,$118.83 ,$209.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.57 ,97,,,$118.83 ,$209.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.83 ,55,,,$118.83 ,$209.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$194.45 ,90,,,$118.83 ,$209.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$209.57 ,97,,,$118.83 ,$209.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.57 ,97,,,$118.83 ,$209.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.57 ,97,,,$118.83 ,$209.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.64 ,85,,,$118.83 ,$209.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$194.45 ,90,,,$118.83 ,$209.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.83 ,55,,,$118.83 ,$209.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.25 ,90,,,$118.83 ,$209.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.83 ,55,,,$118.83 ,$209.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.93 ,93,,,$118.83 ,$209.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EYEGARD/ (EYE COVERS) S2,8786524,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EZ WRAP FOR O2 CANNULA (,8784126,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EZ-DETECT PROF DISPENSER,8782194,CDM,270,RC,,HCPCS,outpatient,,,$40.00 ,$30.00 ,,$36.80 ,92,,,$22.00 ,$38.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.00 ,$38.80 ,other,,Not applicable. No negotiated rates per contract,$34.40 ,86,,,$22.00 ,$38.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.00 ,80,,,$22.00 ,$38.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.00 ,75,,,$22.00 ,$38.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.20 ,93,,,$22.00 ,$38.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EZ-STABILIZER (EZ-10 ACC,8782085,CDM,270,RC,,HCPCS,outpatient,,,$139.50 ,$104.63 ,,$128.34 ,92,,,$76.73 ,$135.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.73 ,$135.32 ,other,,Not applicable. No negotiated rates per contract,$119.97 ,86,,,$76.73 ,$135.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$111.60 ,80,,,$76.73 ,$135.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.63 ,75,,,$76.73 ,$135.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.74 ,93,,,$76.73 ,$135.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FAST-FIX 360 CURVED NDL,8786665,CDM,270,RC,,HCPCS,outpatient,,,"$2,273.75 ","$1,705.31 ",,"$2,091.85 ",92,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,250.56 ",55,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,250.56 ","$2,205.54 ",other,,Not applicable. No negotiated rates per contract,"$1,955.43 ",86,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,819.00 ",80,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,250.56 ",55,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,160.06 ",95,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,160.06 ",95,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,705.31 ",75,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,932.69 ",85,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,205.54 ",97,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,250.56 ",55,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,046.38 ",90,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,205.54 ",97,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,205.54 ",97,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,205.54 ",97,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,932.69 ",85,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,046.38 ",90,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,250.56 ",55,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,160.06 ",90,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,250.56 ",55,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,114.59 ",93,,,"$1,250.56 ","$2,205.54 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8782916,CDM,270,RC,,HCPCS,outpatient,,,$209.82 ,$157.37 ,,$193.03 ,92,,,$115.40 ,$203.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.40 ,55,,,$115.40 ,$203.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$115.40 ,$203.53 ,other,,Not applicable. No negotiated rates per contract,$180.45 ,86,,,$115.40 ,$203.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$167.86 ,80,,,$115.40 ,$203.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.40 ,55,,,$115.40 ,$203.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.33 ,95,,,$115.40 ,$203.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.33 ,95,,,$115.40 ,$203.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.37 ,75,,,$115.40 ,$203.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.35 ,85,,,$115.40 ,$203.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.53 ,97,,,$115.40 ,$203.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.40 ,55,,,$115.40 ,$203.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.84 ,90,,,$115.40 ,$203.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.53 ,97,,,$115.40 ,$203.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.53 ,97,,,$115.40 ,$203.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.53 ,97,,,$115.40 ,$203.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.35 ,85,,,$115.40 ,$203.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$188.84 ,90,,,$115.40 ,$203.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.40 ,55,,,$115.40 ,$203.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.33 ,90,,,$115.40 ,$203.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.40 ,55,,,$115.40 ,$203.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.13 ,93,,,$115.40 ,$203.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8785227,CDM,270,RC,,HCPCS,outpatient,,,$189.44 ,$142.08 ,,$174.28 ,92,,,$104.19 ,$183.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.19 ,55,,,$104.19 ,$183.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.19 ,$183.76 ,other,,Not applicable. No negotiated rates per contract,$162.92 ,86,,,$104.19 ,$183.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.55 ,80,,,$104.19 ,$183.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.19 ,55,,,$104.19 ,$183.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.97 ,95,,,$104.19 ,$183.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.97 ,95,,,$104.19 ,$183.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.08 ,75,,,$104.19 ,$183.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$161.02 ,85,,,$104.19 ,$183.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.76 ,97,,,$104.19 ,$183.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.19 ,55,,,$104.19 ,$183.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.50 ,90,,,$104.19 ,$183.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.76 ,97,,,$104.19 ,$183.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.76 ,97,,,$104.19 ,$183.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.76 ,97,,,$104.19 ,$183.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.02 ,85,,,$104.19 ,$183.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.50 ,90,,,$104.19 ,$183.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.19 ,55,,,$104.19 ,$183.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.97 ,90,,,$104.19 ,$183.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.19 ,55,,,$104.19 ,$183.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.18 ,93,,,$104.19 ,$183.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8785228,CDM,270,RC,,HCPCS,outpatient,,,$192.20 ,$144.15 ,,$176.82 ,92,,,$105.71 ,$186.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.71 ,55,,,$105.71 ,$186.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.71 ,$186.43 ,other,,Not applicable. No negotiated rates per contract,$165.29 ,86,,,$105.71 ,$186.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$153.76 ,80,,,$105.71 ,$186.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.71 ,55,,,$105.71 ,$186.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.59 ,95,,,$105.71 ,$186.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.59 ,95,,,$105.71 ,$186.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.15 ,75,,,$105.71 ,$186.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.37 ,85,,,$105.71 ,$186.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.43 ,97,,,$105.71 ,$186.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.71 ,55,,,$105.71 ,$186.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.98 ,90,,,$105.71 ,$186.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.43 ,97,,,$105.71 ,$186.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.43 ,97,,,$105.71 ,$186.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.43 ,97,,,$105.71 ,$186.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.37 ,85,,,$105.71 ,$186.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.98 ,90,,,$105.71 ,$186.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.71 ,55,,,$105.71 ,$186.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.59 ,90,,,$105.71 ,$186.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.71 ,55,,,$105.71 ,$186.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.75 ,93,,,$105.71 ,$186.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8785077,CDM,270,RC,,HCPCS,outpatient,,,$618.50 ,$463.88 ,,$569.02 ,92,,,$340.18 ,$599.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$340.18 ,55,,,$340.18 ,$599.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$340.18 ,$599.95 ,other,,Not applicable. No negotiated rates per contract,$531.91 ,86,,,$340.18 ,$599.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$494.80 ,80,,,$340.18 ,$599.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$340.18 ,55,,,$340.18 ,$599.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$587.58 ,95,,,$340.18 ,$599.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.58 ,95,,,$340.18 ,$599.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$463.88 ,75,,,$340.18 ,$599.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$525.73 ,85,,,$340.18 ,$599.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$599.95 ,97,,,$340.18 ,$599.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$340.18 ,55,,,$340.18 ,$599.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$556.65 ,90,,,$340.18 ,$599.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$599.95 ,97,,,$340.18 ,$599.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$599.95 ,97,,,$340.18 ,$599.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$599.95 ,97,,,$340.18 ,$599.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$525.73 ,85,,,$340.18 ,$599.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$556.65 ,90,,,$340.18 ,$599.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$340.18 ,55,,,$340.18 ,$599.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$587.58 ,90,,,$340.18 ,$599.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$340.18 ,55,,,$340.18 ,$599.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$575.21 ,93,,,$340.18 ,$599.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8942852,CDM,270,RC,,HCPCS,outpatient,,,$786.61 ,$589.96 ,,$723.68 ,92,,,$432.64 ,$763.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$432.64 ,$763.01 ,other,,Not applicable. No negotiated rates per contract,$676.48 ,86,,,$432.64 ,$763.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$629.29 ,80,,,$432.64 ,$763.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.96 ,75,,,$432.64 ,$763.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$731.55 ,93,,,$432.64 ,$763.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8942853,CDM,270,RC,27808,HCPCS,outpatient,,,$786.61 ,$589.96 ,,$723.68 ,92,,,$432.64 ,$763.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$432.64 ,$763.01 ,other,,Not applicable. No negotiated rates per contract,$676.48 ,86,,,$432.64 ,$763.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$629.29 ,80,,,$432.64 ,$763.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.96 ,75,,,$432.64 ,$763.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$731.55 ,93,,,$432.64 ,$763.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FEEDING TUBE,8942854,CDM,270,RC,27808,HCPCS,outpatient,,,$786.61 ,$589.96 ,,$723.68 ,92,,,$432.64 ,$763.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$432.64 ,$763.01 ,other,,Not applicable. No negotiated rates per contract,$676.48 ,86,,,$432.64 ,$763.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$629.29 ,80,,,$432.64 ,$763.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$747.28 ,95,,,$432.64 ,$763.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$589.96 ,75,,,$432.64 ,$763.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.01 ,97,,,$432.64 ,$763.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$668.62 ,85,,,$432.64 ,$763.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$707.95 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$747.28 ,90,,,$432.64 ,$763.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$432.64 ,55,,,$432.64 ,$763.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$731.55 ,93,,,$432.64 ,$763.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FHC DISPOSABLE HAND/FORE,8783217,CDM,270,RC,,HCPCS,outpatient,,,$293.29 ,$219.97 ,,$269.83 ,92,,,$161.31 ,$284.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$161.31 ,55,,,$161.31 ,$284.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$161.31 ,$284.49 ,other,,Not applicable. No negotiated rates per contract,$252.23 ,86,,,$161.31 ,$284.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$234.63 ,80,,,$161.31 ,$284.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$161.31 ,55,,,$161.31 ,$284.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.63 ,95,,,$161.31 ,$284.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.63 ,95,,,$161.31 ,$284.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.97 ,75,,,$161.31 ,$284.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$249.30 ,85,,,$161.31 ,$284.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.49 ,97,,,$161.31 ,$284.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.31 ,55,,,$161.31 ,$284.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.96 ,90,,,$161.31 ,$284.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$284.49 ,97,,,$161.31 ,$284.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.49 ,97,,,$161.31 ,$284.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$284.49 ,97,,,$161.31 ,$284.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.30 ,85,,,$161.31 ,$284.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.96 ,90,,,$161.31 ,$284.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.31 ,55,,,$161.31 ,$284.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$278.63 ,90,,,$161.31 ,$284.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.31 ,55,,,$161.31 ,$284.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.76 ,93,,,$161.31 ,$284.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FHC LATERAL SHOULDER HOL,8783216,CDM,270,RC,,HCPCS,outpatient,,,"$6,915.43 ","$5,186.57 ",,"$6,362.20 ",92,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,803.49 ",55,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,803.49 ","$6,707.97 ",other,,Not applicable. No negotiated rates per contract,"$5,947.27 ",86,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,532.34 ",80,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,803.49 ",55,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,569.66 ",95,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,569.66 ",95,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,186.57 ",75,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,878.12 ",85,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,707.97 ",97,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,803.49 ",55,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,223.89 ",90,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,707.97 ",97,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,707.97 ",97,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,707.97 ",97,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,878.12 ",85,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,223.89 ",90,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,803.49 ",55,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,569.66 ",90,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,803.49 ",55,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,431.35 ",93,,,"$3,803.49 ","$6,707.97 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FIBERLOOP,8782095,CDM,270,RC,,HCPCS,outpatient,,,$446.88 ,$335.16 ,,$411.13 ,92,,,$245.78 ,$433.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$245.78 ,55,,,$245.78 ,$433.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$245.78 ,$433.47 ,other,,Not applicable. No negotiated rates per contract,$384.32 ,86,,,$245.78 ,$433.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$357.50 ,80,,,$245.78 ,$433.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$245.78 ,55,,,$245.78 ,$433.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.54 ,95,,,$245.78 ,$433.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$424.54 ,95,,,$245.78 ,$433.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$335.16 ,75,,,$245.78 ,$433.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$379.85 ,85,,,$245.78 ,$433.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$433.47 ,97,,,$245.78 ,$433.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.78 ,55,,,$245.78 ,$433.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$402.19 ,90,,,$245.78 ,$433.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.47 ,97,,,$245.78 ,$433.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.47 ,97,,,$245.78 ,$433.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.47 ,97,,,$245.78 ,$433.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.85 ,85,,,$245.78 ,$433.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$402.19 ,90,,,$245.78 ,$433.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.78 ,55,,,$245.78 ,$433.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.54 ,90,,,$245.78 ,$433.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.78 ,55,,,$245.78 ,$433.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.60 ,93,,,$245.78 ,$433.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FIBERTAK,8942855,CDM,270,RC,,HCPCS,outpatient,,,"$1,989.00 ","$1,491.75 ",,"$1,829.88 ",92,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,093.95 ",55,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,093.95 ","$1,929.33 ",other,,Not applicable. No negotiated rates per contract,"$1,710.54 ",86,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,591.20 ",80,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,093.95 ",55,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,889.55 ",95,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,889.55 ",95,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,491.75 ",75,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,690.65 ",85,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,929.33 ",97,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,093.95 ",55,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,790.10 ",90,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,929.33 ",97,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,929.33 ",97,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,929.33 ",97,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,690.65 ",85,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,790.10 ",90,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,093.95 ",55,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,889.55 ",90,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,093.95 ",55,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,849.77 ",93,,,"$1,093.95 ","$1,929.33 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FIBERTAK BICEPS IMPLANT,8942856,CDM,270,RC,,HCPCS,outpatient,,,"$2,960.30 ","$2,220.23 ",,"$2,723.48 ",92,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,628.17 ",55,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,628.17 ","$2,871.49 ",other,,Not applicable. No negotiated rates per contract,"$2,545.86 ",86,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,368.24 ",80,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,628.17 ",55,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,812.29 ",95,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,812.29 ",95,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,220.23 ",75,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,516.26 ",85,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,871.49 ",97,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,628.17 ",55,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,664.27 ",90,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,871.49 ",97,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,871.49 ",97,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,871.49 ",97,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,516.26 ",85,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,664.27 ",90,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,628.17 ",55,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,812.29 ",90,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,628.17 ",55,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,753.08 ",93,,,"$1,628.17 ","$2,871.49 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FIBERTAK DISPOSABLES STR,8942857,CDM,270,RC,,HCPCS,outpatient,,,$926.25 ,$694.69 ,,$852.15 ,92,,,$509.44 ,$898.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$509.44 ,55,,,$509.44 ,$898.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$509.44 ,$898.46 ,other,,Not applicable. No negotiated rates per contract,$796.58 ,86,,,$509.44 ,$898.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$741.00 ,80,,,$509.44 ,$898.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$509.44 ,55,,,$509.44 ,$898.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.94 ,95,,,$509.44 ,$898.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$879.94 ,95,,,$509.44 ,$898.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$694.69 ,75,,,$509.44 ,$898.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$787.31 ,85,,,$509.44 ,$898.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$898.46 ,97,,,$509.44 ,$898.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$509.44 ,55,,,$509.44 ,$898.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$833.63 ,90,,,$509.44 ,$898.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$898.46 ,97,,,$509.44 ,$898.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$898.46 ,97,,,$509.44 ,$898.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$898.46 ,97,,,$509.44 ,$898.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$787.31 ,85,,,$509.44 ,$898.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$833.63 ,90,,,$509.44 ,$898.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$509.44 ,55,,,$509.44 ,$898.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.94 ,90,,,$509.44 ,$898.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$509.44 ,55,,,$509.44 ,$898.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$861.41 ,93,,,$509.44 ,$898.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FILE FOLDERS,8784739,CDM,270,RC,53744,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FILMARRAY  BCID IDENTIFICATION  PANEL,8783902,CDM,270,RC,,HCPCS,outpatient,,,"$11,175.00 ","$8,381.25 ",,"$10,281.00 ",92,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$6,146.25 ",55,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$6,146.25 ","$10,839.75 ",other,,Not applicable. No negotiated rates per contract,"$9,610.50 ",86,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$8,940.00 ",80,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$6,146.25 ",55,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,616.25 ",95,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$10,616.25 ",95,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$8,381.25 ",75,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$9,498.75 ",85,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$10,839.75 ",97,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,146.25 ",55,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,057.50 ",90,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$10,839.75 ",97,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$10,839.75 ",97,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$10,839.75 ",97,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,498.75 ",85,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$10,057.50 ",90,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,146.25 ",55,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,616.25 ",90,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,146.25 ",55,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,392.75 ",93,,,"$6,146.25 ","$10,839.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FILTER WATER CARTRIDGE,8783199,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FILTERLINE H SET ADULT C,8786261,CDM,270,RC,,HCPCS,outpatient,,,$117.49 ,$88.12 ,,$108.09 ,92,,,$64.62 ,$113.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.62 ,55,,,$64.62 ,$113.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.62 ,$113.97 ,other,,Not applicable. No negotiated rates per contract,$101.04 ,86,,,$64.62 ,$113.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$93.99 ,80,,,$64.62 ,$113.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.62 ,55,,,$64.62 ,$113.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.62 ,95,,,$64.62 ,$113.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.62 ,95,,,$64.62 ,$113.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.12 ,75,,,$64.62 ,$113.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$99.87 ,85,,,$64.62 ,$113.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.97 ,97,,,$64.62 ,$113.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.62 ,55,,,$64.62 ,$113.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.74 ,90,,,$64.62 ,$113.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.97 ,97,,,$64.62 ,$113.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.97 ,97,,,$64.62 ,$113.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.97 ,97,,,$64.62 ,$113.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.87 ,85,,,$64.62 ,$113.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.74 ,90,,,$64.62 ,$113.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.62 ,55,,,$64.62 ,$113.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.62 ,90,,,$64.62 ,$113.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.62 ,55,,,$64.62 ,$113.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.27 ,93,,,$64.62 ,$113.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FILTERLINE H SET INFANT/,8786262,CDM,270,RC,,HCPCS,outpatient,,,$147.56 ,$110.67 ,,$135.76 ,92,,,$81.16 ,$143.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.16 ,55,,,$81.16 ,$143.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.16 ,$143.13 ,other,,Not applicable. No negotiated rates per contract,$126.90 ,86,,,$81.16 ,$143.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.05 ,80,,,$81.16 ,$143.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.16 ,55,,,$81.16 ,$143.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.18 ,95,,,$81.16 ,$143.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.18 ,95,,,$81.16 ,$143.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.67 ,75,,,$81.16 ,$143.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.43 ,85,,,$81.16 ,$143.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.13 ,97,,,$81.16 ,$143.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.16 ,55,,,$81.16 ,$143.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.80 ,90,,,$81.16 ,$143.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.13 ,97,,,$81.16 ,$143.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.13 ,97,,,$81.16 ,$143.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.13 ,97,,,$81.16 ,$143.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.43 ,85,,,$81.16 ,$143.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.80 ,90,,,$81.16 ,$143.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.16 ,55,,,$81.16 ,$143.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.18 ,90,,,$81.16 ,$143.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.16 ,55,,,$81.16 ,$143.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.23 ,93,,,$81.16 ,$143.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FINGER KNUCKLE BENDER (L,8786172,CDM,270,RC,,HCPCS,outpatient,,,$103.85 ,$77.89 ,,$95.54 ,92,,,$57.12 ,$100.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.12 ,$100.73 ,other,,Not applicable. No negotiated rates per contract,$89.31 ,86,,,$57.12 ,$100.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.08 ,80,,,$57.12 ,$100.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.89 ,75,,,$57.12 ,$100.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.58 ,93,,,$57.12 ,$100.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FINGER KNUCKLE BENDER (M,8786169,CDM,270,RC,,HCPCS,outpatient,,,$103.85 ,$77.89 ,,$95.54 ,92,,,$57.12 ,$100.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.12 ,$100.73 ,other,,Not applicable. No negotiated rates per contract,$89.31 ,86,,,$57.12 ,$100.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.08 ,80,,,$57.12 ,$100.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.89 ,75,,,$57.12 ,$100.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.58 ,93,,,$57.12 ,$100.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FINGER KNUCKLE BENDER (S,8786171,CDM,270,RC,,HCPCS,outpatient,,,$103.85 ,$77.89 ,,$95.54 ,92,,,$57.12 ,$100.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.12 ,$100.73 ,other,,Not applicable. No negotiated rates per contract,$89.31 ,86,,,$57.12 ,$100.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.08 ,80,,,$57.12 ,$100.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.89 ,75,,,$57.12 ,$100.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.58 ,93,,,$57.12 ,$100.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FIRE EXTINGUISHER BUCKEY,8783453,CDM,270,RC,,HCPCS,outpatient,,,$584.00 ,$438.00 ,,$537.28 ,92,,,$321.20 ,$566.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$321.20 ,55,,,$321.20 ,$566.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$321.20 ,$566.48 ,other,,Not applicable. No negotiated rates per contract,$502.24 ,86,,,$321.20 ,$566.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$467.20 ,80,,,$321.20 ,$566.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$321.20 ,55,,,$321.20 ,$566.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$554.80 ,95,,,$321.20 ,$566.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$554.80 ,95,,,$321.20 ,$566.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$438.00 ,75,,,$321.20 ,$566.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$496.40 ,85,,,$321.20 ,$566.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$566.48 ,97,,,$321.20 ,$566.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.20 ,55,,,$321.20 ,$566.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$525.60 ,90,,,$321.20 ,$566.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$566.48 ,97,,,$321.20 ,$566.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$566.48 ,97,,,$321.20 ,$566.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$566.48 ,97,,,$321.20 ,$566.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$496.40 ,85,,,$321.20 ,$566.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$525.60 ,90,,,$321.20 ,$566.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.20 ,55,,,$321.20 ,$566.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$554.80 ,90,,,$321.20 ,$566.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.20 ,55,,,$321.20 ,$566.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.12 ,93,,,$321.20 ,$566.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FIREPOWER SERICES,8782002,CDM,270,RC,52474,HCPCS,outpatient,,,"$3,322.00 ","$2,491.50 ",,"$3,056.24 ",92,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,827.10 ",55,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,827.10 ","$3,222.34 ",other,,Not applicable. No negotiated rates per contract,"$2,856.92 ",86,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,657.60 ",80,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,827.10 ",55,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,155.90 ",95,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,155.90 ",95,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,491.50 ",75,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,823.70 ",85,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,222.34 ",97,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,827.10 ",55,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,989.80 ",90,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,222.34 ",97,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,222.34 ",97,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,222.34 ",97,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,823.70 ",85,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,989.80 ",90,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,827.10 ",55,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,155.90 ",90,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,827.10 ",55,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,089.46 ",93,,,"$1,827.10 ","$3,222.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
FLANGE,8782501,CDM,270,RC,,HCPCS,outpatient,,,$49.75 ,$37.31 ,,$45.77 ,92,,,$27.36 ,$48.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.36 ,$48.26 ,other,,Not applicable. No negotiated rates per contract,$42.79 ,86,,,$27.36 ,$48.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.80 ,80,,,$27.36 ,$48.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.31 ,75,,,$27.36 ,$48.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.27 ,93,,,$27.36 ,$48.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FLANGE,8781916,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FLEET SALINE ADULT ENEMA,8782616,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FLYTE HOOD W/ PEEL AWAY OLD ONES,8786824,CDM,272,RC,,HCPCS,outpatient,,,$313.40 ,$235.05 ,,$288.33 ,92,,,$172.37 ,$304.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$172.37 ,55,,,$172.37 ,$304.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$172.37 ,$304.00 ,other,,Not applicable. No negotiated rates per contract,$269.52 ,86,,,$172.37 ,$304.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$250.72 ,80,,,$172.37 ,$304.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$172.37 ,55,,,$172.37 ,$304.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.73 ,95,,,$172.37 ,$304.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$297.73 ,95,,,$172.37 ,$304.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$235.05 ,75,,,$172.37 ,$304.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$266.39 ,85,,,$172.37 ,$304.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$304.00 ,97,,,$172.37 ,$304.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.37 ,55,,,$172.37 ,$304.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$282.06 ,90,,,$172.37 ,$304.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$304.00 ,97,,,$172.37 ,$304.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.00 ,97,,,$172.37 ,$304.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.00 ,97,,,$172.37 ,$304.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.39 ,85,,,$172.37 ,$304.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$282.06 ,90,,,$172.37 ,$304.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.37 ,55,,,$172.37 ,$304.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.73 ,90,,,$172.37 ,$304.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.37 ,55,,,$172.37 ,$304.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$291.46 ,93,,,$172.37 ,$304.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FMS INFLOW TUBING         INFL.,8783767,CDM,270,RC,,HCPCS,outpatient,,,$320.09 ,$240.07 ,,$294.48 ,92,,,$176.05 ,$310.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$176.05 ,55,,,$176.05 ,$310.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$176.05 ,$310.49 ,other,,Not applicable. No negotiated rates per contract,$275.28 ,86,,,$176.05 ,$310.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$256.07 ,80,,,$176.05 ,$310.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$176.05 ,55,,,$176.05 ,$310.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.09 ,95,,,$176.05 ,$310.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$304.09 ,95,,,$176.05 ,$310.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.07 ,75,,,$176.05 ,$310.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$272.08 ,85,,,$176.05 ,$310.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$310.49 ,97,,,$176.05 ,$310.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.05 ,55,,,$176.05 ,$310.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$288.08 ,90,,,$176.05 ,$310.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$310.49 ,97,,,$176.05 ,$310.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.49 ,97,,,$176.05 ,$310.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$310.49 ,97,,,$176.05 ,$310.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.08 ,85,,,$176.05 ,$310.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.08 ,90,,,$176.05 ,$310.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.05 ,55,,,$176.05 ,$310.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$304.09 ,90,,,$176.05 ,$310.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$176.05 ,55,,,$176.05 ,$310.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.68 ,93,,,$176.05 ,$310.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FMS INTERMEDIARY TUBING     FMS,8783766,CDM,270,RC,,HCPCS,outpatient,,,$148.92 ,$111.69 ,,$137.01 ,92,,,$81.91 ,$144.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.91 ,55,,,$81.91 ,$144.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.91 ,$144.45 ,other,,Not applicable. No negotiated rates per contract,$128.07 ,86,,,$81.91 ,$144.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$119.14 ,80,,,$81.91 ,$144.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.91 ,55,,,$81.91 ,$144.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.47 ,95,,,$81.91 ,$144.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.47 ,95,,,$81.91 ,$144.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.69 ,75,,,$81.91 ,$144.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.58 ,85,,,$81.91 ,$144.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.45 ,97,,,$81.91 ,$144.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.91 ,55,,,$81.91 ,$144.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.03 ,90,,,$81.91 ,$144.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.45 ,97,,,$81.91 ,$144.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.45 ,97,,,$81.91 ,$144.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.45 ,97,,,$81.91 ,$144.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.58 ,85,,,$81.91 ,$144.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.03 ,90,,,$81.91 ,$144.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.91 ,55,,,$81.91 ,$144.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.47 ,90,,,$81.91 ,$144.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.91 ,55,,,$81.91 ,$144.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.50 ,93,,,$81.91 ,$144.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FMS VUE INFLOW TUBING       FMS,8783816,CDM,270,RC,,HCPCS,outpatient,,,$335.81 ,$251.86 ,,$308.95 ,92,,,$184.70 ,$325.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$184.70 ,55,,,$184.70 ,$325.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$184.70 ,$325.74 ,other,,Not applicable. No negotiated rates per contract,$288.80 ,86,,,$184.70 ,$325.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$268.65 ,80,,,$184.70 ,$325.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$184.70 ,55,,,$184.70 ,$325.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$319.02 ,95,,,$184.70 ,$325.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$319.02 ,95,,,$184.70 ,$325.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.86 ,75,,,$184.70 ,$325.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$285.44 ,85,,,$184.70 ,$325.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$325.74 ,97,,,$184.70 ,$325.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.70 ,55,,,$184.70 ,$325.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.23 ,90,,,$184.70 ,$325.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$325.74 ,97,,,$184.70 ,$325.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$325.74 ,97,,,$184.70 ,$325.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$325.74 ,97,,,$184.70 ,$325.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$285.44 ,85,,,$184.70 ,$325.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.23 ,90,,,$184.70 ,$325.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.70 ,55,,,$184.70 ,$325.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$319.02 ,90,,,$184.70 ,$325.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.70 ,55,,,$184.70 ,$325.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.30 ,93,,,$184.70 ,$325.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORCE FIBE SUTURE (OR),8786888,CDM,270,RC,,HCPCS,outpatient,,,$254.33 ,$190.75 ,,$233.98 ,92,,,$139.88 ,$246.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.88 ,55,,,$139.88 ,$246.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.88 ,$246.70 ,other,,Not applicable. No negotiated rates per contract,$218.72 ,86,,,$139.88 ,$246.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.46 ,80,,,$139.88 ,$246.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.88 ,55,,,$139.88 ,$246.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.61 ,95,,,$139.88 ,$246.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.61 ,95,,,$139.88 ,$246.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.75 ,75,,,$139.88 ,$246.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$216.18 ,85,,,$139.88 ,$246.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.70 ,97,,,$139.88 ,$246.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.88 ,55,,,$139.88 ,$246.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.90 ,90,,,$139.88 ,$246.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.70 ,97,,,$139.88 ,$246.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.70 ,97,,,$139.88 ,$246.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.70 ,97,,,$139.88 ,$246.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.18 ,85,,,$139.88 ,$246.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.90 ,90,,,$139.88 ,$246.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.88 ,55,,,$139.88 ,$246.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.61 ,90,,,$139.88 ,$246.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.88 ,55,,,$139.88 ,$246.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$236.53 ,93,,,$139.88 ,$246.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORCEPS TISSUE 1 X2 TEET,8782738,CDM,270,RC,,HCPCS,outpatient,,,$80.85 ,$60.64 ,,$74.38 ,92,,,$44.47 ,$78.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.47 ,55,,,$44.47 ,$78.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.47 ,$78.42 ,other,,Not applicable. No negotiated rates per contract,$69.53 ,86,,,$44.47 ,$78.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.68 ,80,,,$44.47 ,$78.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.47 ,55,,,$44.47 ,$78.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.81 ,95,,,$44.47 ,$78.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.81 ,95,,,$44.47 ,$78.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.64 ,75,,,$44.47 ,$78.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.72 ,85,,,$44.47 ,$78.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.42 ,97,,,$44.47 ,$78.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.47 ,55,,,$44.47 ,$78.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.77 ,90,,,$44.47 ,$78.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.42 ,97,,,$44.47 ,$78.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.42 ,97,,,$44.47 ,$78.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.42 ,97,,,$44.47 ,$78.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.72 ,85,,,$44.47 ,$78.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.77 ,90,,,$44.47 ,$78.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.47 ,55,,,$44.47 ,$78.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.81 ,90,,,$44.47 ,$78.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.47 ,55,,,$44.47 ,$78.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.19 ,93,,,$44.47 ,$78.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORCEPS,8784170,CDM,270,RC,29893,HCPCS,outpatient,,,$92.61 ,$69.46 ,,$85.20 ,92,,,$50.94 ,$89.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.94 ,$89.83 ,other,,Not applicable. No negotiated rates per contract,$79.64 ,86,,,$50.94 ,$89.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$74.09 ,80,,,$50.94 ,$89.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.98 ,95,,,$50.94 ,$89.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.98 ,95,,,$50.94 ,$89.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.46 ,75,,,$50.94 ,$89.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$78.72 ,85,,,$50.94 ,$89.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.35 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.72 ,85,,,$50.94 ,$89.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.35 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.98 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.13 ,93,,,$50.94 ,$89.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORCEPS,8784766,CDM,270,RC,29893,HCPCS,outpatient,,,$128.03 ,$96.02 ,,$117.79 ,92,,,$70.42 ,$124.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.42 ,55,,,$70.42 ,$124.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.42 ,$124.19 ,other,,Not applicable. No negotiated rates per contract,$110.11 ,86,,,$70.42 ,$124.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.42 ,80,,,$70.42 ,$124.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.42 ,55,,,$70.42 ,$124.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.63 ,95,,,$70.42 ,$124.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.63 ,95,,,$70.42 ,$124.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.02 ,75,,,$70.42 ,$124.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.83 ,85,,,$70.42 ,$124.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.19 ,97,,,$70.42 ,$124.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.42 ,55,,,$70.42 ,$124.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.23 ,90,,,$70.42 ,$124.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.19 ,97,,,$70.42 ,$124.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.19 ,97,,,$70.42 ,$124.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.19 ,97,,,$70.42 ,$124.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.83 ,85,,,$70.42 ,$124.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.23 ,90,,,$70.42 ,$124.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.42 ,55,,,$70.42 ,$124.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.63 ,90,,,$70.42 ,$124.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.42 ,55,,,$70.42 ,$124.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.07 ,93,,,$70.42 ,$124.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORCEPS,8784767,CDM,270,RC,29893,HCPCS,outpatient,,,$409.69 ,$307.27 ,,$376.91 ,92,,,$225.33 ,$397.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$225.33 ,55,,,$225.33 ,$397.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$225.33 ,$397.40 ,other,,Not applicable. No negotiated rates per contract,$352.33 ,86,,,$225.33 ,$397.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$327.75 ,80,,,$225.33 ,$397.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$225.33 ,55,,,$225.33 ,$397.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.21 ,95,,,$225.33 ,$397.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$389.21 ,95,,,$225.33 ,$397.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$307.27 ,75,,,$225.33 ,$397.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$348.24 ,85,,,$225.33 ,$397.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$397.40 ,97,,,$225.33 ,$397.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.33 ,55,,,$225.33 ,$397.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.72 ,90,,,$225.33 ,$397.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$397.40 ,97,,,$225.33 ,$397.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.40 ,97,,,$225.33 ,$397.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$397.40 ,97,,,$225.33 ,$397.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$348.24 ,85,,,$225.33 ,$397.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$368.72 ,90,,,$225.33 ,$397.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.33 ,55,,,$225.33 ,$397.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.21 ,90,,,$225.33 ,$397.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.33 ,55,,,$225.33 ,$397.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.01 ,93,,,$225.33 ,$397.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FORM/ADULT NURSING ASSESSMENT RECERT. FOLLOW-UP OASIS C1/ICD-10 (HH) NEW,8782293,CDM,270,RC,,HCPCS,outpatient,,,$363.15 ,$272.36 ,,$334.10 ,92,,,$199.73 ,$352.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$199.73 ,55,,,$199.73 ,$352.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$199.73 ,$352.26 ,other,,Not applicable. No negotiated rates per contract,$312.31 ,86,,,$199.73 ,$352.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$290.52 ,80,,,$199.73 ,$352.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$199.73 ,55,,,$199.73 ,$352.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.99 ,95,,,$199.73 ,$352.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$344.99 ,95,,,$199.73 ,$352.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.36 ,75,,,$199.73 ,$352.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$308.68 ,85,,,$199.73 ,$352.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$352.26 ,97,,,$199.73 ,$352.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.73 ,55,,,$199.73 ,$352.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$326.84 ,90,,,$199.73 ,$352.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$352.26 ,97,,,$199.73 ,$352.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$352.26 ,97,,,$199.73 ,$352.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$352.26 ,97,,,$199.73 ,$352.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.68 ,85,,,$199.73 ,$352.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$326.84 ,90,,,$199.73 ,$352.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$199.73 ,55,,,$199.73 ,$352.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$344.99 ,90,,,$199.73 ,$352.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$199.73 ,55,,,$199.73 ,$352.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$337.73 ,93,,,$199.73 ,$352.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FRAZIER SUCTION TUBE (8F,8782742,CDM,270,RC,,HCPCS,outpatient,,,$536.02 ,$402.02 ,,$493.14 ,92,,,$294.81 ,$519.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.81 ,$519.94 ,other,,Not applicable. No negotiated rates per contract,$460.98 ,86,,,$294.81 ,$519.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.82 ,80,,,$294.81 ,$519.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.22 ,95,,,$294.81 ,$519.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$509.22 ,95,,,$294.81 ,$519.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$402.02 ,75,,,$294.81 ,$519.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.62 ,85,,,$294.81 ,$519.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$482.42 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.62 ,85,,,$294.81 ,$519.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.42 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.22 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$498.50 ,93,,,$294.81 ,$519.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FRAZIER SUCTION TUBE 10F,8782743,CDM,270,RC,,HCPCS,outpatient,,,$536.02 ,$402.02 ,,$493.14 ,92,,,$294.81 ,$519.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.81 ,$519.94 ,other,,Not applicable. No negotiated rates per contract,$460.98 ,86,,,$294.81 ,$519.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.82 ,80,,,$294.81 ,$519.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.22 ,95,,,$294.81 ,$519.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$509.22 ,95,,,$294.81 ,$519.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$402.02 ,75,,,$294.81 ,$519.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.62 ,85,,,$294.81 ,$519.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$482.42 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.94 ,97,,,$294.81 ,$519.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.62 ,85,,,$294.81 ,$519.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.42 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.22 ,90,,,$294.81 ,$519.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.81 ,55,,,$294.81 ,$519.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$498.50 ,93,,,$294.81 ,$519.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FREER ELEVATOR 4.5MM 7 1,8783641,CDM,270,RC,,HCPCS,outpatient,,,$127.88 ,$95.91 ,,$117.65 ,92,,,$70.33 ,$124.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.33 ,$124.04 ,other,,Not applicable. No negotiated rates per contract,$109.98 ,86,,,$70.33 ,$124.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.30 ,80,,,$70.33 ,$124.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.49 ,95,,,$70.33 ,$124.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.49 ,95,,,$70.33 ,$124.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.91 ,75,,,$70.33 ,$124.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.70 ,85,,,$70.33 ,$124.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.09 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.70 ,85,,,$70.33 ,$124.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.09 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.49 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.93 ,93,,,$70.33 ,$124.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FRENCH EYE NEEDLE HOLDER,8783643,CDM,270,RC,,HCPCS,outpatient,,,$492.19 ,$369.14 ,,$452.81 ,92,,,$270.70 ,$477.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$270.70 ,55,,,$270.70 ,$477.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$270.70 ,$477.42 ,other,,Not applicable. No negotiated rates per contract,$423.28 ,86,,,$270.70 ,$477.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$393.75 ,80,,,$270.70 ,$477.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$270.70 ,55,,,$270.70 ,$477.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.58 ,95,,,$270.70 ,$477.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$467.58 ,95,,,$270.70 ,$477.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$369.14 ,75,,,$270.70 ,$477.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$418.36 ,85,,,$270.70 ,$477.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$477.42 ,97,,,$270.70 ,$477.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.70 ,55,,,$270.70 ,$477.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.97 ,90,,,$270.70 ,$477.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$477.42 ,97,,,$270.70 ,$477.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.42 ,97,,,$270.70 ,$477.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$477.42 ,97,,,$270.70 ,$477.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$418.36 ,85,,,$270.70 ,$477.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.97 ,90,,,$270.70 ,$477.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.70 ,55,,,$270.70 ,$477.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$467.58 ,90,,,$270.70 ,$477.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$270.70 ,55,,,$270.70 ,$477.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.74 ,93,,,$270.70 ,$477.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
FRONT HOUSING ASSEMBLY V,8785854,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GARBOVEL C02 TUBE SET,8942858,CDM,270,RC,,HCPCS,outpatient,,,"$1,100.75 ",$825.56 ,,"$1,012.69 ",92,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$605.41 ,55,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$605.41 ,"$1,067.73 ",other,,Not applicable. No negotiated rates per contract,$946.65 ,86,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$880.60 ,80,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$605.41 ,55,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,045.71 ",95,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,045.71 ",95,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$825.56 ,75,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$935.64 ,85,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,067.73 ",97,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$605.41 ,55,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$990.68 ,90,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,067.73 ",97,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,067.73 ",97,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,067.73 ",97,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$935.64 ,85,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$990.68 ,90,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$605.41 ,55,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,045.71 ",90,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$605.41 ,55,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,023.70 ",93,,,$605.41 ,"$1,067.73 ",percent of total billed charges,,93% of total billed charges for outpatient setting
GE MAMMO LEASE RENEWAL A,8783231,CDM,270,RC,,HCPCS,outpatient,,,$942.00 ,$706.50 ,,$866.64 ,92,,,$518.10 ,$913.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$518.10 ,$913.74 ,other,,Not applicable. No negotiated rates per contract,$810.12 ,86,,,$518.10 ,$913.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$753.60 ,80,,,$518.10 ,$913.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$894.90 ,95,,,$518.10 ,$913.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$706.50 ,75,,,$518.10 ,$913.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$913.74 ,97,,,$518.10 ,$913.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$800.70 ,85,,,$518.10 ,$913.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$847.80 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$894.90 ,90,,,$518.10 ,$913.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.10 ,55,,,$518.10 ,$913.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$876.06 ,93,,,$518.10 ,$913.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GENESIS TAMPER-EVIDENT A,8782751,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GERI-SLEEVES,8786137,CDM,270,RC,50896,HCPCS,outpatient,,,$101.60 ,$76.20 ,,$93.47 ,92,,,$55.88 ,$98.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.88 ,55,,,$55.88 ,$98.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.88 ,$98.55 ,other,,Not applicable. No negotiated rates per contract,$87.38 ,86,,,$55.88 ,$98.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$81.28 ,80,,,$55.88 ,$98.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.88 ,55,,,$55.88 ,$98.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.52 ,95,,,$55.88 ,$98.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.52 ,95,,,$55.88 ,$98.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.20 ,75,,,$55.88 ,$98.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$86.36 ,85,,,$55.88 ,$98.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$98.55 ,97,,,$55.88 ,$98.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.88 ,55,,,$55.88 ,$98.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.44 ,90,,,$55.88 ,$98.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.55 ,97,,,$55.88 ,$98.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.55 ,97,,,$55.88 ,$98.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.55 ,97,,,$55.88 ,$98.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.36 ,85,,,$55.88 ,$98.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.44 ,90,,,$55.88 ,$98.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.88 ,55,,,$55.88 ,$98.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.52 ,90,,,$55.88 ,$98.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.88 ,55,,,$55.88 ,$98.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.49 ,93,,,$55.88 ,$98.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GERI-SLEEVES,8786136,CDM,270,RC,50895,HCPCS,outpatient,,,$103.31 ,$77.48 ,,$95.05 ,92,,,$56.82 ,$100.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.82 ,$100.21 ,other,,Not applicable. No negotiated rates per contract,$88.85 ,86,,,$56.82 ,$100.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$82.65 ,80,,,$56.82 ,$100.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.14 ,95,,,$56.82 ,$100.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.14 ,95,,,$56.82 ,$100.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.48 ,75,,,$56.82 ,$100.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$87.81 ,85,,,$56.82 ,$100.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.98 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.81 ,85,,,$56.82 ,$100.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.98 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.14 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.08 ,93,,,$56.82 ,$100.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GERI-SLEEVES,8786142,CDM,270,RC,51488,HCPCS,outpatient,,,$103.31 ,$77.48 ,,$95.05 ,92,,,$56.82 ,$100.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.82 ,$100.21 ,other,,Not applicable. No negotiated rates per contract,$88.85 ,86,,,$56.82 ,$100.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$82.65 ,80,,,$56.82 ,$100.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.14 ,95,,,$56.82 ,$100.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.14 ,95,,,$56.82 ,$100.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.48 ,75,,,$56.82 ,$100.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$87.81 ,85,,,$56.82 ,$100.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.98 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.21 ,97,,,$56.82 ,$100.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.81 ,85,,,$56.82 ,$100.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.98 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.14 ,90,,,$56.82 ,$100.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.82 ,55,,,$56.82 ,$100.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.08 ,93,,,$56.82 ,$100.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLIDERITE SINGLE USE STYLET,9578992,CDM,270,RC,31605,HCPCS,outpatient,,,$82.50 ,$61.88 ,,$75.90 ,92,,,$45.38 ,$80.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.38 ,55,,,$45.38 ,$80.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.38 ,$80.03 ,other,,Not applicable. No negotiated rates per contract,$70.95 ,86,,,$45.38 ,$80.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$66.00 ,80,,,$45.38 ,$80.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.38 ,55,,,$45.38 ,$80.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.38 ,95,,,$45.38 ,$80.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.38 ,95,,,$45.38 ,$80.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.88 ,75,,,$45.38 ,$80.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$70.13 ,85,,,$45.38 ,$80.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.03 ,97,,,$45.38 ,$80.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,55,,,$45.38 ,$80.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.25 ,90,,,$45.38 ,$80.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.03 ,97,,,$45.38 ,$80.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.03 ,97,,,$45.38 ,$80.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.03 ,97,,,$45.38 ,$80.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.13 ,85,,,$45.38 ,$80.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.25 ,90,,,$45.38 ,$80.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.38 ,55,,,$45.38 ,$80.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.38 ,90,,,$45.38 ,$80.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.38 ,55,,,$45.38 ,$80.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.73 ,93,,,$45.38 ,$80.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLIDESCOPE  SZ 4,8786963,CDM,270,RC,,HCPCS,outpatient,,,$139.50 ,$104.63 ,,$128.34 ,92,,,$76.73 ,$135.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.73 ,$135.32 ,other,,Not applicable. No negotiated rates per contract,$119.97 ,86,,,$76.73 ,$135.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$111.60 ,80,,,$76.73 ,$135.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.63 ,75,,,$76.73 ,$135.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.74 ,93,,,$76.73 ,$135.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLIDESCOPE SZ 2,8786965,CDM,270,RC,,HCPCS,outpatient,,,$166.03 ,$124.52 ,,$152.75 ,92,,,$91.32 ,$161.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.32 ,55,,,$91.32 ,$161.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$91.32 ,$161.05 ,other,,Not applicable. No negotiated rates per contract,$142.79 ,86,,,$91.32 ,$161.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.82 ,80,,,$91.32 ,$161.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.32 ,55,,,$91.32 ,$161.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.73 ,95,,,$91.32 ,$161.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.73 ,95,,,$91.32 ,$161.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.52 ,75,,,$91.32 ,$161.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$141.13 ,85,,,$91.32 ,$161.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$161.05 ,97,,,$91.32 ,$161.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.32 ,55,,,$91.32 ,$161.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$149.43 ,90,,,$91.32 ,$161.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$161.05 ,97,,,$91.32 ,$161.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.05 ,97,,,$91.32 ,$161.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.05 ,97,,,$91.32 ,$161.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.13 ,85,,,$91.32 ,$161.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.43 ,90,,,$91.32 ,$161.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.32 ,55,,,$91.32 ,$161.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.73 ,90,,,$91.32 ,$161.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.32 ,55,,,$91.32 ,$161.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.41 ,93,,,$91.32 ,$161.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLIDESCOPE SZ 3,8786964,CDM,270,RC,,HCPCS,outpatient,,,$132.53 ,$99.40 ,,$121.93 ,92,,,$72.89 ,$128.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.89 ,$128.55 ,other,,Not applicable. No negotiated rates per contract,$113.98 ,86,,,$72.89 ,$128.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$106.02 ,80,,,$72.89 ,$128.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.90 ,95,,,$72.89 ,$128.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.90 ,95,,,$72.89 ,$128.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.40 ,75,,,$72.89 ,$128.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.65 ,85,,,$72.89 ,$128.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.28 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.55 ,97,,,$72.89 ,$128.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.65 ,85,,,$72.89 ,$128.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.28 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.90 ,90,,,$72.89 ,$128.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.89 ,55,,,$72.89 ,$128.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.25 ,93,,,$72.89 ,$128.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLIDESCOPE SZ1,8786966,CDM,270,RC,,HCPCS,outpatient,,,$174.00 ,$130.50 ,,$160.08 ,92,,,$95.70 ,$168.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$95.70 ,$168.78 ,other,,Not applicable. No negotiated rates per contract,$149.64 ,86,,,$95.70 ,$168.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$139.20 ,80,,,$95.70 ,$168.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,95,,,$95.70 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.30 ,95,,,$95.70 ,$168.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.50 ,75,,,$95.70 ,$168.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.90 ,85,,,$95.70 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.60 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.78 ,97,,,$95.70 ,$168.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.90 ,85,,,$95.70 ,$168.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.60 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.30 ,90,,,$95.70 ,$168.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.70 ,55,,,$95.70 ,$168.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.82 ,93,,,$95.70 ,$168.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVE,8786162,CDM,270,RC,,HCPCS,outpatient,,,$175.02 ,$131.27 ,,$161.02 ,92,,,$96.26 ,$169.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.26 ,$169.77 ,other,,Not applicable. No negotiated rates per contract,$150.52 ,86,,,$96.26 ,$169.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.02 ,80,,,$96.26 ,$169.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.27 ,75,,,$96.26 ,$169.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.77 ,93,,,$96.26 ,$169.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8785721,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8783075,CDM,270,RC,,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8786131,CDM,270,RC,50752,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8786133,CDM,270,RC,50754,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8786130,CDM,270,RC,50751,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8786134,CDM,270,RC,50755,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GLOVES,8786132,CDM,270,RC,50753,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GOWN SMART SLEEVE XXL X-LONG,8782536,CDM,270,RC,,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GOWN,8785580,CDM,270,RC,,HCPCS,outpatient,,,$150.66 ,$113.00 ,,$138.61 ,92,,,$82.86 ,$146.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.86 ,55,,,$82.86 ,$146.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.86 ,$146.14 ,other,,Not applicable. No negotiated rates per contract,$129.57 ,86,,,$82.86 ,$146.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.53 ,80,,,$82.86 ,$146.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.86 ,55,,,$82.86 ,$146.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.13 ,95,,,$82.86 ,$146.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.13 ,95,,,$82.86 ,$146.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.00 ,75,,,$82.86 ,$146.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.06 ,85,,,$82.86 ,$146.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.14 ,97,,,$82.86 ,$146.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.86 ,55,,,$82.86 ,$146.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.59 ,90,,,$82.86 ,$146.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.14 ,97,,,$82.86 ,$146.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.14 ,97,,,$82.86 ,$146.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.14 ,97,,,$82.86 ,$146.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.06 ,85,,,$82.86 ,$146.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.59 ,90,,,$82.86 ,$146.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.86 ,55,,,$82.86 ,$146.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.13 ,90,,,$82.86 ,$146.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.86 ,55,,,$82.86 ,$146.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.11 ,93,,,$82.86 ,$146.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GOWN,8843983,CDM,270,RC,,HCPCS,outpatient,,,$85.02 ,$63.77 ,,$78.22 ,92,,,$46.76 ,$82.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.76 ,55,,,$46.76 ,$82.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.76 ,$82.47 ,other,,Not applicable. No negotiated rates per contract,$73.12 ,86,,,$46.76 ,$82.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.02 ,80,,,$46.76 ,$82.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.76 ,55,,,$46.76 ,$82.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.77 ,95,,,$46.76 ,$82.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.77 ,95,,,$46.76 ,$82.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.77 ,75,,,$46.76 ,$82.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.27 ,85,,,$46.76 ,$82.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.47 ,97,,,$46.76 ,$82.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.76 ,55,,,$46.76 ,$82.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.52 ,90,,,$46.76 ,$82.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.47 ,97,,,$46.76 ,$82.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.47 ,97,,,$46.76 ,$82.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.47 ,97,,,$46.76 ,$82.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.27 ,85,,,$46.76 ,$82.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.52 ,90,,,$46.76 ,$82.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.76 ,55,,,$46.76 ,$82.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.77 ,90,,,$46.76 ,$82.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.76 ,55,,,$46.76 ,$82.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.07 ,93,,,$46.76 ,$82.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GOWN,8786699,CDM,270,RC,,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.80 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GOWN,8786696,CDM,270,RC,54038,HCPCS,outpatient,,,$40.00 ,$30.00 ,,$36.80 ,92,,,$22.00 ,$38.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.00 ,$38.80 ,other,,Not applicable. No negotiated rates per contract,$34.40 ,86,,,$22.00 ,$38.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.00 ,80,,,$22.00 ,$38.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.00 ,75,,,$22.00 ,$38.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.20 ,93,,,$22.00 ,$38.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
GUIDE WIRE,8786863,CDM,270,RC,,HCPCS,outpatient,,,$196.62 ,$147.47 ,,$180.89 ,92,,,$108.14 ,$190.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.14 ,55,,,$108.14 ,$190.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$108.14 ,$190.72 ,other,,Not applicable. No negotiated rates per contract,$169.09 ,86,,,$108.14 ,$190.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$157.30 ,80,,,$108.14 ,$190.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.14 ,55,,,$108.14 ,$190.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.79 ,95,,,$108.14 ,$190.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$186.79 ,95,,,$108.14 ,$190.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$147.47 ,75,,,$108.14 ,$190.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$167.13 ,85,,,$108.14 ,$190.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.72 ,97,,,$108.14 ,$190.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.14 ,55,,,$108.14 ,$190.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.96 ,90,,,$108.14 ,$190.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.72 ,97,,,$108.14 ,$190.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.72 ,97,,,$108.14 ,$190.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.72 ,97,,,$108.14 ,$190.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$167.13 ,85,,,$108.14 ,$190.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.96 ,90,,,$108.14 ,$190.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.14 ,55,,,$108.14 ,$190.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.79 ,90,,,$108.14 ,$190.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.14 ,55,,,$108.14 ,$190.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.86 ,93,,,$108.14 ,$190.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HANGING FILE FOLDERS  (S,8784627,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HARMONIC ACE 36CM W/ ERG,8783809,CDM,270,RC,,HCPCS,outpatient,,,"$2,906.41 ","$2,179.81 ",,"$2,673.90 ",92,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,598.53 ",55,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,598.53 ","$2,819.22 ",other,,Not applicable. No negotiated rates per contract,"$2,499.51 ",86,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,325.13 ",80,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,598.53 ",55,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,761.09 ",95,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,761.09 ",95,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,179.81 ",75,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,470.45 ",85,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,819.22 ",97,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,598.53 ",55,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,615.77 ",90,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,819.22 ",97,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,819.22 ",97,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,819.22 ",97,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,470.45 ",85,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,615.77 ",90,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,598.53 ",55,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,761.09 ",90,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,598.53 ",55,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,702.96 ",93,,,"$1,598.53 ","$2,819.22 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HARMONIC FOCUS 9CM CURVE,8783810,CDM,270,RC,,HCPCS,outpatient,,,"$1,462.00 ","$1,096.50 ",,"$1,345.04 ",92,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$804.10 ,55,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$804.10 ,"$1,418.14 ",other,,Not applicable. No negotiated rates per contract,"$1,257.32 ",86,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,169.60 ",80,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$804.10 ,55,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,388.90 ",95,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,388.90 ",95,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,096.50 ",75,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,242.70 ",85,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,418.14 ",97,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$804.10 ,55,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,315.80 ",90,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,418.14 ",97,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,418.14 ",97,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,418.14 ",97,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,242.70 ",85,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,315.80 ",90,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$804.10 ,55,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,388.90 ",90,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$804.10 ,55,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,359.66 ",93,,,$804.10 ,"$1,418.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HEAD BLOCK,8843980,CDM,270,RC,,HCPCS,outpatient,,,$37.54 ,$28.16 ,,$34.54 ,92,,,$20.65 ,$36.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.65 ,55,,,$20.65 ,$36.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.65 ,$36.41 ,other,,Not applicable. No negotiated rates per contract,$32.28 ,86,,,$20.65 ,$36.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.03 ,80,,,$20.65 ,$36.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.65 ,55,,,$20.65 ,$36.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.66 ,95,,,$20.65 ,$36.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.66 ,95,,,$20.65 ,$36.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.16 ,75,,,$20.65 ,$36.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.91 ,85,,,$20.65 ,$36.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.41 ,97,,,$20.65 ,$36.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.65 ,55,,,$20.65 ,$36.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.79 ,90,,,$20.65 ,$36.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.41 ,97,,,$20.65 ,$36.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.41 ,97,,,$20.65 ,$36.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.41 ,97,,,$20.65 ,$36.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.91 ,85,,,$20.65 ,$36.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.79 ,90,,,$20.65 ,$36.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.65 ,55,,,$20.65 ,$36.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.66 ,90,,,$20.65 ,$36.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.65 ,55,,,$20.65 ,$36.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.91 ,93,,,$20.65 ,$36.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEAD REST WITH ET SLITS,8786518,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEALIX 4.5 ADVANCE         HEAL,8783804,CDM,270,RC,,HCPCS,outpatient,,,"$1,893.63 ","$1,420.22 ",,"$1,742.14 ",92,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,041.50 ","$1,836.82 ",other,,Not applicable. No negotiated rates per contract,"$1,628.52 ",86,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,514.90 ",80,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.95 ",95,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,798.95 ",95,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,420.22 ",75,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,609.59 ",85,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,704.27 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,609.59 ",85,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,704.27 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.95 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,761.08 ",93,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HEALIX 4.5 TRIPLE,8783801,CDM,270,RC,,HCPCS,outpatient,,,"$1,987.64 ","$1,490.73 ",,"$1,828.63 ",92,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,093.20 ",55,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,093.20 ","$1,928.01 ",other,,Not applicable. No negotiated rates per contract,"$1,709.37 ",86,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,590.11 ",80,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,093.20 ",55,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,888.26 ",95,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,888.26 ",95,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,490.73 ",75,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,689.49 ",85,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,928.01 ",97,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,093.20 ",55,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,788.88 ",90,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,928.01 ",97,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,928.01 ",97,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,928.01 ",97,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,689.49 ",85,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,788.88 ",90,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,093.20 ",55,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,888.26 ",90,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,093.20 ",55,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,848.51 ",93,,,"$1,093.20 ","$1,928.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HEALIX 6.5 ADVANCE BR W/,8942859,CDM,270,RC,,HCPCS,outpatient,,,"$1,893.63 ","$1,420.22 ",,"$1,742.14 ",92,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,041.50 ","$1,836.82 ",other,,Not applicable. No negotiated rates per contract,"$1,628.52 ",86,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,514.90 ",80,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.95 ",95,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,798.95 ",95,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,420.22 ",75,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,609.59 ",85,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,704.27 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,836.82 ",97,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,609.59 ",85,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,704.27 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.95 ",90,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,041.50 ",55,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,761.08 ",93,,,"$1,041.50 ","$1,836.82 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HEEL FLOAT (SKIL-CARE HE,8786128,CDM,270,RC,,HCPCS,outpatient,,,$259.19 ,$194.39 ,,$238.45 ,92,,,$142.55 ,$251.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.55 ,55,,,$142.55 ,$251.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.55 ,$251.41 ,other,,Not applicable. No negotiated rates per contract,$222.90 ,86,,,$142.55 ,$251.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.35 ,80,,,$142.55 ,$251.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.55 ,55,,,$142.55 ,$251.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.23 ,95,,,$142.55 ,$251.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.23 ,95,,,$142.55 ,$251.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.39 ,75,,,$142.55 ,$251.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.31 ,85,,,$142.55 ,$251.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.41 ,97,,,$142.55 ,$251.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.55 ,55,,,$142.55 ,$251.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.27 ,90,,,$142.55 ,$251.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.41 ,97,,,$142.55 ,$251.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.41 ,97,,,$142.55 ,$251.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.41 ,97,,,$142.55 ,$251.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.31 ,85,,,$142.55 ,$251.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.27 ,90,,,$142.55 ,$251.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.55 ,55,,,$142.55 ,$251.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.23 ,90,,,$142.55 ,$251.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.55 ,55,,,$142.55 ,$251.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.05 ,93,,,$142.55 ,$251.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEEL PROTECTOR TRIPLE-PL,8786135,CDM,270,RC,,HCPCS,outpatient,,,$44.72 ,$33.54 ,,$41.14 ,92,,,$24.60 ,$43.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.60 ,$43.38 ,other,,Not applicable. No negotiated rates per contract,$38.46 ,86,,,$24.60 ,$43.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.78 ,80,,,$24.60 ,$43.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.54 ,75,,,$24.60 ,$43.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.59 ,93,,,$24.60 ,$43.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEELBO PAD L3480,8971142,CDM,270,RC,L3480,HCPCS,outpatient,,,$85.00 ,$63.75 ,,$78.20 ,92,,,$46.75 ,$82.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.75 ,$82.45 ,other,,Not applicable. No negotiated rates per contract,$73.10 ,86,,,$46.75 ,$82.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.00 ,80,,,$46.75 ,$82.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.75 ,75,,,$46.75 ,$82.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.05 ,93,,,$46.75 ,$82.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEMADUCT,8782520,CDM,270,RC,,HCPCS,outpatient,,,$257.74 ,$193.31 ,,$237.12 ,92,,,$141.76 ,$250.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.76 ,55,,,$141.76 ,$250.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$141.76 ,$250.01 ,other,,Not applicable. No negotiated rates per contract,$221.66 ,86,,,$141.76 ,$250.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$206.19 ,80,,,$141.76 ,$250.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.76 ,55,,,$141.76 ,$250.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.85 ,95,,,$141.76 ,$250.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$244.85 ,95,,,$141.76 ,$250.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.31 ,75,,,$141.76 ,$250.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$219.08 ,85,,,$141.76 ,$250.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.01 ,97,,,$141.76 ,$250.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.76 ,55,,,$141.76 ,$250.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.97 ,90,,,$141.76 ,$250.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.01 ,97,,,$141.76 ,$250.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.01 ,97,,,$141.76 ,$250.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.01 ,97,,,$141.76 ,$250.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.08 ,85,,,$141.76 ,$250.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$231.97 ,90,,,$141.76 ,$250.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.76 ,55,,,$141.76 ,$250.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.85 ,90,,,$141.76 ,$250.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.76 ,55,,,$141.76 ,$250.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.70 ,93,,,$141.76 ,$250.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HERAEUS,9536215,CDM,272,RC,55192,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
"HERNIA PATCH (ONFLEX 4""",8782318,CDM,270,RC,,HCPCS,outpatient,,,"$2,252.50 ","$1,689.38 ",,"$2,072.30 ",92,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,238.88 ",55,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,238.88 ","$2,184.93 ",other,,Not applicable. No negotiated rates per contract,"$1,937.15 ",86,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,802.00 ",80,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,238.88 ",55,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,139.88 ",95,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,139.88 ",95,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,689.38 ",75,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,914.63 ",85,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,184.93 ",97,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,238.88 ",55,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,027.25 ",90,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,184.93 ",97,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,184.93 ",97,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,184.93 ",97,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,914.63 ",85,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,027.25 ",90,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,238.88 ",55,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,139.88 ",90,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,238.88 ",55,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,094.83 ",93,,,"$1,238.88 ","$2,184.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HERNIA PATCH LARGE CIRCL,8782323,CDM,270,RC,,HCPCS,outpatient,,,"$4,122.50 ","$3,091.88 ",,"$3,792.70 ",92,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,267.38 ",55,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,267.38 ","$3,998.83 ",other,,Not applicable. No negotiated rates per contract,"$3,545.35 ",86,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,298.00 ",80,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,267.38 ",55,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,916.38 ",95,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,916.38 ",95,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,091.88 ",75,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,504.13 ",85,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,998.83 ",97,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,267.38 ",55,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,710.25 ",90,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,998.83 ",97,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,998.83 ",97,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,998.83 ",97,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,504.13 ",85,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,710.25 ",90,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,267.38 ",55,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,916.38 ",90,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,267.38 ",55,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,833.93 ",93,,,"$2,267.38 ","$3,998.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"HERNIA PATCH VENTRIO ST MEDIUM OVAL 4.3"" X 5.5"" ( 11CM X 14CM) (EXPANDABLE)- OR",8782321,CDM,270,RC,,HCPCS,outpatient,,,"$5,400.00 ","$4,050.00 ",,"$4,968.00 ",92,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,970.00 ",55,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,970.00 ","$5,238.00 ",other,,Not applicable. No negotiated rates per contract,"$4,644.00 ",86,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,320.00 ",80,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,970.00 ",55,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,130.00 ",95,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,130.00 ",95,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,050.00 ",75,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,590.00 ",85,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,238.00 ",97,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,970.00 ",55,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,860.00 ",90,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,238.00 ",97,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,238.00 ",97,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,238.00 ",97,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,590.00 ",85,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,860.00 ",90,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,970.00 ",55,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,130.00 ",90,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,970.00 ",55,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,022.00 ",93,,,"$2,970.00 ","$5,238.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"HERNIA PATCH VENTRIO ST SMALL OVAL 3.1"" X 4.7"" ( 8.0cm x 12cm) (EXPANDABLE)- OR (DAVOL)",8782320,CDM,278,RC,C1781,HCPCS,both,,,"$4,125.48 ","$3,094.11 ",,"$3,795.44 ",92,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,269.01 ",55,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,269.01 ","$4,001.72 ",other,,Not applicable. No negotiated rates per contract,"$3,547.91 ",86,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,300.38 ",80,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,269.01 ",55,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.21 ",95,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,919.21 ",95,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,094.11 ",75,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,506.66 ",85,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,001.72 ",97,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,269.01 ",55,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,712.93 ",90,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,001.72 ",97,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,001.72 ",97,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,001.72 ",97,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,506.66 ",85,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,712.93 ",90,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.01 ",55,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,919.21 ",90,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,269.01 ",55,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,836.70 ",93,,,"$2,269.01 ","$4,001.72 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HERNIA PATCH,8782324,CDM,270,RC,,HCPCS,outpatient,,,"$3,352.40 ","$2,514.30 ",,"$3,084.21 ",92,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,843.82 ",55,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,843.82 ","$3,251.83 ",other,,Not applicable. No negotiated rates per contract,"$2,883.06 ",86,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,681.92 ",80,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,843.82 ",55,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,184.78 ",95,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,184.78 ",95,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,514.30 ",75,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,849.54 ",85,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,251.83 ",97,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,843.82 ",55,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,017.16 ",90,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,251.83 ",97,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,251.83 ",97,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,251.83 ",97,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,849.54 ",85,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,017.16 ",90,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,843.82 ",55,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,184.78 ",90,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,843.82 ",55,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,117.73 ",93,,,"$1,843.82 ","$3,251.83 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HERNIA PATCH,8785076,CDM,270,RC,,HCPCS,outpatient,,,"$3,036.67 ","$2,277.50 ",,"$2,793.74 ",92,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,670.17 ",55,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,670.17 ","$2,945.57 ",other,,Not applicable. No negotiated rates per contract,"$2,611.54 ",86,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,429.34 ",80,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,670.17 ",55,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,884.84 ",95,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,884.84 ",95,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,277.50 ",75,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,581.17 ",85,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,945.57 ",97,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,670.17 ",55,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,733.00 ",90,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,945.57 ",97,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,945.57 ",97,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,945.57 ",97,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,581.17 ",85,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,733.00 ",90,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,670.17 ",55,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,884.84 ",90,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,670.17 ",55,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,824.10 ",93,,,"$1,670.17 ","$2,945.57 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HEWSON SUTURE RETRIEVER,8961305,CDM,270,RC,,HCPCS,outpatient,,,"$1,418.44 ","$1,063.83 ",,"$1,304.96 ",92,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$780.14 ,55,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$780.14 ,"$1,375.89 ",other,,Not applicable. No negotiated rates per contract,"$1,219.86 ",86,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,134.75 ",80,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$780.14 ,55,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,347.52 ",95,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,347.52 ",95,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,063.83 ",75,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,205.67 ",85,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,375.89 ",97,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$780.14 ,55,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,276.60 ",90,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,375.89 ",97,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,375.89 ",97,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,375.89 ",97,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,205.67 ",85,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,276.60 ",90,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$780.14 ,55,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,347.52 ",90,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$780.14 ,55,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,319.15 ",93,,,$780.14 ,"$1,375.89 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HFO,8971149,CDM,270,RC,L3923,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HIGH STRENGHT GUIDE PIN,8782871,CDM,270,RC,,HCPCS,outpatient,,,$343.98 ,$257.99 ,,$316.46 ,92,,,$189.19 ,$333.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$189.19 ,55,,,$189.19 ,$333.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$189.19 ,$333.66 ,other,,Not applicable. No negotiated rates per contract,$295.82 ,86,,,$189.19 ,$333.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$275.18 ,80,,,$189.19 ,$333.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$189.19 ,55,,,$189.19 ,$333.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$326.78 ,95,,,$189.19 ,$333.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.78 ,95,,,$189.19 ,$333.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.99 ,75,,,$189.19 ,$333.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$292.38 ,85,,,$189.19 ,$333.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$333.66 ,97,,,$189.19 ,$333.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.19 ,55,,,$189.19 ,$333.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$309.58 ,90,,,$189.19 ,$333.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$333.66 ,97,,,$189.19 ,$333.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$333.66 ,97,,,$189.19 ,$333.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$333.66 ,97,,,$189.19 ,$333.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$292.38 ,85,,,$189.19 ,$333.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$309.58 ,90,,,$189.19 ,$333.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.19 ,55,,,$189.19 ,$333.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$326.78 ,90,,,$189.19 ,$333.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.19 ,55,,,$189.19 ,$333.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$319.90 ,93,,,$189.19 ,$333.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HINGED KNEE SUPPORT W/OPEN L1810,8971135,CDM,270,RC,L1810,HCPCS,outpatient,,,$270.00 ,$202.50 ,,$248.40 ,92,,,$148.50 ,$261.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$148.50 ,55,,,$148.50 ,$261.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$148.50 ,$261.90 ,other,,Not applicable. No negotiated rates per contract,$232.20 ,86,,,$148.50 ,$261.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$216.00 ,80,,,$148.50 ,$261.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$148.50 ,55,,,$148.50 ,$261.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.50 ,95,,,$148.50 ,$261.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$256.50 ,95,,,$148.50 ,$261.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$202.50 ,75,,,$148.50 ,$261.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$229.50 ,85,,,$148.50 ,$261.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.90 ,97,,,$148.50 ,$261.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.50 ,55,,,$148.50 ,$261.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$243.00 ,90,,,$148.50 ,$261.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.90 ,97,,,$148.50 ,$261.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.90 ,97,,,$148.50 ,$261.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.90 ,97,,,$148.50 ,$261.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$229.50 ,85,,,$148.50 ,$261.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$243.00 ,90,,,$148.50 ,$261.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.50 ,55,,,$148.50 ,$261.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.50 ,90,,,$148.50 ,$261.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.50 ,55,,,$148.50 ,$261.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.10 ,93,,,$148.50 ,$261.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HOHMANN BONE ELEVATOR (O,8782050,CDM,270,RC,,HCPCS,outpatient,,,$276.21 ,$207.16 ,,$254.11 ,92,,,$151.92 ,$267.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$151.92 ,55,,,$151.92 ,$267.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$151.92 ,$267.92 ,other,,Not applicable. No negotiated rates per contract,$237.54 ,86,,,$151.92 ,$267.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$220.97 ,80,,,$151.92 ,$267.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$151.92 ,55,,,$151.92 ,$267.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.40 ,95,,,$151.92 ,$267.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$262.40 ,95,,,$151.92 ,$267.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$207.16 ,75,,,$151.92 ,$267.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$234.78 ,85,,,$151.92 ,$267.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.92 ,97,,,$151.92 ,$267.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.92 ,55,,,$151.92 ,$267.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.59 ,90,,,$151.92 ,$267.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.92 ,97,,,$151.92 ,$267.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.92 ,97,,,$151.92 ,$267.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.92 ,97,,,$151.92 ,$267.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$234.78 ,85,,,$151.92 ,$267.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$248.59 ,90,,,$151.92 ,$267.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.92 ,55,,,$151.92 ,$267.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.40 ,90,,,$151.92 ,$267.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.92 ,55,,,$151.92 ,$267.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.88 ,93,,,$151.92 ,$267.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HOMEPUMP ECLIPSE C-SERIES TUBING,8784101,CDM,270,RC,,HCPCS,outpatient,,,$200.46 ,$150.35 ,,$184.42 ,92,,,$110.25 ,$194.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$110.25 ,55,,,$110.25 ,$194.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$110.25 ,$194.45 ,other,,Not applicable. No negotiated rates per contract,$172.40 ,86,,,$110.25 ,$194.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$160.37 ,80,,,$110.25 ,$194.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$110.25 ,55,,,$110.25 ,$194.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.44 ,95,,,$110.25 ,$194.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.44 ,95,,,$110.25 ,$194.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$150.35 ,75,,,$110.25 ,$194.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$170.39 ,85,,,$110.25 ,$194.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$194.45 ,97,,,$110.25 ,$194.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.25 ,55,,,$110.25 ,$194.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.41 ,90,,,$110.25 ,$194.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$194.45 ,97,,,$110.25 ,$194.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$194.45 ,97,,,$110.25 ,$194.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$194.45 ,97,,,$110.25 ,$194.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$170.39 ,85,,,$110.25 ,$194.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.41 ,90,,,$110.25 ,$194.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.25 ,55,,,$110.25 ,$194.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.44 ,90,,,$110.25 ,$194.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.25 ,55,,,$110.25 ,$194.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.43 ,93,,,$110.25 ,$194.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HOOD INSPECTION (PM WORK,8783677,CDM,270,RC,,HCPCS,outpatient,,,"$3,873.32 ","$2,904.99 ",,"$3,563.45 ",92,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,130.33 ",55,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,130.33 ","$3,757.12 ",other,,Not applicable. No negotiated rates per contract,"$3,331.06 ",86,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,098.66 ",80,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,130.33 ",55,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,679.65 ",95,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,679.65 ",95,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,904.99 ",75,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,292.32 ",85,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,757.12 ",97,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,130.33 ",55,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,485.99 ",90,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,757.12 ",97,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,757.12 ",97,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,757.12 ",97,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,292.32 ",85,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,485.99 ",90,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,130.33 ",55,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,679.65 ",90,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,130.33 ",55,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,602.19 ",93,,,"$2,130.33 ","$3,757.12 ",percent of total billed charges,,93% of total billed charges for outpatient setting
HOOK,8782709,CDM,270,RC,53620,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HOOK,8782710,CDM,270,RC,53632,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HOSPIRA SAPPHIRE PRIMARY MICROBORE TUBING INFUSION SET,8782020,CDM,270,RC,,HCPCS,outpatient,,,$70.37 ,$52.78 ,,$64.74 ,92,,,$38.70 ,$68.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.70 ,55,,,$38.70 ,$68.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.70 ,$68.26 ,other,,Not applicable. No negotiated rates per contract,$60.52 ,86,,,$38.70 ,$68.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.30 ,80,,,$38.70 ,$68.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.70 ,55,,,$38.70 ,$68.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.85 ,95,,,$38.70 ,$68.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.85 ,95,,,$38.70 ,$68.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.78 ,75,,,$38.70 ,$68.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.81 ,85,,,$38.70 ,$68.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.26 ,97,,,$38.70 ,$68.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.70 ,55,,,$38.70 ,$68.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.33 ,90,,,$38.70 ,$68.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.26 ,97,,,$38.70 ,$68.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.26 ,97,,,$38.70 ,$68.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.26 ,97,,,$38.70 ,$68.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.81 ,85,,,$38.70 ,$68.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.33 ,90,,,$38.70 ,$68.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.70 ,55,,,$38.70 ,$68.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.85 ,90,,,$38.70 ,$68.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.70 ,55,,,$38.70 ,$68.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.44 ,93,,,$38.70 ,$68.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HOT SWAP HARD DRIVE SOLU,8786031,CDM,270,RC,,HCPCS,outpatient,,,$779.00 ,$584.25 ,,$716.68 ,92,,,$428.45 ,$755.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$428.45 ,55,,,$428.45 ,$755.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$428.45 ,$755.63 ,other,,Not applicable. No negotiated rates per contract,$669.94 ,86,,,$428.45 ,$755.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$623.20 ,80,,,$428.45 ,$755.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$428.45 ,55,,,$428.45 ,$755.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$740.05 ,95,,,$428.45 ,$755.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$740.05 ,95,,,$428.45 ,$755.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$584.25 ,75,,,$428.45 ,$755.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$662.15 ,85,,,$428.45 ,$755.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$755.63 ,97,,,$428.45 ,$755.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$428.45 ,55,,,$428.45 ,$755.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$701.10 ,90,,,$428.45 ,$755.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$755.63 ,97,,,$428.45 ,$755.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$755.63 ,97,,,$428.45 ,$755.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$755.63 ,97,,,$428.45 ,$755.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$662.15 ,85,,,$428.45 ,$755.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$701.10 ,90,,,$428.45 ,$755.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$428.45 ,55,,,$428.45 ,$755.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$740.05 ,90,,,$428.45 ,$755.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$428.45 ,55,,,$428.45 ,$755.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$724.47 ,93,,,$428.45 ,$755.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HUMID-VENT 2 STRAIGHT,8781911,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HUMIDIFIER COOL MIST (41,8784972,CDM,270,RC,,HCPCS,outpatient,,,$148.48 ,$111.36 ,,$136.60 ,92,,,$81.66 ,$144.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.66 ,55,,,$81.66 ,$144.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.66 ,$144.03 ,other,,Not applicable. No negotiated rates per contract,$127.69 ,86,,,$81.66 ,$144.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.78 ,80,,,$81.66 ,$144.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.66 ,55,,,$81.66 ,$144.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.06 ,95,,,$81.66 ,$144.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.06 ,95,,,$81.66 ,$144.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.36 ,75,,,$81.66 ,$144.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.21 ,85,,,$81.66 ,$144.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.03 ,97,,,$81.66 ,$144.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.66 ,55,,,$81.66 ,$144.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.63 ,90,,,$81.66 ,$144.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.03 ,97,,,$81.66 ,$144.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.03 ,97,,,$81.66 ,$144.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.03 ,97,,,$81.66 ,$144.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.21 ,85,,,$81.66 ,$144.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.63 ,90,,,$81.66 ,$144.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.66 ,55,,,$81.66 ,$144.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.06 ,90,,,$81.66 ,$144.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.66 ,55,,,$81.66 ,$144.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.09 ,93,,,$81.66 ,$144.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HYPERINFLATION SYSTEM W/,8785157,CDM,270,RC,,HCPCS,outpatient,,,$108.58 ,$81.44 ,,$99.89 ,92,,,$59.72 ,$105.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$59.72 ,55,,,$59.72 ,$105.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$59.72 ,$105.32 ,other,,Not applicable. No negotiated rates per contract,$93.38 ,86,,,$59.72 ,$105.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$86.86 ,80,,,$59.72 ,$105.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$59.72 ,55,,,$59.72 ,$105.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.15 ,95,,,$59.72 ,$105.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.15 ,95,,,$59.72 ,$105.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$81.44 ,75,,,$59.72 ,$105.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$92.29 ,85,,,$59.72 ,$105.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$105.32 ,97,,,$59.72 ,$105.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.72 ,55,,,$59.72 ,$105.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.72 ,90,,,$59.72 ,$105.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.32 ,97,,,$59.72 ,$105.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.32 ,97,,,$59.72 ,$105.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.32 ,97,,,$59.72 ,$105.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.29 ,85,,,$59.72 ,$105.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.72 ,90,,,$59.72 ,$105.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.72 ,55,,,$59.72 ,$105.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.15 ,90,,,$59.72 ,$105.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$59.72 ,55,,,$59.72 ,$105.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.98 ,93,,,$59.72 ,$105.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Heated Tube Set with Real-Time Pressure Sensing (RTP) for Pneumo Sure High Flow Insufflator,10612822,CDM,272,RC,,HCPCS,outpatient,,,$347.69 ,$260.77 ,,$319.87 ,92,,,$191.23 ,$337.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$191.23 ,55,,,$191.23 ,$337.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$191.23 ,$337.26 ,other,,Not applicable. No negotiated rates per contract,$299.01 ,86,,,$191.23 ,$337.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$278.15 ,80,,,$191.23 ,$337.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$191.23 ,55,,,$191.23 ,$337.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.31 ,95,,,$191.23 ,$337.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.31 ,95,,,$191.23 ,$337.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.77 ,75,,,$191.23 ,$337.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$295.54 ,85,,,$191.23 ,$337.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.26 ,97,,,$191.23 ,$337.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.23 ,55,,,$191.23 ,$337.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.92 ,90,,,$191.23 ,$337.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.26 ,97,,,$191.23 ,$337.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.26 ,97,,,$191.23 ,$337.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.26 ,97,,,$191.23 ,$337.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.54 ,85,,,$191.23 ,$337.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$312.92 ,90,,,$191.23 ,$337.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.23 ,55,,,$191.23 ,$337.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.31 ,90,,,$191.23 ,$337.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.23 ,55,,,$191.23 ,$337.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.35 ,93,,,$191.23 ,$337.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SIZE 1 SUPRAGLOTTIC AIRWAY,8783068,CDM,270,RC,,HCPCS,outpatient,,,$154.35 ,$115.76 ,,$142.00 ,92,,,$84.89 ,$149.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.89 ,$149.72 ,other,,Not applicable. No negotiated rates per contract,$132.74 ,86,,,$84.89 ,$149.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.48 ,80,,,$84.89 ,$149.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.63 ,95,,,$84.89 ,$149.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.63 ,95,,,$84.89 ,$149.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.76 ,75,,,$84.89 ,$149.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.20 ,85,,,$84.89 ,$149.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.92 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.20 ,85,,,$84.89 ,$149.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.92 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.63 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.55 ,93,,,$84.89 ,$149.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SIZE 1.5 SUPRAGLOTTIC AIRWAY,8783066,CDM,270,RC,,HCPCS,outpatient,,,$154.35 ,$115.76 ,,$142.00 ,92,,,$84.89 ,$149.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.89 ,$149.72 ,other,,Not applicable. No negotiated rates per contract,$132.74 ,86,,,$84.89 ,$149.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.48 ,80,,,$84.89 ,$149.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.63 ,95,,,$84.89 ,$149.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.63 ,95,,,$84.89 ,$149.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.76 ,75,,,$84.89 ,$149.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.20 ,85,,,$84.89 ,$149.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.92 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.72 ,97,,,$84.89 ,$149.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.20 ,85,,,$84.89 ,$149.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.92 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.63 ,90,,,$84.89 ,$149.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.89 ,55,,,$84.89 ,$149.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.55 ,93,,,$84.89 ,$149.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SZ 2 SUPRAGLOTTIC AIRWAY,8783069,CDM,270,RC,,HCPCS,outpatient,,,$153.45 ,$115.09 ,,$141.17 ,92,,,$84.40 ,$148.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.40 ,55,,,$84.40 ,$148.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.40 ,$148.85 ,other,,Not applicable. No negotiated rates per contract,$131.97 ,86,,,$84.40 ,$148.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$122.76 ,80,,,$84.40 ,$148.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.40 ,55,,,$84.40 ,$148.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.78 ,95,,,$84.40 ,$148.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.78 ,95,,,$84.40 ,$148.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.09 ,75,,,$84.40 ,$148.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.43 ,85,,,$84.40 ,$148.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.85 ,97,,,$84.40 ,$148.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.40 ,55,,,$84.40 ,$148.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.11 ,90,,,$84.40 ,$148.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.85 ,97,,,$84.40 ,$148.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.85 ,97,,,$84.40 ,$148.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.85 ,97,,,$84.40 ,$148.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.43 ,85,,,$84.40 ,$148.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.11 ,90,,,$84.40 ,$148.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.40 ,55,,,$84.40 ,$148.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.78 ,90,,,$84.40 ,$148.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.40 ,55,,,$84.40 ,$148.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.71 ,93,,,$84.40 ,$148.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SZ 3 SMALL ADULT SUPRAGLOTTIC AIRWAY,8783070,CDM,270,RC,,HCPCS,outpatient,,,$240.99 ,$180.74 ,,$221.71 ,92,,,$132.54 ,$233.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.54 ,55,,,$132.54 ,$233.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.54 ,$233.76 ,other,,Not applicable. No negotiated rates per contract,$207.25 ,86,,,$132.54 ,$233.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.79 ,80,,,$132.54 ,$233.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.54 ,55,,,$132.54 ,$233.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.94 ,95,,,$132.54 ,$233.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.94 ,95,,,$132.54 ,$233.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.74 ,75,,,$132.54 ,$233.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.84 ,85,,,$132.54 ,$233.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.76 ,97,,,$132.54 ,$233.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.54 ,55,,,$132.54 ,$233.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.89 ,90,,,$132.54 ,$233.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.76 ,97,,,$132.54 ,$233.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.76 ,97,,,$132.54 ,$233.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.76 ,97,,,$132.54 ,$233.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.84 ,85,,,$132.54 ,$233.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.89 ,90,,,$132.54 ,$233.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.54 ,55,,,$132.54 ,$233.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.94 ,90,,,$132.54 ,$233.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.54 ,55,,,$132.54 ,$233.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.12 ,93,,,$132.54 ,$233.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SZ 4 MEDIUM ADULT SUPRAGLOTTIC AIRWAY,8783071,CDM,270,RC,,HCPCS,outpatient,,,$253.68 ,$190.26 ,,$233.39 ,92,,,$139.52 ,$246.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.52 ,55,,,$139.52 ,$246.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.52 ,$246.07 ,other,,Not applicable. No negotiated rates per contract,$218.16 ,86,,,$139.52 ,$246.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$202.94 ,80,,,$139.52 ,$246.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.52 ,55,,,$139.52 ,$246.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.00 ,95,,,$139.52 ,$246.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.00 ,95,,,$139.52 ,$246.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.26 ,75,,,$139.52 ,$246.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.63 ,85,,,$139.52 ,$246.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.07 ,97,,,$139.52 ,$246.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.52 ,55,,,$139.52 ,$246.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.31 ,90,,,$139.52 ,$246.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.07 ,97,,,$139.52 ,$246.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.07 ,97,,,$139.52 ,$246.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.07 ,97,,,$139.52 ,$246.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.63 ,85,,,$139.52 ,$246.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.31 ,90,,,$139.52 ,$246.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.52 ,55,,,$139.52 ,$246.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.00 ,90,,,$139.52 ,$246.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.52 ,55,,,$139.52 ,$246.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.92 ,93,,,$139.52 ,$246.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I-GEL SZ 5  SUPRAGLOTTIC AIRWAY,8783067,CDM,270,RC,,HCPCS,outpatient,,,$253.53 ,$190.15 ,,$233.25 ,92,,,$139.44 ,$245.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.44 ,55,,,$139.44 ,$245.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.44 ,$245.92 ,other,,Not applicable. No negotiated rates per contract,$218.04 ,86,,,$139.44 ,$245.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$202.82 ,80,,,$139.44 ,$245.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.44 ,55,,,$139.44 ,$245.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.85 ,95,,,$139.44 ,$245.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$240.85 ,95,,,$139.44 ,$245.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.15 ,75,,,$139.44 ,$245.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.50 ,85,,,$139.44 ,$245.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$245.92 ,97,,,$139.44 ,$245.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.44 ,55,,,$139.44 ,$245.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.18 ,90,,,$139.44 ,$245.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$245.92 ,97,,,$139.44 ,$245.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.92 ,97,,,$139.44 ,$245.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$245.92 ,97,,,$139.44 ,$245.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.50 ,85,,,$139.44 ,$245.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.18 ,90,,,$139.44 ,$245.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.44 ,55,,,$139.44 ,$245.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.85 ,90,,,$139.44 ,$245.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.44 ,55,,,$139.44 ,$245.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.78 ,93,,,$139.44 ,$245.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
I.V. PRIMARY PLUMSET POL,8783699,CDM,270,RC,,HCPCS,outpatient,,,$118.50 ,$88.88 ,,$109.02 ,92,,,$65.18 ,$114.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.18 ,55,,,$65.18 ,$114.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.18 ,$114.95 ,other,,Not applicable. No negotiated rates per contract,$101.91 ,86,,,$65.18 ,$114.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$94.80 ,80,,,$65.18 ,$114.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.18 ,55,,,$65.18 ,$114.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.58 ,95,,,$65.18 ,$114.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.58 ,95,,,$65.18 ,$114.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.88 ,75,,,$65.18 ,$114.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.73 ,85,,,$65.18 ,$114.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.95 ,97,,,$65.18 ,$114.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.18 ,55,,,$65.18 ,$114.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.65 ,90,,,$65.18 ,$114.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.95 ,97,,,$65.18 ,$114.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.95 ,97,,,$65.18 ,$114.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.95 ,97,,,$65.18 ,$114.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,85,,,$65.18 ,$114.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.65 ,90,,,$65.18 ,$114.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.18 ,55,,,$65.18 ,$114.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.58 ,90,,,$65.18 ,$114.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.18 ,55,,,$65.18 ,$114.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.21 ,93,,,$65.18 ,$114.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IB KIT,8942860,CDM,270,RC,,HCPCS,outpatient,,,"$5,414.76 ","$4,061.07 ",,"$4,981.58 ",92,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,978.12 ",55,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,978.12 ","$5,252.32 ",other,,Not applicable. No negotiated rates per contract,"$4,656.69 ",86,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,331.81 ",80,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,978.12 ",55,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,144.02 ",95,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,144.02 ",95,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,061.07 ",75,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,602.55 ",85,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,252.32 ",97,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,978.12 ",55,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,873.28 ",90,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,252.32 ",97,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,252.32 ",97,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,252.32 ",97,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,602.55 ",85,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,873.28 ",90,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,978.12 ",55,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,144.02 ",90,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,978.12 ",55,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,035.73 ",93,,,"$2,978.12 ","$5,252.32 ",percent of total billed charges,,93% of total billed charges for outpatient setting
IH SURVEYS ROOM PRESSURE,8783678,CDM,270,RC,,HCPCS,outpatient,,,$623.00 ,$467.25 ,,$573.16 ,92,,,$342.65 ,$604.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$342.65 ,55,,,$342.65 ,$604.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$342.65 ,$604.31 ,other,,Not applicable. No negotiated rates per contract,$535.78 ,86,,,$342.65 ,$604.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$498.40 ,80,,,$342.65 ,$604.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$342.65 ,55,,,$342.65 ,$604.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$591.85 ,95,,,$342.65 ,$604.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$591.85 ,95,,,$342.65 ,$604.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$467.25 ,75,,,$342.65 ,$604.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$529.55 ,85,,,$342.65 ,$604.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$604.31 ,97,,,$342.65 ,$604.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$342.65 ,55,,,$342.65 ,$604.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$560.70 ,90,,,$342.65 ,$604.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$604.31 ,97,,,$342.65 ,$604.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$604.31 ,97,,,$342.65 ,$604.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$604.31 ,97,,,$342.65 ,$604.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$529.55 ,85,,,$342.65 ,$604.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$560.70 ,90,,,$342.65 ,$604.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$342.65 ,55,,,$342.65 ,$604.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$591.85 ,90,,,$342.65 ,$604.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$342.65 ,55,,,$342.65 ,$604.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$579.39 ,93,,,$342.65 ,$604.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"IMMOBILIZER 20""  KNEE",8785086,CDM,270,RC,,HCPCS,outpatient,,,$127.64 ,$95.73 ,,$117.43 ,92,,,$70.20 ,$123.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.20 ,55,,,$70.20 ,$123.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.20 ,$123.81 ,other,,Not applicable. No negotiated rates per contract,$109.77 ,86,,,$70.20 ,$123.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.11 ,80,,,$70.20 ,$123.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.20 ,55,,,$70.20 ,$123.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.26 ,95,,,$70.20 ,$123.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.26 ,95,,,$70.20 ,$123.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.73 ,75,,,$70.20 ,$123.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.49 ,85,,,$70.20 ,$123.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.81 ,97,,,$70.20 ,$123.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.20 ,55,,,$70.20 ,$123.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.88 ,90,,,$70.20 ,$123.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.81 ,97,,,$70.20 ,$123.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.81 ,97,,,$70.20 ,$123.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.81 ,97,,,$70.20 ,$123.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.49 ,85,,,$70.20 ,$123.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.88 ,90,,,$70.20 ,$123.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.20 ,55,,,$70.20 ,$123.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.26 ,90,,,$70.20 ,$123.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.20 ,55,,,$70.20 ,$123.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.71 ,93,,,$70.20 ,$123.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER 24 KNEE IMMO,8785087,CDM,270,RC,,HCPCS,outpatient,,,$138.03 ,$103.52 ,,$126.99 ,92,,,$75.92 ,$133.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$75.92 ,55,,,$75.92 ,$133.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$75.92 ,$133.89 ,other,,Not applicable. No negotiated rates per contract,$118.71 ,86,,,$75.92 ,$133.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$110.42 ,80,,,$75.92 ,$133.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$75.92 ,55,,,$75.92 ,$133.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.13 ,95,,,$75.92 ,$133.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.13 ,95,,,$75.92 ,$133.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.52 ,75,,,$75.92 ,$133.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$117.33 ,85,,,$75.92 ,$133.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.89 ,97,,,$75.92 ,$133.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.92 ,55,,,$75.92 ,$133.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.23 ,90,,,$75.92 ,$133.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.89 ,97,,,$75.92 ,$133.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.89 ,97,,,$75.92 ,$133.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.89 ,97,,,$75.92 ,$133.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.33 ,85,,,$75.92 ,$133.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.23 ,90,,,$75.92 ,$133.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.92 ,55,,,$75.92 ,$133.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.13 ,90,,,$75.92 ,$133.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.92 ,55,,,$75.92 ,$133.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.37 ,93,,,$75.92 ,$133.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER CLINIC LG SHOULDER,8785105,CDM,270,RC,,HCPCS,outpatient,,,$39.99 ,$29.99 ,,$36.79 ,92,,,$21.99 ,$38.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.99 ,$38.79 ,other,,Not applicable. No negotiated rates per contract,$34.39 ,86,,,$21.99 ,$38.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.99 ,80,,,$21.99 ,$38.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.99 ,95,,,$21.99 ,$38.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.99 ,95,,,$21.99 ,$38.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.99 ,75,,,$21.99 ,$38.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.99 ,85,,,$21.99 ,$38.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.79 ,97,,,$21.99 ,$38.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.99 ,85,,,$21.99 ,$38.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.99 ,90,,,$21.99 ,$38.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.99 ,55,,,$21.99 ,$38.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.19 ,93,,,$21.99 ,$38.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER CLINIC MED SHOULDER,8785104,CDM,270,RC,,HCPCS,outpatient,,,$40.86 ,$30.65 ,,$37.59 ,92,,,$22.47 ,$39.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.47 ,55,,,$22.47 ,$39.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.47 ,$39.63 ,other,,Not applicable. No negotiated rates per contract,$35.14 ,86,,,$22.47 ,$39.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.69 ,80,,,$22.47 ,$39.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.47 ,55,,,$22.47 ,$39.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.82 ,95,,,$22.47 ,$39.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.82 ,95,,,$22.47 ,$39.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.65 ,75,,,$22.47 ,$39.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.73 ,85,,,$22.47 ,$39.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.63 ,97,,,$22.47 ,$39.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.47 ,55,,,$22.47 ,$39.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.77 ,90,,,$22.47 ,$39.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.63 ,97,,,$22.47 ,$39.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.63 ,97,,,$22.47 ,$39.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.63 ,97,,,$22.47 ,$39.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.73 ,85,,,$22.47 ,$39.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.77 ,90,,,$22.47 ,$39.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.47 ,55,,,$22.47 ,$39.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.82 ,90,,,$22.47 ,$39.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.47 ,55,,,$22.47 ,$39.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,93,,,$22.47 ,$39.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER CLINIC SMALL SHOULDER,8785103,CDM,270,RC,,HCPCS,outpatient,,,$34.65 ,$25.99 ,,$31.88 ,92,,,$19.06 ,$33.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.06 ,$33.61 ,other,,Not applicable. No negotiated rates per contract,$29.80 ,86,,,$19.06 ,$33.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.72 ,80,,,$19.06 ,$33.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.92 ,95,,,$19.06 ,$33.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.92 ,95,,,$19.06 ,$33.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.99 ,75,,,$19.06 ,$33.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.45 ,85,,,$19.06 ,$33.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.19 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.61 ,97,,,$19.06 ,$33.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.45 ,85,,,$19.06 ,$33.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.19 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.92 ,90,,,$19.06 ,$33.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.06 ,55,,,$19.06 ,$33.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.22 ,93,,,$19.06 ,$33.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER INNOVATOR RE,8786143,CDM,270,RC,,HCPCS,outpatient,,,$487.69 ,$365.77 ,,$448.67 ,92,,,$268.23 ,$473.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$268.23 ,55,,,$268.23 ,$473.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$268.23 ,$473.06 ,other,,Not applicable. No negotiated rates per contract,$419.41 ,86,,,$268.23 ,$473.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$390.15 ,80,,,$268.23 ,$473.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$268.23 ,55,,,$268.23 ,$473.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$463.31 ,95,,,$268.23 ,$473.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$463.31 ,95,,,$268.23 ,$473.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$365.77 ,75,,,$268.23 ,$473.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$414.54 ,85,,,$268.23 ,$473.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$473.06 ,97,,,$268.23 ,$473.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.23 ,55,,,$268.23 ,$473.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.92 ,90,,,$268.23 ,$473.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$473.06 ,97,,,$268.23 ,$473.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$473.06 ,97,,,$268.23 ,$473.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$473.06 ,97,,,$268.23 ,$473.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$414.54 ,85,,,$268.23 ,$473.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.92 ,90,,,$268.23 ,$473.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$268.23 ,55,,,$268.23 ,$473.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$463.31 ,90,,,$268.23 ,$473.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$268.23 ,55,,,$268.23 ,$473.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.55 ,93,,,$268.23 ,$473.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER LG KNEE SUPP,8785095,CDM,270,RC,,HCPCS,outpatient,,,$50.57 ,$37.93 ,,$46.52 ,92,,,$27.81 ,$49.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.81 ,55,,,$27.81 ,$49.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.81 ,$49.05 ,other,,Not applicable. No negotiated rates per contract,$43.49 ,86,,,$27.81 ,$49.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.46 ,80,,,$27.81 ,$49.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.81 ,55,,,$27.81 ,$49.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.04 ,95,,,$27.81 ,$49.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.04 ,95,,,$27.81 ,$49.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.93 ,75,,,$27.81 ,$49.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.98 ,85,,,$27.81 ,$49.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.05 ,97,,,$27.81 ,$49.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.81 ,55,,,$27.81 ,$49.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.51 ,90,,,$27.81 ,$49.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.05 ,97,,,$27.81 ,$49.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.05 ,97,,,$27.81 ,$49.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.05 ,97,,,$27.81 ,$49.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.98 ,85,,,$27.81 ,$49.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.51 ,90,,,$27.81 ,$49.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.81 ,55,,,$27.81 ,$49.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.04 ,90,,,$27.81 ,$49.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.81 ,55,,,$27.81 ,$49.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.03 ,93,,,$27.81 ,$49.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER LG SHOULDER LARGE,8785063,CDM,270,RC,,HCPCS,outpatient,,,$87.89 ,$65.92 ,,$80.86 ,92,,,$48.34 ,$85.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.34 ,55,,,$48.34 ,$85.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.34 ,$85.25 ,other,,Not applicable. No negotiated rates per contract,$75.59 ,86,,,$48.34 ,$85.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$70.31 ,80,,,$48.34 ,$85.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.34 ,55,,,$48.34 ,$85.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.50 ,95,,,$48.34 ,$85.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.50 ,95,,,$48.34 ,$85.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.92 ,75,,,$48.34 ,$85.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.71 ,85,,,$48.34 ,$85.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.25 ,97,,,$48.34 ,$85.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.34 ,55,,,$48.34 ,$85.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.10 ,90,,,$48.34 ,$85.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.25 ,97,,,$48.34 ,$85.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.25 ,97,,,$48.34 ,$85.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.25 ,97,,,$48.34 ,$85.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.71 ,85,,,$48.34 ,$85.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.10 ,90,,,$48.34 ,$85.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.34 ,55,,,$48.34 ,$85.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.50 ,90,,,$48.34 ,$85.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.34 ,55,,,$48.34 ,$85.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.74 ,93,,,$48.34 ,$85.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER MED KNEE SUPPORT (79-82635),8785094,CDM,270,RC,,HCPCS,outpatient,,,$86.80 ,$65.10 ,,$79.86 ,92,,,$47.74 ,$84.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.74 ,$84.20 ,other,,Not applicable. No negotiated rates per contract,$74.65 ,86,,,$47.74 ,$84.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.44 ,80,,,$47.74 ,$84.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.10 ,75,,,$47.74 ,$84.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.72 ,93,,,$47.74 ,$84.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER SM KNEE SUPP,8785093,CDM,270,RC,,HCPCS,outpatient,,,$49.25 ,$36.94 ,,$45.31 ,92,,,$27.09 ,$47.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.09 ,$47.77 ,other,,Not applicable. No negotiated rates per contract,$42.36 ,86,,,$27.09 ,$47.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.40 ,80,,,$27.09 ,$47.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.79 ,95,,,$27.09 ,$47.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.94 ,75,,,$27.09 ,$47.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.77 ,97,,,$27.09 ,$47.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.86 ,85,,,$27.09 ,$47.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.33 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.79 ,90,,,$27.09 ,$47.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.09 ,55,,,$27.09 ,$47.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.80 ,93,,,$27.09 ,$47.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER XLG KNEE SUPPORT (79-82638),8785096,CDM,270,RC,,HCPCS,outpatient,,,$86.80 ,$65.10 ,,$79.86 ,92,,,$47.74 ,$84.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.74 ,$84.20 ,other,,Not applicable. No negotiated rates per contract,$74.65 ,86,,,$47.74 ,$84.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.44 ,80,,,$47.74 ,$84.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.46 ,95,,,$47.74 ,$84.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.10 ,75,,,$47.74 ,$84.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.20 ,97,,,$47.74 ,$84.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.78 ,85,,,$47.74 ,$84.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.12 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.46 ,90,,,$47.74 ,$84.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.74 ,55,,,$47.74 ,$84.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.72 ,93,,,$47.74 ,$84.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER XXLG KNEE SU,8785097,CDM,270,RC,,HCPCS,outpatient,,,$47.19 ,$35.39 ,,$43.41 ,92,,,$25.95 ,$45.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.95 ,$45.77 ,other,,Not applicable. No negotiated rates per contract,$40.58 ,86,,,$25.95 ,$45.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.75 ,80,,,$25.95 ,$45.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.39 ,75,,,$25.95 ,$45.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,93,,,$25.95 ,$45.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER XXLG SHOULDE,8785065,CDM,270,RC,,HCPCS,outpatient,,,$90.60 ,$67.95 ,,$83.35 ,92,,,$49.83 ,$87.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.83 ,$87.88 ,other,,Not applicable. No negotiated rates per contract,$77.92 ,86,,,$49.83 ,$87.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.48 ,80,,,$49.83 ,$87.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.07 ,95,,,$49.83 ,$87.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.07 ,95,,,$49.83 ,$87.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.95 ,75,,,$49.83 ,$87.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.01 ,85,,,$49.83 ,$87.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.54 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.01 ,85,,,$49.83 ,$87.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.54 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.07 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.26 ,93,,,$49.83 ,$87.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER,8785106,CDM,270,RC,,HCPCS,outpatient,,,$40.25 ,$30.19 ,,$37.03 ,92,,,$22.14 ,$39.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.14 ,$39.04 ,other,,Not applicable. No negotiated rates per contract,$34.62 ,86,,,$22.14 ,$39.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.20 ,80,,,$22.14 ,$39.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.24 ,95,,,$22.14 ,$39.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.24 ,95,,,$22.14 ,$39.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.19 ,75,,,$22.14 ,$39.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.21 ,85,,,$22.14 ,$39.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.23 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.21 ,85,,,$22.14 ,$39.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.23 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.24 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.43 ,93,,,$22.14 ,$39.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER,8785135,CDM,270,RC,,HCPCS,outpatient,,,$223.30 ,$167.48 ,,$205.44 ,92,,,$122.82 ,$216.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$122.82 ,$216.60 ,other,,Not applicable. No negotiated rates per contract,$192.04 ,86,,,$122.82 ,$216.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$178.64 ,80,,,$122.82 ,$216.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.14 ,95,,,$122.82 ,$216.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.14 ,95,,,$122.82 ,$216.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$167.48 ,75,,,$122.82 ,$216.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$189.81 ,85,,,$122.82 ,$216.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.97 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.81 ,85,,,$122.82 ,$216.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$200.97 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.14 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.67 ,93,,,$122.82 ,$216.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER,8785136,CDM,270,RC,,HCPCS,outpatient,,,$223.30 ,$167.48 ,,$205.44 ,92,,,$122.82 ,$216.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$122.82 ,$216.60 ,other,,Not applicable. No negotiated rates per contract,$192.04 ,86,,,$122.82 ,$216.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$178.64 ,80,,,$122.82 ,$216.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.14 ,95,,,$122.82 ,$216.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.14 ,95,,,$122.82 ,$216.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$167.48 ,75,,,$122.82 ,$216.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$189.81 ,85,,,$122.82 ,$216.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.97 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.60 ,97,,,$122.82 ,$216.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.81 ,85,,,$122.82 ,$216.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$200.97 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.14 ,90,,,$122.82 ,$216.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.82 ,55,,,$122.82 ,$216.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.67 ,93,,,$122.82 ,$216.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER,8785191,CDM,270,RC,,HCPCS,outpatient,,,$211.27 ,$158.45 ,,$194.37 ,92,,,$116.20 ,$204.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$116.20 ,55,,,$116.20 ,$204.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$116.20 ,$204.93 ,other,,Not applicable. No negotiated rates per contract,$181.69 ,86,,,$116.20 ,$204.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$169.02 ,80,,,$116.20 ,$204.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$116.20 ,55,,,$116.20 ,$204.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.71 ,95,,,$116.20 ,$204.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.71 ,95,,,$116.20 ,$204.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.45 ,75,,,$116.20 ,$204.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.58 ,85,,,$116.20 ,$204.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.93 ,97,,,$116.20 ,$204.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.20 ,55,,,$116.20 ,$204.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.14 ,90,,,$116.20 ,$204.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.93 ,97,,,$116.20 ,$204.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.93 ,97,,,$116.20 ,$204.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.93 ,97,,,$116.20 ,$204.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.58 ,85,,,$116.20 ,$204.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$190.14 ,90,,,$116.20 ,$204.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.20 ,55,,,$116.20 ,$204.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.71 ,90,,,$116.20 ,$204.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.20 ,55,,,$116.20 ,$204.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.48 ,93,,,$116.20 ,$204.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMMOBILIZER,8785130,CDM,270,RC,,HCPCS,outpatient,,,$91.22 ,$68.42 ,,$83.92 ,92,,,$50.17 ,$88.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.17 ,55,,,$50.17 ,$88.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.17 ,$88.48 ,other,,Not applicable. No negotiated rates per contract,$78.45 ,86,,,$50.17 ,$88.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.98 ,80,,,$50.17 ,$88.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.17 ,55,,,$50.17 ,$88.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.66 ,95,,,$50.17 ,$88.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.66 ,95,,,$50.17 ,$88.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.42 ,75,,,$50.17 ,$88.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.54 ,85,,,$50.17 ,$88.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.48 ,97,,,$50.17 ,$88.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.17 ,55,,,$50.17 ,$88.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.10 ,90,,,$50.17 ,$88.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.48 ,97,,,$50.17 ,$88.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.48 ,97,,,$50.17 ,$88.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.48 ,97,,,$50.17 ,$88.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.54 ,85,,,$50.17 ,$88.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.10 ,90,,,$50.17 ,$88.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.17 ,55,,,$50.17 ,$88.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.66 ,90,,,$50.17 ,$88.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.17 ,55,,,$50.17 ,$88.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.83 ,93,,,$50.17 ,$88.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IMPLANT SYS,8782096,CDM,278,RC,,HCPCS,both,,,"$7,837.50 ","$5,878.13 ",,"$7,210.50 ",92,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$4,310.63 ",55,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$4,310.63 ","$7,602.38 ",other,,Not applicable. No negotiated rates per contract,"$6,740.25 ",86,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$6,270.00 ",80,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$4,310.63 ",55,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,445.63 ",95,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,445.63 ",95,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,878.13 ",75,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,661.88 ",85,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,602.38 ",97,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,310.63 ",55,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,053.75 ",90,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,602.38 ",97,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,602.38 ",97,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,602.38 ",97,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,661.88 ",85,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,053.75 ",90,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,310.63 ",55,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,445.63 ",90,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,310.63 ",55,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,288.88 ",93,,,"$4,310.63 ","$7,602.38 ",percent of total billed charges,,93% of total billed charges for outpatient setting
IMPLANT,8786670,CDM,270,RC,,HCPCS,outpatient,,,"$2,231.25 ","$1,673.44 ",,"$2,052.75 ",92,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,227.19 ",55,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,227.19 ","$2,164.31 ",other,,Not applicable. No negotiated rates per contract,"$1,918.88 ",86,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,785.00 ",80,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,227.19 ",55,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,119.69 ",95,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,119.69 ",95,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,673.44 ",75,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,896.56 ",85,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,164.31 ",97,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,227.19 ",55,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,008.13 ",90,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,164.31 ",97,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,164.31 ",97,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,164.31 ",97,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,896.56 ",85,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.13 ",90,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,227.19 ",55,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,119.69 ",90,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,227.19 ",55,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,075.06 ",93,,,"$1,227.19 ","$2,164.31 ",percent of total billed charges,,93% of total billed charges for outpatient setting
IMPLANT,8786886,CDM,270,RC,,HCPCS,outpatient,,,"$1,933.75 ","$1,450.31 ",,"$1,779.05 ",92,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,063.56 ",55,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,063.56 ","$1,875.74 ",other,,Not applicable. No negotiated rates per contract,"$1,663.03 ",86,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,547.00 ",80,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,063.56 ",55,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.06 ",95,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,837.06 ",95,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,450.31 ",75,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,643.69 ",85,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,875.74 ",97,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.56 ",55,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,740.38 ",90,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,875.74 ",97,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.74 ",97,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.74 ",97,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,643.69 ",85,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,740.38 ",90,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.56 ",55,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.06 ",90,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.56 ",55,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.39 ",93,,,"$1,063.56 ","$1,875.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
INDWELLING SLIT CATH SET,8942861,CDM,270,RC,,HCPCS,outpatient,,,$697.83 ,$523.37 ,,$642.00 ,92,,,$383.81 ,$676.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$383.81 ,55,,,$383.81 ,$676.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$383.81 ,$676.90 ,other,,Not applicable. No negotiated rates per contract,$600.13 ,86,,,$383.81 ,$676.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$558.26 ,80,,,$383.81 ,$676.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$383.81 ,55,,,$383.81 ,$676.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$662.94 ,95,,,$383.81 ,$676.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$662.94 ,95,,,$383.81 ,$676.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$523.37 ,75,,,$383.81 ,$676.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$593.16 ,85,,,$383.81 ,$676.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$676.90 ,97,,,$383.81 ,$676.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.81 ,55,,,$383.81 ,$676.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$628.05 ,90,,,$383.81 ,$676.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$676.90 ,97,,,$383.81 ,$676.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$676.90 ,97,,,$383.81 ,$676.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$676.90 ,97,,,$383.81 ,$676.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$593.16 ,85,,,$383.81 ,$676.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$628.05 ,90,,,$383.81 ,$676.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$383.81 ,55,,,$383.81 ,$676.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$662.94 ,90,,,$383.81 ,$676.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$383.81 ,55,,,$383.81 ,$676.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$648.98 ,93,,,$383.81 ,$676.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
INFLATION HANDLE (FOR SI,8782232,CDM,270,RC,,HCPCS,outpatient,,,"$1,089.00 ",$816.75 ,,"$1,001.88 ",92,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$598.95 ,55,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$598.95 ,"$1,056.33 ",other,,Not applicable. No negotiated rates per contract,$936.54 ,86,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$871.20 ,80,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$598.95 ,55,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,034.55 ",95,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,034.55 ",95,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$816.75 ,75,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$925.65 ,85,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,056.33 ",97,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$598.95 ,55,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$980.10 ,90,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,056.33 ",97,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,056.33 ",97,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,056.33 ",97,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$925.65 ,85,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$980.10 ,90,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$598.95 ,55,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,034.55 ",90,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$598.95 ,55,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,012.77 ",93,,,$598.95 ,"$1,056.33 ",percent of total billed charges,,93% of total billed charges for outpatient setting
INFUSION PUMP  (AGILIA D,8783134,CDM,270,RC,,HCPCS,outpatient,,,"$5,525.00 ","$4,143.75 ",,"$5,083.00 ",92,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,038.75 ",55,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,038.75 ","$5,359.25 ",other,,Not applicable. No negotiated rates per contract,"$4,751.50 ",86,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,420.00 ",80,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,038.75 ",55,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,248.75 ",95,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,248.75 ",95,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,143.75 ",75,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,696.25 ",85,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,359.25 ",97,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,038.75 ",55,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,972.50 ",90,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,359.25 ",97,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,359.25 ",97,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,359.25 ",97,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,696.25 ",85,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,972.50 ",90,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,038.75 ",55,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,248.75 ",90,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,038.75 ",55,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,138.25 ",93,,,"$3,038.75 ","$5,359.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
INSTRATEK,8783724,CDM,270,RC,,HCPCS,outpatient,,,$902.50 ,$676.88 ,,$830.30 ,92,,,$496.38 ,$875.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$496.38 ,$875.43 ,other,,Not applicable. No negotiated rates per contract,$776.15 ,86,,,$496.38 ,$875.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$722.00 ,80,,,$496.38 ,$875.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$857.38 ,95,,,$496.38 ,$875.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$857.38 ,95,,,$496.38 ,$875.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$676.88 ,75,,,$496.38 ,$875.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$767.13 ,85,,,$496.38 ,$875.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$812.25 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$875.43 ,97,,,$496.38 ,$875.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$767.13 ,85,,,$496.38 ,$875.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$812.25 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$857.38 ,90,,,$496.38 ,$875.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$496.38 ,55,,,$496.38 ,$875.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$839.33 ,93,,,$496.38 ,$875.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
INSTRUMENT FRAZIER SUCTION (12FR),8785653,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
INSTRUMENT PROTECTION RO,8783845,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
INSULTED WEIGHTED CUP,8786153,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
INTEGRA MESHED BILAYER WOUNDMATRIX SIZE 2 X 2,8783726,CDM,278,RC,,HCPCS,both,,,"$13,762.50 ","$10,321.88 ",,"$12,661.50 ",92,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$7,569.38 ",55,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$7,569.38 ","$13,349.63 ",other,,Not applicable. No negotiated rates per contract,"$11,835.75 ",86,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$11,010.00 ",80,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$7,569.38 ",55,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$13,074.38 ",95,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$13,074.38 ",95,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$10,321.88 ",75,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$11,698.13 ",85,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$13,349.63 ",97,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,569.38 ",55,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$12,386.25 ",90,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$13,349.63 ",97,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$13,349.63 ",97,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$13,349.63 ",97,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,698.13 ",85,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$12,386.25 ",90,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,569.38 ",55,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$13,074.38 ",90,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,569.38 ",55,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$12,799.13 ",93,,,"$7,569.38 ","$13,349.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
INTEGRA MESHED BILAYER WOUND MATRIX SIZE 4X5,9587142,CDM,278,RC,,HCPCS,both,,,"$24,192.00 ","$18,144.00 ",,"$22,256.64 ",92,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$13,305.60 ",55,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$13,305.60 ","$23,466.24 ",other,,Not applicable. No negotiated rates per contract,"$20,805.12 ",86,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$19,353.60 ",80,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$13,305.60 ",55,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$22,982.40 ",95,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$22,982.40 ",95,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$18,144.00 ",75,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$20,563.20 ",85,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$23,466.24 ",97,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$13,305.60 ",55,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$21,772.80 ",90,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$23,466.24 ",97,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$23,466.24 ",97,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$23,466.24 ",97,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$20,563.20 ",85,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$21,772.80 ",90,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$13,305.60 ",55,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$22,982.40 ",90,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$13,305.60 ",55,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$22,498.56 ",93,,,"$13,305.60 ","$23,466.24 ",percent of total billed charges,,93% of total billed charges for outpatient setting
INTRAOCULAR LENS CHARGE,8787073,CDM,276,RC,,HCPCS,both,,,"$1,132.00 ",$849.00 ,,"$1,041.44 ",92,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$622.60 ,55,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$622.60 ,"$1,098.04 ",other,,Not applicable. No negotiated rates per contract,$973.52 ,86,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$905.60 ,80,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$622.60 ,55,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,075.40 ",95,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,075.40 ",95,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$849.00 ,75,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$962.20 ,85,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,098.04 ",97,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$622.60 ,55,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,018.80 ",90,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,098.04 ",97,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,098.04 ",97,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,098.04 ",97,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$962.20 ,85,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,018.80 ",90,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$622.60 ,55,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,075.40 ",90,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$622.60 ,55,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,052.76 ",93,,,$622.60 ,"$1,098.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"IOBAN 2 STERI- DRAPE125""w x83""L (19"" x 9-43/8"")",8998372,CDM,270,RC,,HCPCS,outpatient,,,$224.68 ,$168.51 ,,$206.71 ,92,,,$123.57 ,$217.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$123.57 ,55,,,$123.57 ,$217.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$123.57 ,$217.94 ,other,,Not applicable. No negotiated rates per contract,$193.22 ,86,,,$123.57 ,$217.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$179.74 ,80,,,$123.57 ,$217.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$123.57 ,55,,,$123.57 ,$217.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.45 ,95,,,$123.57 ,$217.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.45 ,95,,,$123.57 ,$217.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.51 ,75,,,$123.57 ,$217.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$190.98 ,85,,,$123.57 ,$217.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$217.94 ,97,,,$123.57 ,$217.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.57 ,55,,,$123.57 ,$217.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.21 ,90,,,$123.57 ,$217.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.94 ,97,,,$123.57 ,$217.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.94 ,97,,,$123.57 ,$217.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.94 ,97,,,$123.57 ,$217.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.98 ,85,,,$123.57 ,$217.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$202.21 ,90,,,$123.57 ,$217.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.57 ,55,,,$123.57 ,$217.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.45 ,90,,,$123.57 ,$217.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.57 ,55,,,$123.57 ,$217.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.95 ,93,,,$123.57 ,$217.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IRRIJET,8786892,CDM,270,RC,,HCPCS,outpatient,,,$120.90 ,$90.68 ,,$111.23 ,92,,,$66.50 ,$117.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.50 ,$117.27 ,other,,Not applicable. No negotiated rates per contract,$103.97 ,86,,,$66.50 ,$117.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.72 ,80,,,$66.50 ,$117.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.86 ,95,,,$66.50 ,$117.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.86 ,95,,,$66.50 ,$117.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.68 ,75,,,$66.50 ,$117.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.77 ,85,,,$66.50 ,$117.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.81 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.27 ,97,,,$66.50 ,$117.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.77 ,85,,,$66.50 ,$117.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.81 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.86 ,90,,,$66.50 ,$117.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.50 ,55,,,$66.50 ,$117.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.44 ,93,,,$66.50 ,$117.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IRRISEPT,9708825,CDM,272,RC,55394,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
ISTAT PRINTER RECHARGE B,8783174,CDM,270,RC,,HCPCS,outpatient,,,$245.00 ,$183.75 ,,$225.40 ,92,,,$134.75 ,$237.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$134.75 ,55,,,$134.75 ,$237.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$134.75 ,$237.65 ,other,,Not applicable. No negotiated rates per contract,$210.70 ,86,,,$134.75 ,$237.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$196.00 ,80,,,$134.75 ,$237.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$134.75 ,55,,,$134.75 ,$237.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.75 ,95,,,$134.75 ,$237.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$232.75 ,95,,,$134.75 ,$237.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.75 ,75,,,$134.75 ,$237.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$208.25 ,85,,,$134.75 ,$237.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$237.65 ,97,,,$134.75 ,$237.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.75 ,55,,,$134.75 ,$237.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.50 ,90,,,$134.75 ,$237.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.65 ,97,,,$134.75 ,$237.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.65 ,97,,,$134.75 ,$237.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.65 ,97,,,$134.75 ,$237.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.25 ,85,,,$134.75 ,$237.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$220.50 ,90,,,$134.75 ,$237.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.75 ,55,,,$134.75 ,$237.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.75 ,90,,,$134.75 ,$237.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.75 ,55,,,$134.75 ,$237.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$227.85 ,93,,,$134.75 ,$237.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV      (SURGE TUBE ),8782022,CDM,270,RC,,HCPCS,outpatient,,,$28.35 ,$21.26 ,,$26.08 ,92,,,$15.59 ,$27.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.59 ,$27.50 ,other,,Not applicable. No negotiated rates per contract,$24.38 ,86,,,$15.59 ,$27.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.68 ,80,,,$15.59 ,$27.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.26 ,75,,,$15.59 ,$27.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.37 ,93,,,$15.59 ,$27.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV  GRAVITY TUBING PRIMARY (new order (20669-28),8782021,CDM,270,RC,,HCPCS,outpatient,,,$37.98 ,$28.49 ,,$34.94 ,92,,,$20.89 ,$36.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.89 ,55,,,$20.89 ,$36.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.89 ,$36.84 ,other,,Not applicable. No negotiated rates per contract,$32.66 ,86,,,$20.89 ,$36.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.38 ,80,,,$20.89 ,$36.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.89 ,55,,,$20.89 ,$36.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.08 ,95,,,$20.89 ,$36.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.08 ,95,,,$20.89 ,$36.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.49 ,75,,,$20.89 ,$36.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.28 ,85,,,$20.89 ,$36.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.84 ,97,,,$20.89 ,$36.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.89 ,55,,,$20.89 ,$36.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.18 ,90,,,$20.89 ,$36.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.84 ,97,,,$20.89 ,$36.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.84 ,97,,,$20.89 ,$36.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.84 ,97,,,$20.89 ,$36.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.28 ,85,,,$20.89 ,$36.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.18 ,90,,,$20.89 ,$36.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.89 ,55,,,$20.89 ,$36.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.08 ,90,,,$20.89 ,$36.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.89 ,55,,,$20.89 ,$36.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.32 ,93,,,$20.89 ,$36.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV  LIDOCAINE/D5W) 4MG/M,8782477,CDM,258,RC,,HCPCS,outpatient,4,mg,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV (OR)  PRIMARY PLUMSET 3 CLAVE Y SITES,8783700,CDM,270,RC,,HCPCS,outpatient,,,$36.14 ,$27.11 ,,$33.25 ,92,,,$19.88 ,$35.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.88 ,55,,,$19.88 ,$35.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.88 ,$35.06 ,other,,Not applicable. No negotiated rates per contract,$31.08 ,86,,,$19.88 ,$35.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.91 ,80,,,$19.88 ,$35.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.88 ,55,,,$19.88 ,$35.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.33 ,95,,,$19.88 ,$35.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.33 ,95,,,$19.88 ,$35.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.11 ,75,,,$19.88 ,$35.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.72 ,85,,,$19.88 ,$35.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.06 ,97,,,$19.88 ,$35.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.88 ,55,,,$19.88 ,$35.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.53 ,90,,,$19.88 ,$35.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.06 ,97,,,$19.88 ,$35.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.06 ,97,,,$19.88 ,$35.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.06 ,97,,,$19.88 ,$35.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.72 ,85,,,$19.88 ,$35.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.53 ,90,,,$19.88 ,$35.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.88 ,55,,,$19.88 ,$35.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.33 ,90,,,$19.88 ,$35.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.88 ,55,,,$19.88 ,$35.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.61 ,93,,,$19.88 ,$35.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .45% NACL/5% DEXTROSE BAXTER HEALTHCARE,8782630,CDM,258,RC,,HCPCS,outpatient,,,$42.09 ,$31.57 ,,$38.72 ,92,,,$23.15 ,$40.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.15 ,55,,,$23.15 ,$40.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.15 ,$40.83 ,other,,Not applicable. No negotiated rates per contract,$36.20 ,86,,,$23.15 ,$40.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.67 ,80,,,$23.15 ,$40.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.15 ,55,,,$23.15 ,$40.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.99 ,95,,,$23.15 ,$40.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.99 ,95,,,$23.15 ,$40.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.57 ,75,,,$23.15 ,$40.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.78 ,85,,,$23.15 ,$40.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.83 ,97,,,$23.15 ,$40.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.15 ,55,,,$23.15 ,$40.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.88 ,90,,,$23.15 ,$40.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.83 ,97,,,$23.15 ,$40.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.83 ,97,,,$23.15 ,$40.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.83 ,97,,,$23.15 ,$40.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.78 ,85,,,$23.15 ,$40.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.88 ,90,,,$23.15 ,$40.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.15 ,55,,,$23.15 ,$40.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.99 ,90,,,$23.15 ,$40.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.15 ,55,,,$23.15 ,$40.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.14 ,93,,,$23.15 ,$40.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .45% NACL/5% DEXTROSE HOSPIRA (792609),8782623,CDM,258,RC,,HCPCS,outpatient,,,$31.94 ,$23.96 ,,$29.38 ,92,,,$17.57 ,$30.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.57 ,$30.98 ,other,,Not applicable. No negotiated rates per contract,$27.47 ,86,,,$17.57 ,$30.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.55 ,80,,,$17.57 ,$30.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.96 ,75,,,$17.57 ,$30.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,93,,,$17.57 ,$30.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .45%NACL INJECTION 10,8782626,CDM,258,RC,,HCPCS,outpatient,,,$31.41 ,$23.56 ,,$28.90 ,92,,,$17.28 ,$30.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.28 ,55,,,$17.28 ,$30.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.28 ,$30.47 ,other,,Not applicable. No negotiated rates per contract,$27.01 ,86,,,$17.28 ,$30.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.13 ,80,,,$17.28 ,$30.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.28 ,55,,,$17.28 ,$30.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.84 ,95,,,$17.28 ,$30.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.84 ,95,,,$17.28 ,$30.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.56 ,75,,,$17.28 ,$30.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.70 ,85,,,$17.28 ,$30.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.47 ,97,,,$17.28 ,$30.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.28 ,55,,,$17.28 ,$30.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.27 ,90,,,$17.28 ,$30.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.47 ,97,,,$17.28 ,$30.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.47 ,97,,,$17.28 ,$30.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.47 ,97,,,$17.28 ,$30.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.70 ,85,,,$17.28 ,$30.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.27 ,90,,,$17.28 ,$30.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.28 ,55,,,$17.28 ,$30.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.84 ,90,,,$17.28 ,$30.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.28 ,55,,,$17.28 ,$30.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.21 ,93,,,$17.28 ,$30.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .5% DEX IN H20,8782631,CDM,258,RC,,HCPCS,outpatient,,,$35.18 ,$26.39 ,,$32.37 ,92,,,$19.35 ,$34.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.35 ,$34.12 ,other,,Not applicable. No negotiated rates per contract,$30.25 ,86,,,$19.35 ,$34.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.14 ,80,,,$19.35 ,$34.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.42 ,95,,,$19.35 ,$34.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.42 ,95,,,$19.35 ,$34.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.39 ,75,,,$19.35 ,$34.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.90 ,85,,,$19.35 ,$34.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.66 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.90 ,85,,,$19.35 ,$34.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.66 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.42 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.72 ,93,,,$19.35 ,$34.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL  VIALFLEX CONTAINER 500ML,8782633,CDM,258,RC,,HCPCS,outpatient,500,ml,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL 1000ML  BIN,8782625,CDM,258,RC,,HCPCS,outpatient,1000,ml,$38.15 ,$28.61 ,,$35.10 ,92,,,$20.98 ,$37.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.98 ,$37.01 ,other,,Not applicable. No negotiated rates per contract,$32.81 ,86,,,$20.98 ,$37.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.52 ,80,,,$20.98 ,$37.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.24 ,95,,,$20.98 ,$37.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.24 ,95,,,$20.98 ,$37.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.61 ,75,,,$20.98 ,$37.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.43 ,85,,,$20.98 ,$37.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.34 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.01 ,97,,,$20.98 ,$37.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.43 ,85,,,$20.98 ,$37.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.34 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.24 ,90,,,$20.98 ,$37.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.98 ,55,,,$20.98 ,$37.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.48 ,93,,,$20.98 ,$37.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL 100ML  (HOSPIRA),8782639,CDM,258,RC,,HCPCS,outpatient,100,ml,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL 250ML,8782636,CDM,258,RC,,HCPCS,outpatient,250,ml,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL 500ML (HOSPI,8782632,CDM,258,RC,,HCPCS,outpatient,500,ml,$38.76 ,$29.07 ,,$35.66 ,92,,,$21.32 ,$37.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.32 ,$37.60 ,other,,Not applicable. No negotiated rates per contract,$33.33 ,86,,,$21.32 ,$37.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.01 ,80,,,$21.32 ,$37.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.82 ,95,,,$21.32 ,$37.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.82 ,95,,,$21.32 ,$37.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.07 ,75,,,$21.32 ,$37.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.95 ,85,,,$21.32 ,$37.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.88 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.60 ,97,,,$21.32 ,$37.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.95 ,85,,,$21.32 ,$37.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.88 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.82 ,90,,,$21.32 ,$37.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.32 ,55,,,$21.32 ,$37.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.05 ,93,,,$21.32 ,$37.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL 50ML HOSPIRA,8782640,CDM,258,RC,,HCPCS,outpatient,50,ml,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV .9% NACL INDIVIDUAL B,8782126,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV 20 MEQ KCL IN 5% DEXT,8782622,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV 5% DEX .225 NACL 1000,8782627,CDM,258,RC,,HCPCS,outpatient,,,$36.40 ,$27.30 ,,$33.49 ,92,,,$20.02 ,$35.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.02 ,$35.31 ,other,,Not applicable. No negotiated rates per contract,$31.30 ,86,,,$20.02 ,$35.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.12 ,80,,,$20.02 ,$35.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.30 ,75,,,$20.02 ,$35.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.85 ,93,,,$20.02 ,$35.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV 5% DEXTROSE / 9% NACL,8786718,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV 5% DEXTROSE IN RINGER,8782624,CDM,258,RC,,HCPCS,outpatient,,,$38.41 ,$28.81 ,,$35.34 ,92,,,$21.13 ,$37.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.13 ,$37.26 ,other,,Not applicable. No negotiated rates per contract,$33.03 ,86,,,$21.13 ,$37.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.73 ,80,,,$21.13 ,$37.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.49 ,95,,,$21.13 ,$37.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.49 ,95,,,$21.13 ,$37.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.81 ,75,,,$21.13 ,$37.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.65 ,85,,,$21.13 ,$37.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.57 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.65 ,85,,,$21.13 ,$37.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.57 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.49 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.72 ,93,,,$21.13 ,$37.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV AGILIA VOLUMAT SECOND,8783136,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV BD Q-SYTE (385100),8785811,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV BUTTERFLY 21G X 3/4 (367281),8785724,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV BUTTERFLY 23G X 3/4,8785810,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV BUTTERFLY 25G X 3/4 (,8785725,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 14G AUTOGUARD (381467),8785720,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 16G AUTOGUARD (381454),8785719,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 18G AUTOGUARD,8785718,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 20G AUTOGUARD (381434),8785717,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 20G X 1.25 SAFET,8785215,CDM,270,RC,,HCPCS,outpatient,,,$497.25 ,$372.94 ,,$457.47 ,92,,,$273.49 ,$482.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.49 ,$482.33 ,other,,Not applicable. No negotiated rates per contract,$427.64 ,86,,,$273.49 ,$482.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.80 ,80,,,$273.49 ,$482.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.94 ,75,,,$273.49 ,$482.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.44 ,93,,,$273.49 ,$482.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 22G AUTOGUARD,8785726,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 22G X1SAFETY VIA,8785213,CDM,270,RC,,HCPCS,outpatient,,,$497.25 ,$372.94 ,,$457.47 ,92,,,$273.49 ,$482.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.49 ,$482.33 ,other,,Not applicable. No negotiated rates per contract,$427.64 ,86,,,$273.49 ,$482.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.80 ,80,,,$273.49 ,$482.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.94 ,75,,,$273.49 ,$482.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.44 ,93,,,$273.49 ,$482.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH 24G AUTOGUARD,8785716,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH PROTECTIVE 22G (,8785062,CDM,270,RC,,HCPCS,outpatient,,,$495.08 ,$371.31 ,,$455.47 ,92,,,$272.29 ,$480.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$272.29 ,55,,,$272.29 ,$480.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$272.29 ,$480.23 ,other,,Not applicable. No negotiated rates per contract,$425.77 ,86,,,$272.29 ,$480.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$396.06 ,80,,,$272.29 ,$480.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$272.29 ,55,,,$272.29 ,$480.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.33 ,95,,,$272.29 ,$480.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$470.33 ,95,,,$272.29 ,$480.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.31 ,75,,,$272.29 ,$480.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$420.82 ,85,,,$272.29 ,$480.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$480.23 ,97,,,$272.29 ,$480.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.29 ,55,,,$272.29 ,$480.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$445.57 ,90,,,$272.29 ,$480.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$480.23 ,97,,,$272.29 ,$480.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.23 ,97,,,$272.29 ,$480.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$480.23 ,97,,,$272.29 ,$480.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$420.82 ,85,,,$272.29 ,$480.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$445.57 ,90,,,$272.29 ,$480.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.29 ,55,,,$272.29 ,$480.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$470.33 ,90,,,$272.29 ,$480.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.29 ,55,,,$272.29 ,$480.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$460.42 ,93,,,$272.29 ,$480.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATH via valve 18G X 1.25 SA,8785214,CDM,270,RC,,HCPCS,outpatient,,,$497.25 ,$372.94 ,,$457.47 ,92,,,$273.49 ,$482.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.49 ,$482.33 ,other,,Not applicable. No negotiated rates per contract,$427.64 ,86,,,$273.49 ,$482.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.80 ,80,,,$273.49 ,$482.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.39 ,95,,,$273.49 ,$482.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.94 ,75,,,$273.49 ,$482.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.33 ,97,,,$273.49 ,$482.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.66 ,85,,,$273.49 ,$482.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.53 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$472.39 ,90,,,$273.49 ,$482.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.49 ,55,,,$273.49 ,$482.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.44 ,93,,,$273.49 ,$482.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATHETER PROTECTIV 16,8785060,CDM,270,RC,,HCPCS,outpatient,,,$470.35 ,$352.76 ,,$432.72 ,92,,,$258.69 ,$456.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$258.69 ,55,,,$258.69 ,$456.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$258.69 ,$456.24 ,other,,Not applicable. No negotiated rates per contract,$404.50 ,86,,,$258.69 ,$456.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$376.28 ,80,,,$258.69 ,$456.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$258.69 ,55,,,$258.69 ,$456.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$446.83 ,95,,,$258.69 ,$456.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$446.83 ,95,,,$258.69 ,$456.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$352.76 ,75,,,$258.69 ,$456.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$399.80 ,85,,,$258.69 ,$456.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$456.24 ,97,,,$258.69 ,$456.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$258.69 ,55,,,$258.69 ,$456.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$423.32 ,90,,,$258.69 ,$456.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$456.24 ,97,,,$258.69 ,$456.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$456.24 ,97,,,$258.69 ,$456.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$456.24 ,97,,,$258.69 ,$456.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$399.80 ,85,,,$258.69 ,$456.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$423.32 ,90,,,$258.69 ,$456.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$258.69 ,55,,,$258.69 ,$456.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$446.83 ,90,,,$258.69 ,$456.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$258.69 ,55,,,$258.69 ,$456.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$437.43 ,93,,,$258.69 ,$456.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATHETER PROTECTIV 18,8785061,CDM,270,RC,,HCPCS,outpatient,,,$481.88 ,$361.41 ,,$443.33 ,92,,,$265.03 ,$467.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$265.03 ,55,,,$265.03 ,$467.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$265.03 ,$467.42 ,other,,Not applicable. No negotiated rates per contract,$414.42 ,86,,,$265.03 ,$467.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$385.50 ,80,,,$265.03 ,$467.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$265.03 ,55,,,$265.03 ,$467.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.79 ,95,,,$265.03 ,$467.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$457.79 ,95,,,$265.03 ,$467.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$361.41 ,75,,,$265.03 ,$467.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$409.60 ,85,,,$265.03 ,$467.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$467.42 ,97,,,$265.03 ,$467.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.03 ,55,,,$265.03 ,$467.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.69 ,90,,,$265.03 ,$467.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.42 ,97,,,$265.03 ,$467.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.42 ,97,,,$265.03 ,$467.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.42 ,97,,,$265.03 ,$467.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$409.60 ,85,,,$265.03 ,$467.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$433.69 ,90,,,$265.03 ,$467.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.03 ,55,,,$265.03 ,$467.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$457.79 ,90,,,$265.03 ,$467.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.03 ,55,,,$265.03 ,$467.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.15 ,93,,,$265.03 ,$467.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CATHETER PROTECTIV 20,8785741,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV CYSTO SETS,8785670,CDM,270,RC,,HCPCS,outpatient,,,$49.91 ,$37.43 ,,$45.92 ,92,,,$27.45 ,$48.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.45 ,$48.41 ,other,,Not applicable. No negotiated rates per contract,$42.92 ,86,,,$27.45 ,$48.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.93 ,80,,,$27.45 ,$48.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.41 ,95,,,$27.45 ,$48.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.41 ,95,,,$27.45 ,$48.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.43 ,75,,,$27.45 ,$48.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.42 ,85,,,$27.45 ,$48.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.92 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.42 ,85,,,$27.45 ,$48.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.92 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.41 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.42 ,93,,,$27.45 ,$48.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV EXCEL  CONTAINER .9% NACL 250ml,8783093,CDM,270,RC,,HCPCS,outpatient,,,$32.64 ,$24.48 ,,$30.03 ,92,,,$17.95 ,$31.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.95 ,55,,,$17.95 ,$31.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.95 ,$31.66 ,other,,Not applicable. No negotiated rates per contract,$28.07 ,86,,,$17.95 ,$31.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.11 ,80,,,$17.95 ,$31.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.95 ,55,,,$17.95 ,$31.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.01 ,95,,,$17.95 ,$31.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.01 ,95,,,$17.95 ,$31.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.48 ,75,,,$17.95 ,$31.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.74 ,85,,,$17.95 ,$31.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.66 ,97,,,$17.95 ,$31.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.95 ,55,,,$17.95 ,$31.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.38 ,90,,,$17.95 ,$31.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.66 ,97,,,$17.95 ,$31.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.66 ,97,,,$17.95 ,$31.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.66 ,97,,,$17.95 ,$31.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.74 ,85,,,$17.95 ,$31.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.38 ,90,,,$17.95 ,$31.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.95 ,55,,,$17.95 ,$31.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.01 ,90,,,$17.95 ,$31.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.95 ,55,,,$17.95 ,$31.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.36 ,93,,,$17.95 ,$31.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV INJECTION CAP,8782596,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV LACTATED RINGERS INJ,8782621,CDM,258,RC,,HCPCS,outpatient,,,$39.46 ,$29.60 ,,$36.30 ,92,,,$21.70 ,$38.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.70 ,$38.28 ,other,,Not applicable. No negotiated rates per contract,$33.94 ,86,,,$21.70 ,$38.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.57 ,80,,,$21.70 ,$38.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.49 ,95,,,$21.70 ,$38.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.49 ,95,,,$21.70 ,$38.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.60 ,75,,,$21.70 ,$38.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.54 ,85,,,$21.70 ,$38.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.51 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.54 ,85,,,$21.70 ,$38.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.51 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.49 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.70 ,93,,,$21.70 ,$38.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PIGGYBACK PRIMARY SET,8782638,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PIGGYBACK SECONDARY S,8782024,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PLUMSET BLOOD ADMIINI,8782023,CDM,270,RC,,HCPCS,outpatient,,,$78.05 ,$58.54 ,,$71.81 ,92,,,$42.93 ,$75.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.93 ,55,,,$42.93 ,$75.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.93 ,$75.71 ,other,,Not applicable. No negotiated rates per contract,$67.12 ,86,,,$42.93 ,$75.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.44 ,80,,,$42.93 ,$75.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.93 ,55,,,$42.93 ,$75.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.15 ,95,,,$42.93 ,$75.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.15 ,95,,,$42.93 ,$75.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.54 ,75,,,$42.93 ,$75.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.34 ,85,,,$42.93 ,$75.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.71 ,97,,,$42.93 ,$75.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.93 ,55,,,$42.93 ,$75.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.25 ,90,,,$42.93 ,$75.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.71 ,97,,,$42.93 ,$75.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.71 ,97,,,$42.93 ,$75.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.71 ,97,,,$42.93 ,$75.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.34 ,85,,,$42.93 ,$75.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.25 ,90,,,$42.93 ,$75.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.93 ,55,,,$42.93 ,$75.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.15 ,90,,,$42.93 ,$75.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.93 ,55,,,$42.93 ,$75.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.59 ,93,,,$42.93 ,$75.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PRESSURE INFUSOR 1000 (950194310),8785230,CDM,270,RC,,HCPCS,outpatient,,,$93.08 ,$69.81 ,,$85.63 ,92,,,$51.19 ,$90.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.19 ,55,,,$51.19 ,$90.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$51.19 ,$90.29 ,other,,Not applicable. No negotiated rates per contract,$80.05 ,86,,,$51.19 ,$90.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$74.46 ,80,,,$51.19 ,$90.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.19 ,55,,,$51.19 ,$90.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.43 ,95,,,$51.19 ,$90.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.43 ,95,,,$51.19 ,$90.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.81 ,75,,,$51.19 ,$90.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$79.12 ,85,,,$51.19 ,$90.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.29 ,97,,,$51.19 ,$90.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.19 ,55,,,$51.19 ,$90.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.77 ,90,,,$51.19 ,$90.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.29 ,97,,,$51.19 ,$90.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.29 ,97,,,$51.19 ,$90.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.29 ,97,,,$51.19 ,$90.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.12 ,85,,,$51.19 ,$90.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.77 ,90,,,$51.19 ,$90.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.19 ,55,,,$51.19 ,$90.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.43 ,90,,,$51.19 ,$90.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.19 ,55,,,$51.19 ,$90.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.56 ,93,,,$51.19 ,$90.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PRESSURE INFUSOR 500,8785223,CDM,270,RC,,HCPCS,outpatient,,,$110.75 ,$83.06 ,,$101.89 ,92,,,$60.91 ,$107.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.91 ,55,,,$60.91 ,$107.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.91 ,$107.43 ,other,,Not applicable. No negotiated rates per contract,$95.25 ,86,,,$60.91 ,$107.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.60 ,80,,,$60.91 ,$107.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.91 ,55,,,$60.91 ,$107.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.21 ,95,,,$60.91 ,$107.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.21 ,95,,,$60.91 ,$107.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.06 ,75,,,$60.91 ,$107.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$94.14 ,85,,,$60.91 ,$107.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.43 ,97,,,$60.91 ,$107.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.91 ,55,,,$60.91 ,$107.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.68 ,90,,,$60.91 ,$107.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.43 ,97,,,$60.91 ,$107.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.43 ,97,,,$60.91 ,$107.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.43 ,97,,,$60.91 ,$107.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.14 ,85,,,$60.91 ,$107.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.68 ,90,,,$60.91 ,$107.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.91 ,55,,,$60.91 ,$107.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.21 ,90,,,$60.91 ,$107.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.91 ,55,,,$60.91 ,$107.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.00 ,93,,,$60.91 ,$107.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PRIMARY PLUM SET CLAVE Y-SITE,8782026,CDM,270,RC,,HCPCS,outpatient,,,$60.56 ,$45.42 ,,$55.72 ,92,,,$33.31 ,$58.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.31 ,55,,,$33.31 ,$58.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$33.31 ,$58.74 ,other,,Not applicable. No negotiated rates per contract,$52.08 ,86,,,$33.31 ,$58.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.45 ,80,,,$33.31 ,$58.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.31 ,55,,,$33.31 ,$58.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.53 ,95,,,$33.31 ,$58.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.53 ,95,,,$33.31 ,$58.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.42 ,75,,,$33.31 ,$58.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.48 ,85,,,$33.31 ,$58.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.74 ,97,,,$33.31 ,$58.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.31 ,55,,,$33.31 ,$58.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.50 ,90,,,$33.31 ,$58.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.74 ,97,,,$33.31 ,$58.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.74 ,97,,,$33.31 ,$58.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.74 ,97,,,$33.31 ,$58.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.48 ,85,,,$33.31 ,$58.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.50 ,90,,,$33.31 ,$58.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.31 ,55,,,$33.31 ,$58.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.53 ,90,,,$33.31 ,$58.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.31 ,55,,,$33.31 ,$58.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.32 ,93,,,$33.31 ,$58.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV PRIMARY PLUM SET CLAVE 1.6,8782537,CDM,270,RC,,HCPCS,outpatient,,,$82.34 ,$61.76 ,,$75.75 ,92,,,$45.29 ,$79.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.29 ,55,,,$45.29 ,$79.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.29 ,$79.87 ,other,,Not applicable. No negotiated rates per contract,$70.81 ,86,,,$45.29 ,$79.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.87 ,80,,,$45.29 ,$79.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.29 ,55,,,$45.29 ,$79.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.22 ,95,,,$45.29 ,$79.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.22 ,95,,,$45.29 ,$79.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.76 ,75,,,$45.29 ,$79.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.99 ,85,,,$45.29 ,$79.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.87 ,97,,,$45.29 ,$79.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.29 ,55,,,$45.29 ,$79.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.11 ,90,,,$45.29 ,$79.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.87 ,97,,,$45.29 ,$79.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.87 ,97,,,$45.29 ,$79.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.87 ,97,,,$45.29 ,$79.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.99 ,85,,,$45.29 ,$79.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.11 ,90,,,$45.29 ,$79.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.29 ,55,,,$45.29 ,$79.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.22 ,90,,,$45.29 ,$79.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.29 ,55,,,$45.29 ,$79.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.58 ,93,,,$45.29 ,$79.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV TUBING EXTENSION PRES,8785748,CDM,270,RC,,HCPCS,outpatient,,,$27.48 ,$20.61 ,,$25.28 ,92,,,$15.11 ,$26.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.11 ,55,,,$15.11 ,$26.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.11 ,$26.66 ,other,,Not applicable. No negotiated rates per contract,$23.63 ,86,,,$15.11 ,$26.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.98 ,80,,,$15.11 ,$26.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.11 ,55,,,$15.11 ,$26.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.11 ,95,,,$15.11 ,$26.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.11 ,95,,,$15.11 ,$26.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.61 ,75,,,$15.11 ,$26.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.36 ,85,,,$15.11 ,$26.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.66 ,97,,,$15.11 ,$26.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.11 ,55,,,$15.11 ,$26.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.73 ,90,,,$15.11 ,$26.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.66 ,97,,,$15.11 ,$26.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.66 ,97,,,$15.11 ,$26.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.66 ,97,,,$15.11 ,$26.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.36 ,85,,,$15.11 ,$26.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.73 ,90,,,$15.11 ,$26.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.11 ,55,,,$15.11 ,$26.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.11 ,90,,,$15.11 ,$26.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.11 ,55,,,$15.11 ,$26.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.56 ,93,,,$15.11 ,$26.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV TUBING EXTENSION SET (2N8374),8785746,CDM,270,RC,,HCPCS,outpatient,,,$35.18 ,$26.39 ,,$32.37 ,92,,,$19.35 ,$34.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.35 ,$34.12 ,other,,Not applicable. No negotiated rates per contract,$30.25 ,86,,,$19.35 ,$34.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.14 ,80,,,$19.35 ,$34.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.42 ,95,,,$19.35 ,$34.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.42 ,95,,,$19.35 ,$34.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.39 ,75,,,$19.35 ,$34.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.90 ,85,,,$19.35 ,$34.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.66 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.12 ,97,,,$19.35 ,$34.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.90 ,85,,,$19.35 ,$34.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.66 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.42 ,90,,,$19.35 ,$34.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.35 ,55,,,$19.35 ,$34.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.72 ,93,,,$19.35 ,$34.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8786717,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782618,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782619,CDM,258,RC,,HCPCS,outpatient,,,$48.59 ,$36.44 ,,$44.70 ,92,,,$26.72 ,$47.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.72 ,55,,,$26.72 ,$47.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.72 ,$47.13 ,other,,Not applicable. No negotiated rates per contract,$41.79 ,86,,,$26.72 ,$47.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.87 ,80,,,$26.72 ,$47.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.72 ,55,,,$26.72 ,$47.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.16 ,95,,,$26.72 ,$47.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.16 ,95,,,$26.72 ,$47.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.44 ,75,,,$26.72 ,$47.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.30 ,85,,,$26.72 ,$47.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.13 ,97,,,$26.72 ,$47.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.72 ,55,,,$26.72 ,$47.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.73 ,90,,,$26.72 ,$47.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.13 ,97,,,$26.72 ,$47.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.13 ,97,,,$26.72 ,$47.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.13 ,97,,,$26.72 ,$47.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.30 ,85,,,$26.72 ,$47.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.73 ,90,,,$26.72 ,$47.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.72 ,55,,,$26.72 ,$47.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.16 ,90,,,$26.72 ,$47.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.72 ,55,,,$26.72 ,$47.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.19 ,93,,,$26.72 ,$47.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782124,CDM,258,RC,,HCPCS,outpatient,,,$27.30 ,$20.48 ,,$25.12 ,92,,,$15.02 ,$26.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.02 ,$26.48 ,other,,Not applicable. No negotiated rates per contract,$23.48 ,86,,,$15.02 ,$26.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.84 ,80,,,$15.02 ,$26.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.48 ,75,,,$15.02 ,$26.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.39 ,93,,,$15.02 ,$26.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782634,CDM,258,RC,69209,HCPCS,outpatient,,,$28.35 ,$21.26 ,,$26.08 ,92,,,$15.59 ,$27.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.59 ,$27.50 ,other,,Not applicable. No negotiated rates per contract,$24.38 ,86,,,$15.59 ,$27.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.68 ,80,,,$15.59 ,$27.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.26 ,75,,,$15.59 ,$27.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.37 ,93,,,$15.59 ,$27.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8783092,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782125,CDM,258,RC,,HCPCS,outpatient,,,$30.10 ,$22.58 ,,$27.69 ,92,,,$16.56 ,$29.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.56 ,55,,,$16.56 ,$29.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.56 ,$29.20 ,other,,Not applicable. No negotiated rates per contract,$25.89 ,86,,,$16.56 ,$29.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.08 ,80,,,$16.56 ,$29.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.56 ,55,,,$16.56 ,$29.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.60 ,95,,,$16.56 ,$29.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.60 ,95,,,$16.56 ,$29.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.58 ,75,,,$16.56 ,$29.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.59 ,85,,,$16.56 ,$29.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.20 ,97,,,$16.56 ,$29.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.56 ,55,,,$16.56 ,$29.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.09 ,90,,,$16.56 ,$29.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.20 ,97,,,$16.56 ,$29.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.20 ,97,,,$16.56 ,$29.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.20 ,97,,,$16.56 ,$29.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.59 ,85,,,$16.56 ,$29.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.09 ,90,,,$16.56 ,$29.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.56 ,55,,,$16.56 ,$29.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.60 ,90,,,$16.56 ,$29.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.56 ,55,,,$16.56 ,$29.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.99 ,93,,,$16.56 ,$29.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782637,CDM,258,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV,8782635,CDM,270,RC,,HCPCS,outpatient,,,$36.40 ,$27.30 ,,$33.49 ,92,,,$20.02 ,$35.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.02 ,$35.31 ,other,,Not applicable. No negotiated rates per contract,$31.30 ,86,,,$20.02 ,$35.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.12 ,80,,,$20.02 ,$35.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.30 ,75,,,$20.02 ,$35.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.85 ,93,,,$20.02 ,$35.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
IV-PRIMARY PLUM SET W/SECONDARY PORT,9033599,CDM,270,RC,,HCPCS,outpatient,,,$89.28 ,$66.96 ,,$82.14 ,92,,,$49.10 ,$86.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.10 ,55,,,$49.10 ,$86.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.10 ,$86.60 ,other,,Not applicable. No negotiated rates per contract,$76.78 ,86,,,$49.10 ,$86.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.42 ,80,,,$49.10 ,$86.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.10 ,55,,,$49.10 ,$86.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.82 ,95,,,$49.10 ,$86.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.82 ,95,,,$49.10 ,$86.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.96 ,75,,,$49.10 ,$86.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.89 ,85,,,$49.10 ,$86.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.60 ,97,,,$49.10 ,$86.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.10 ,55,,,$49.10 ,$86.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.35 ,90,,,$49.10 ,$86.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.60 ,97,,,$49.10 ,$86.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.60 ,97,,,$49.10 ,$86.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.60 ,97,,,$49.10 ,$86.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.89 ,85,,,$49.10 ,$86.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.35 ,90,,,$49.10 ,$86.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.10 ,55,,,$49.10 ,$86.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.82 ,90,,,$49.10 ,$86.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.10 ,55,,,$49.10 ,$86.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.03 ,93,,,$49.10 ,$86.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9170002,CDM,270,RC,54849,HCPCS,outpatient,,,"$2,764.37 ","$2,073.28 ",,"$2,543.22 ",92,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,520.40 ",55,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,520.40 ","$2,681.44 ",other,,Not applicable. No negotiated rates per contract,"$2,377.36 ",86,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,211.50 ",80,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,520.40 ",55,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,626.15 ",95,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,626.15 ",95,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,073.28 ",75,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,349.71 ",85,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,681.44 ",97,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,520.40 ",55,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,487.93 ",90,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.44 ",97,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.44 ",97,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.44 ",97,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,349.71 ",85,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,487.93 ",90,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,520.40 ",55,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,626.15 ",90,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,520.40 ",55,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,570.86 ",93,,,"$1,520.40 ","$2,681.44 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667302,CDM,278,RC,,HCPCS,both,,,$230.99 ,$173.24 ,,$212.51 ,92,,,$127.04 ,$224.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.04 ,55,,,$127.04 ,$224.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.04 ,$224.06 ,other,,Not applicable. No negotiated rates per contract,$198.65 ,86,,,$127.04 ,$224.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$184.79 ,80,,,$127.04 ,$224.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.04 ,55,,,$127.04 ,$224.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.44 ,95,,,$127.04 ,$224.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$219.44 ,95,,,$127.04 ,$224.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.24 ,75,,,$127.04 ,$224.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$196.34 ,85,,,$127.04 ,$224.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$224.06 ,97,,,$127.04 ,$224.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.04 ,55,,,$127.04 ,$224.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.89 ,90,,,$127.04 ,$224.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.06 ,97,,,$127.04 ,$224.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.06 ,97,,,$127.04 ,$224.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.06 ,97,,,$127.04 ,$224.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.34 ,85,,,$127.04 ,$224.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$207.89 ,90,,,$127.04 ,$224.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.04 ,55,,,$127.04 ,$224.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.44 ,90,,,$127.04 ,$224.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.04 ,55,,,$127.04 ,$224.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.82 ,93,,,$127.04 ,$224.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667303,CDM,272,RC,,HCPCS,outpatient,,,$401.63 ,$301.22 ,,$369.50 ,92,,,$220.90 ,$389.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$220.90 ,55,,,$220.90 ,$389.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$220.90 ,$389.58 ,other,,Not applicable. No negotiated rates per contract,$345.40 ,86,,,$220.90 ,$389.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$321.30 ,80,,,$220.90 ,$389.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$220.90 ,55,,,$220.90 ,$389.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.55 ,95,,,$220.90 ,$389.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$381.55 ,95,,,$220.90 ,$389.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$301.22 ,75,,,$220.90 ,$389.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$341.39 ,85,,,$220.90 ,$389.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$389.58 ,97,,,$220.90 ,$389.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.90 ,55,,,$220.90 ,$389.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$361.47 ,90,,,$220.90 ,$389.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$389.58 ,97,,,$220.90 ,$389.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$389.58 ,97,,,$220.90 ,$389.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$389.58 ,97,,,$220.90 ,$389.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.39 ,85,,,$220.90 ,$389.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$361.47 ,90,,,$220.90 ,$389.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.90 ,55,,,$220.90 ,$389.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$381.55 ,90,,,$220.90 ,$389.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$220.90 ,55,,,$220.90 ,$389.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.52 ,93,,,$220.90 ,$389.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667292,CDM,278,RC,,HCPCS,both,,,"$4,632.08 ","$3,474.06 ",,"$4,261.51 ",92,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,547.64 ",55,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,547.64 ","$4,493.12 ",other,,Not applicable. No negotiated rates per contract,"$3,983.59 ",86,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,705.66 ",80,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,547.64 ",55,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,400.48 ",95,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,400.48 ",95,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,474.06 ",75,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,937.27 ",85,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,493.12 ",97,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,547.64 ",55,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,168.87 ",90,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,493.12 ",97,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,493.12 ",97,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,493.12 ",97,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,937.27 ",85,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,168.87 ",90,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,547.64 ",55,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,400.48 ",90,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,547.64 ",55,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,307.83 ",93,,,"$2,547.64 ","$4,493.12 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667293,CDM,278,RC,76937,HCPCS,both,,,$759.36 ,$569.52 ,,$698.61 ,92,,,$417.65 ,$736.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.65 ,$736.58 ,other,,Not applicable. No negotiated rates per contract,$653.05 ,86,,,$417.65 ,$736.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.49 ,80,,,$417.65 ,$736.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.52 ,75,,,$417.65 ,$736.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.20 ,93,,,$417.65 ,$736.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667294,CDM,278,RC,,HCPCS,both,,,$759.36 ,$569.52 ,,$698.61 ,92,,,$417.65 ,$736.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.65 ,$736.58 ,other,,Not applicable. No negotiated rates per contract,$653.05 ,86,,,$417.65 ,$736.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.49 ,80,,,$417.65 ,$736.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.52 ,75,,,$417.65 ,$736.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.20 ,93,,,$417.65 ,$736.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667295,CDM,278,RC,76937,HCPCS,both,,,$759.36 ,$569.52 ,,$698.61 ,92,,,$417.65 ,$736.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.65 ,$736.58 ,other,,Not applicable. No negotiated rates per contract,$653.05 ,86,,,$417.65 ,$736.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.49 ,80,,,$417.65 ,$736.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.52 ,75,,,$417.65 ,$736.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.20 ,93,,,$417.65 ,$736.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667296,CDM,278,RC,76937,HCPCS,both,,,$759.36 ,$569.52 ,,$698.61 ,92,,,$417.65 ,$736.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.65 ,$736.58 ,other,,Not applicable. No negotiated rates per contract,$653.05 ,86,,,$417.65 ,$736.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.49 ,80,,,$417.65 ,$736.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.52 ,75,,,$417.65 ,$736.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.20 ,93,,,$417.65 ,$736.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667297,CDM,278,RC,76937,HCPCS,both,,,$759.36 ,$569.52 ,,$698.61 ,92,,,$417.65 ,$736.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.65 ,$736.58 ,other,,Not applicable. No negotiated rates per contract,$653.05 ,86,,,$417.65 ,$736.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.49 ,80,,,$417.65 ,$736.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.39 ,95,,,$417.65 ,$736.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.52 ,75,,,$417.65 ,$736.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.58 ,97,,,$417.65 ,$736.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.46 ,85,,,$417.65 ,$736.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.42 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.39 ,90,,,$417.65 ,$736.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.65 ,55,,,$417.65 ,$736.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.20 ,93,,,$417.65 ,$736.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667298,CDM,278,RC,76937,HCPCS,both,,,$154.15 ,$115.61 ,,$141.82 ,92,,,$84.78 ,$149.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.78 ,$149.53 ,other,,Not applicable. No negotiated rates per contract,$132.57 ,86,,,$84.78 ,$149.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.32 ,80,,,$84.78 ,$149.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.61 ,75,,,$84.78 ,$149.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.36 ,93,,,$84.78 ,$149.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667299,CDM,278,RC,76937,HCPCS,both,,,$154.15 ,$115.61 ,,$141.82 ,92,,,$84.78 ,$149.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.78 ,$149.53 ,other,,Not applicable. No negotiated rates per contract,$132.57 ,86,,,$84.78 ,$149.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.32 ,80,,,$84.78 ,$149.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.61 ,75,,,$84.78 ,$149.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.36 ,93,,,$84.78 ,$149.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667300,CDM,278,RC,76937,HCPCS,both,,,$154.15 ,$115.61 ,,$141.82 ,92,,,$84.78 ,$149.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.78 ,$149.53 ,other,,Not applicable. No negotiated rates per contract,$132.57 ,86,,,$84.78 ,$149.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.32 ,80,,,$84.78 ,$149.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.61 ,75,,,$84.78 ,$149.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.36 ,93,,,$84.78 ,$149.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,9667301,CDM,278,RC,76937,HCPCS,both,,,$154.15 ,$115.61 ,,$141.82 ,92,,,$84.78 ,$149.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.78 ,$149.53 ,other,,Not applicable. No negotiated rates per contract,$132.57 ,86,,,$84.78 ,$149.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.32 ,80,,,$84.78 ,$149.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.44 ,95,,,$84.78 ,$149.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.61 ,75,,,$84.78 ,$149.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.53 ,97,,,$84.78 ,$149.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.03 ,85,,,$84.78 ,$149.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.74 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.44 ,90,,,$84.78 ,$149.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.78 ,55,,,$84.78 ,$149.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.36 ,93,,,$84.78 ,$149.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J & J,8783773,CDM,270,RC,,HCPCS,outpatient,,,"$1,309.43 ",$982.07 ,,"$1,204.68 ",92,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$720.19 ,55,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$720.19 ,"$1,270.15 ",other,,Not applicable. No negotiated rates per contract,"$1,126.11 ",86,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,047.54 ",80,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$720.19 ,55,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,243.96 ",95,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,243.96 ",95,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$982.07 ,75,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,113.02 ",85,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,270.15 ",97,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$720.19 ,55,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,178.49 ",90,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,270.15 ",97,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,270.15 ",97,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,270.15 ",97,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,113.02 ",85,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,178.49 ",90,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$720.19 ,55,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,243.96 ",90,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$720.19 ,55,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,217.77 ",93,,,$720.19 ,"$1,270.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
J &J,9667331,CDM,272,RC,,HCPCS,outpatient,,,$371.79 ,$278.84 ,,$342.05 ,92,,,$204.48 ,$360.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.48 ,55,,,$204.48 ,$360.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.48 ,$360.64 ,other,,Not applicable. No negotiated rates per contract,$319.74 ,86,,,$204.48 ,$360.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$297.43 ,80,,,$204.48 ,$360.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.48 ,55,,,$204.48 ,$360.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.20 ,95,,,$204.48 ,$360.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.20 ,95,,,$204.48 ,$360.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.84 ,75,,,$204.48 ,$360.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$316.02 ,85,,,$204.48 ,$360.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.64 ,97,,,$204.48 ,$360.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.48 ,55,,,$204.48 ,$360.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.61 ,90,,,$204.48 ,$360.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.64 ,97,,,$204.48 ,$360.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.64 ,97,,,$204.48 ,$360.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.64 ,97,,,$204.48 ,$360.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.02 ,85,,,$204.48 ,$360.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.61 ,90,,,$204.48 ,$360.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.48 ,55,,,$204.48 ,$360.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.20 ,90,,,$204.48 ,$360.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.48 ,55,,,$204.48 ,$360.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.76 ,93,,,$204.48 ,$360.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
J-LAT LATERAL SUBLUXATION SUPPORT,10036969,CDM,270,RC,55623,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
JACKSON-PRATT RES. KIT DRAIN (EVAC KIT 400ML),8782489,CDM,270,RC,,HCPCS,outpatient,,,$155.95 ,$116.96 ,,$143.47 ,92,,,$85.77 ,$151.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.77 ,55,,,$85.77 ,$151.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.77 ,$151.27 ,other,,Not applicable. No negotiated rates per contract,$134.12 ,86,,,$85.77 ,$151.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.76 ,80,,,$85.77 ,$151.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.77 ,55,,,$85.77 ,$151.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.15 ,95,,,$85.77 ,$151.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.15 ,95,,,$85.77 ,$151.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.96 ,75,,,$85.77 ,$151.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.56 ,85,,,$85.77 ,$151.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$151.27 ,97,,,$85.77 ,$151.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.77 ,55,,,$85.77 ,$151.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.36 ,90,,,$85.77 ,$151.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.27 ,97,,,$85.77 ,$151.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.27 ,97,,,$85.77 ,$151.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.27 ,97,,,$85.77 ,$151.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.56 ,85,,,$85.77 ,$151.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.36 ,90,,,$85.77 ,$151.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.77 ,55,,,$85.77 ,$151.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.15 ,90,,,$85.77 ,$151.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.77 ,55,,,$85.77 ,$151.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.03 ,93,,,$85.77 ,$151.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
JAMESON TENOTOMY SCISSOR,8782051,CDM,270,RC,,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"K-WIRE .035"" X 4"" (OR)",8784800,CDM,270,RC,,HCPCS,outpatient,,,$181.25 ,$135.94 ,,$166.75 ,92,,,$99.69 ,$175.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$99.69 ,55,,,$99.69 ,$175.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$99.69 ,$175.81 ,other,,Not applicable. No negotiated rates per contract,$155.88 ,86,,,$99.69 ,$175.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$145.00 ,80,,,$99.69 ,$175.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$99.69 ,55,,,$99.69 ,$175.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.19 ,95,,,$99.69 ,$175.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$172.19 ,95,,,$99.69 ,$175.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$135.94 ,75,,,$99.69 ,$175.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$154.06 ,85,,,$99.69 ,$175.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$175.81 ,97,,,$99.69 ,$175.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$99.69 ,55,,,$99.69 ,$175.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.13 ,90,,,$99.69 ,$175.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.81 ,97,,,$99.69 ,$175.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.81 ,97,,,$99.69 ,$175.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.81 ,97,,,$99.69 ,$175.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.06 ,85,,,$99.69 ,$175.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$163.13 ,90,,,$99.69 ,$175.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.69 ,55,,,$99.69 ,$175.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.19 ,90,,,$99.69 ,$175.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$99.69 ,55,,,$99.69 ,$175.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.56 ,93,,,$99.69 ,$175.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
K-WIRE / STEINMANN PIN C,8786575,CDM,270,RC,,HCPCS,outpatient,,,"$1,338.75 ","$1,004.06 ",,"$1,231.65 ",92,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$736.31 ,55,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$736.31 ,"$1,298.59 ",other,,Not applicable. No negotiated rates per contract,"$1,151.33 ",86,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,071.00 ",80,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$736.31 ,55,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.81 ",95,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,271.81 ",95,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,004.06 ",75,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,137.94 ",85,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,298.59 ",97,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$736.31 ,55,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,204.88 ",90,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,298.59 ",97,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,298.59 ",97,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,298.59 ",97,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,137.94 ",85,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.88 ",90,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$736.31 ,55,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,271.81 ",90,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$736.31 ,55,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,245.04 ",93,,,$736.31 ,"$1,298.59 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"K-WIRES 9"" X 0.62 (OR)",8783842,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KC100 EXTREMITY DRAPES 90"" X 131""",9084153,CDM,270,RC,,HCPCS,outpatient,,,$98.43 ,$73.82 ,,$90.56 ,92,,,$54.14 ,$95.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$54.14 ,55,,,$54.14 ,$95.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$54.14 ,$95.48 ,other,,Not applicable. No negotiated rates per contract,$84.65 ,86,,,$54.14 ,$95.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$78.74 ,80,,,$54.14 ,$95.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$54.14 ,55,,,$54.14 ,$95.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.51 ,95,,,$54.14 ,$95.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.51 ,95,,,$54.14 ,$95.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.82 ,75,,,$54.14 ,$95.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$83.67 ,85,,,$54.14 ,$95.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.48 ,97,,,$54.14 ,$95.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.14 ,55,,,$54.14 ,$95.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.59 ,90,,,$54.14 ,$95.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.48 ,97,,,$54.14 ,$95.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.48 ,97,,,$54.14 ,$95.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.48 ,97,,,$54.14 ,$95.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.67 ,85,,,$54.14 ,$95.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.59 ,90,,,$54.14 ,$95.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.14 ,55,,,$54.14 ,$95.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.51 ,90,,,$54.14 ,$95.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.14 ,55,,,$54.14 ,$95.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.54 ,93,,,$54.14 ,$95.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP.028"" X 4"" (NEW  OR",8786583,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .028"" X6""(NEW  OR",8786584,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .028"" X 9"" (NEW  OR",8786585,CDM,270,RC,,HCPCS,outpatient,,,$34.30 ,$25.73 ,,$31.56 ,92,,,$18.87 ,$33.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.87 ,$33.27 ,other,,Not applicable. No negotiated rates per contract,$29.50 ,86,,,$18.87 ,$33.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.44 ,80,,,$18.87 ,$33.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.73 ,75,,,$18.87 ,$33.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.90 ,93,,,$18.87 ,$33.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .035"" X 4"" (NEW  OR",8786586,CDM,270,RC,,HCPCS,outpatient,,,$32.11 ,$24.08 ,,$29.54 ,92,,,$17.66 ,$31.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.66 ,$31.15 ,other,,Not applicable. No negotiated rates per contract,$27.61 ,86,,,$17.66 ,$31.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.69 ,80,,,$17.66 ,$31.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.08 ,75,,,$17.66 ,$31.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.86 ,93,,,$17.66 ,$31.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .035"" X 6"" (NEW  OR",8786587,CDM,270,RC,,HCPCS,outpatient,,,$32.11 ,$24.08 ,,$29.54 ,92,,,$17.66 ,$31.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.66 ,$31.15 ,other,,Not applicable. No negotiated rates per contract,$27.61 ,86,,,$17.66 ,$31.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.69 ,80,,,$17.66 ,$31.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.08 ,75,,,$17.66 ,$31.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.86 ,93,,,$17.66 ,$31.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .035"" X 9"" (NEW  OR",8786588,CDM,270,RC,,HCPCS,outpatient,,,$27.30 ,$20.48 ,,$25.12 ,92,,,$15.02 ,$26.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.02 ,$26.48 ,other,,Not applicable. No negotiated rates per contract,$23.48 ,86,,,$15.02 ,$26.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.84 ,80,,,$15.02 ,$26.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.48 ,75,,,$15.02 ,$26.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.39 ,93,,,$15.02 ,$26.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .045"" X 4"" (NEW  OR",8786589,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .045"" X 6"" (NEW  OR",8786590,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .045"" X 9"" (NEW  OR",8786591,CDM,270,RC,,HCPCS,outpatient,,,$27.30 ,$20.48 ,,$25.12 ,92,,,$15.02 ,$26.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.02 ,$26.48 ,other,,Not applicable. No negotiated rates per contract,$23.48 ,86,,,$15.02 ,$26.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.84 ,80,,,$15.02 ,$26.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.48 ,75,,,$15.02 ,$26.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.39 ,93,,,$15.02 ,$26.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .062"" X4"" (NEW  OR",8786592,CDM,270,RC,,HCPCS,outpatient,,,$33.51 ,$25.13 ,,$30.83 ,92,,,$18.43 ,$32.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.43 ,55,,,$18.43 ,$32.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.43 ,$32.50 ,other,,Not applicable. No negotiated rates per contract,$28.82 ,86,,,$18.43 ,$32.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.81 ,80,,,$18.43 ,$32.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.43 ,55,,,$18.43 ,$32.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.83 ,95,,,$18.43 ,$32.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.83 ,95,,,$18.43 ,$32.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.13 ,75,,,$18.43 ,$32.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.48 ,85,,,$18.43 ,$32.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.50 ,97,,,$18.43 ,$32.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.43 ,55,,,$18.43 ,$32.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.16 ,90,,,$18.43 ,$32.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.50 ,97,,,$18.43 ,$32.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.50 ,97,,,$18.43 ,$32.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.50 ,97,,,$18.43 ,$32.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.48 ,85,,,$18.43 ,$32.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.16 ,90,,,$18.43 ,$32.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.43 ,55,,,$18.43 ,$32.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.83 ,90,,,$18.43 ,$32.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.43 ,55,,,$18.43 ,$32.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.16 ,93,,,$18.43 ,$32.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .062"" X 6"" (NEW  OR",8786593,CDM,270,RC,,HCPCS,outpatient,,,$25.64 ,$19.23 ,,$23.59 ,92,,,$14.10 ,$24.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.10 ,$24.87 ,other,,Not applicable. No negotiated rates per contract,$22.05 ,86,,,$14.10 ,$24.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.51 ,80,,,$14.10 ,$24.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.36 ,95,,,$14.10 ,$24.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.23 ,75,,,$14.10 ,$24.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.87 ,97,,,$14.10 ,$24.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.79 ,85,,,$14.10 ,$24.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.08 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.36 ,90,,,$14.10 ,$24.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.10 ,55,,,$14.10 ,$24.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,93,,,$14.10 ,$24.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KIRSCHER WIRE (K-WIRE) SMOOTH TROCAR SINGLE TIP .062"" X 9"" (NEW  OR",8786594,CDM,270,RC,,HCPCS,outpatient,,,$27.30 ,$20.48 ,,$25.12 ,92,,,$15.02 ,$26.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.02 ,$26.48 ,other,,Not applicable. No negotiated rates per contract,$23.48 ,86,,,$15.02 ,$26.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.84 ,80,,,$15.02 ,$26.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.94 ,95,,,$15.02 ,$26.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.48 ,75,,,$15.02 ,$26.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.48 ,97,,,$15.02 ,$26.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.21 ,85,,,$15.02 ,$26.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.57 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.94 ,90,,,$15.02 ,$26.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.02 ,55,,,$15.02 ,$26.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.39 ,93,,,$15.02 ,$26.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KIT (RAPE KIT) COLORADO,8786595,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KIT,8786664,CDM,270,RC,,HCPCS,outpatient,,,"$1,976.25 ","$1,482.19 ",,"$1,818.15 ",92,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,086.94 ","$1,916.96 ",other,,Not applicable. No negotiated rates per contract,"$1,699.58 ",86,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,581.00 ",80,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,877.44 ",95,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,877.44 ",95,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,482.19 ",75,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,679.81 ",85,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,778.63 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,679.81 ",85,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,778.63 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,877.44 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.91 ",93,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KIT. STABLIZATION SHOULDERKIT,8786674,CDM,270,RC,,HCPCS,outpatient,,,$289.71 ,$217.28 ,,$266.53 ,92,,,$159.34 ,$281.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.34 ,55,,,$159.34 ,$281.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.34 ,$281.02 ,other,,Not applicable. No negotiated rates per contract,$249.15 ,86,,,$159.34 ,$281.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$231.77 ,80,,,$159.34 ,$281.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.34 ,55,,,$159.34 ,$281.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.22 ,95,,,$159.34 ,$281.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.22 ,95,,,$159.34 ,$281.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.28 ,75,,,$159.34 ,$281.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.25 ,85,,,$159.34 ,$281.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.02 ,97,,,$159.34 ,$281.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.34 ,55,,,$159.34 ,$281.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.74 ,90,,,$159.34 ,$281.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.02 ,97,,,$159.34 ,$281.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.02 ,97,,,$159.34 ,$281.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.02 ,97,,,$159.34 ,$281.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.25 ,85,,,$159.34 ,$281.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.74 ,90,,,$159.34 ,$281.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.34 ,55,,,$159.34 ,$281.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.22 ,90,,,$159.34 ,$281.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.34 ,55,,,$159.34 ,$281.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.43 ,93,,,$159.34 ,$281.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE,8787037,CDM,270,RC,,HCPCS,outpatient,,,$782.25 ,$586.69 ,,$719.67 ,92,,,$430.24 ,$758.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$430.24 ,55,,,$430.24 ,$758.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$430.24 ,$758.78 ,other,,Not applicable. No negotiated rates per contract,$672.74 ,86,,,$430.24 ,$758.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$625.80 ,80,,,$430.24 ,$758.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$430.24 ,55,,,$430.24 ,$758.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$743.14 ,95,,,$430.24 ,$758.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$743.14 ,95,,,$430.24 ,$758.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$586.69 ,75,,,$430.24 ,$758.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$664.91 ,85,,,$430.24 ,$758.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$758.78 ,97,,,$430.24 ,$758.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$430.24 ,55,,,$430.24 ,$758.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$704.03 ,90,,,$430.24 ,$758.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$758.78 ,97,,,$430.24 ,$758.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$758.78 ,97,,,$430.24 ,$758.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$758.78 ,97,,,$430.24 ,$758.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$664.91 ,85,,,$430.24 ,$758.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$704.03 ,90,,,$430.24 ,$758.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$430.24 ,55,,,$430.24 ,$758.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$743.14 ,90,,,$430.24 ,$758.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$430.24 ,55,,,$430.24 ,$758.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$727.49 ,93,,,$430.24 ,$758.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE BRACE ENHANCED TROM,8785078,CDM,270,RC,,HCPCS,outpatient,,,$572.46 ,$429.35 ,,$526.66 ,92,,,$314.85 ,$555.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$314.85 ,55,,,$314.85 ,$555.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$314.85 ,$555.29 ,other,,Not applicable. No negotiated rates per contract,$492.32 ,86,,,$314.85 ,$555.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$457.97 ,80,,,$314.85 ,$555.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$314.85 ,55,,,$314.85 ,$555.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.84 ,95,,,$314.85 ,$555.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$543.84 ,95,,,$314.85 ,$555.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$429.35 ,75,,,$314.85 ,$555.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$486.59 ,85,,,$314.85 ,$555.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$555.29 ,97,,,$314.85 ,$555.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$314.85 ,55,,,$314.85 ,$555.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$515.21 ,90,,,$314.85 ,$555.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$555.29 ,97,,,$314.85 ,$555.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$555.29 ,97,,,$314.85 ,$555.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$555.29 ,97,,,$314.85 ,$555.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$486.59 ,85,,,$314.85 ,$555.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$515.21 ,90,,,$314.85 ,$555.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$314.85 ,55,,,$314.85 ,$555.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.84 ,90,,,$314.85 ,$555.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$314.85 ,55,,,$314.85 ,$555.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.39 ,93,,,$314.85 ,$555.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE BRACE KNEE RANGER I,8786148,CDM,270,RC,,HCPCS,outpatient,,,$486.75 ,$365.06 ,,$447.81 ,92,,,$267.71 ,$472.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$267.71 ,55,,,$267.71 ,$472.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$267.71 ,$472.15 ,other,,Not applicable. No negotiated rates per contract,$418.61 ,86,,,$267.71 ,$472.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$389.40 ,80,,,$267.71 ,$472.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$267.71 ,55,,,$267.71 ,$472.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.41 ,95,,,$267.71 ,$472.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$462.41 ,95,,,$267.71 ,$472.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$365.06 ,75,,,$267.71 ,$472.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$413.74 ,85,,,$267.71 ,$472.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$472.15 ,97,,,$267.71 ,$472.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.71 ,55,,,$267.71 ,$472.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.08 ,90,,,$267.71 ,$472.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.15 ,97,,,$267.71 ,$472.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.15 ,97,,,$267.71 ,$472.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.15 ,97,,,$267.71 ,$472.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$413.74 ,85,,,$267.71 ,$472.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.08 ,90,,,$267.71 ,$472.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.71 ,55,,,$267.71 ,$472.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$462.41 ,90,,,$267.71 ,$472.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.71 ,55,,,$267.71 ,$472.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$452.68 ,93,,,$267.71 ,$472.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE IMMOBILIZER L1830,8971137,CDM,270,RC,L1830,HCPCS,outpatient,,,$252.00 ,$189.00 ,,$231.84 ,92,,,$138.60 ,$244.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$138.60 ,55,,,$138.60 ,$244.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$138.60 ,$244.44 ,other,,Not applicable. No negotiated rates per contract,$216.72 ,86,,,$138.60 ,$244.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$201.60 ,80,,,$138.60 ,$244.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$138.60 ,55,,,$138.60 ,$244.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.40 ,95,,,$138.60 ,$244.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$239.40 ,95,,,$138.60 ,$244.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.00 ,75,,,$138.60 ,$244.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$214.20 ,85,,,$138.60 ,$244.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.44 ,97,,,$138.60 ,$244.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.60 ,55,,,$138.60 ,$244.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.80 ,90,,,$138.60 ,$244.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$244.44 ,97,,,$138.60 ,$244.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.44 ,97,,,$138.60 ,$244.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.44 ,97,,,$138.60 ,$244.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.20 ,85,,,$138.60 ,$244.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.80 ,90,,,$138.60 ,$244.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.60 ,55,,,$138.60 ,$244.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.40 ,90,,,$138.60 ,$244.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.60 ,55,,,$138.60 ,$244.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.36 ,93,,,$138.60 ,$244.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PALACOS R 1 X 40 SI,8787036,CDM,270,RC,,HCPCS,outpatient,,,$787.50 ,$590.63 ,,$724.50 ,92,,,$433.13 ,$763.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$433.13 ,$763.88 ,other,,Not applicable. No negotiated rates per contract,$677.25 ,86,,,$433.13 ,$763.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$630.00 ,80,,,$433.13 ,$763.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.13 ,95,,,$433.13 ,$763.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$748.13 ,95,,,$433.13 ,$763.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$590.63 ,75,,,$433.13 ,$763.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$669.38 ,85,,,$433.13 ,$763.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.75 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$763.88 ,97,,,$433.13 ,$763.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$669.38 ,85,,,$433.13 ,$763.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$708.75 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$748.13 ,90,,,$433.13 ,$763.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$433.13 ,55,,,$433.13 ,$763.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$732.38 ,93,,,$433.13 ,$763.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN ALL POLY PAT PLY 29MM,8787028,CDM,270,RC,,HCPCS,outpatient,,,"$2,786.51 ","$2,089.88 ",,"$2,563.59 ",92,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,532.58 ","$2,702.91 ",other,,Not applicable. No negotiated rates per contract,"$2,396.40 ",86,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,229.21 ",80,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.18 ",95,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,647.18 ",95,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,089.88 ",75,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,368.53 ",85,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,507.86 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,368.53 ",85,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,507.86 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.18 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,591.45 ",93,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN ALL POLY PAT PLY 35MM,8787035,CDM,270,RC,,HCPCS,outpatient,,,"$2,786.51 ","$2,089.88 ",,"$2,563.59 ",92,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,532.58 ","$2,702.91 ",other,,Not applicable. No negotiated rates per contract,"$2,396.40 ",86,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,229.21 ",80,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.18 ",95,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,647.18 ",95,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,089.88 ",75,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,368.53 ",85,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,507.86 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,702.91 ",97,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,368.53 ",85,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,507.86 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,647.18 ",90,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,532.58 ",55,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,591.45 ",93,,,"$1,532.58 ","$2,702.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN ASF PS 110MM PL,8787034,CDM,270,RC,,HCPCS,outpatient,,,"$4,038.19 ","$3,028.64 ",,"$3,715.13 ",92,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,221.00 ",55,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,221.00 ","$3,917.04 ",other,,Not applicable. No negotiated rates per contract,"$3,472.84 ",86,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,230.55 ",80,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,221.00 ",55,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,836.28 ",95,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,836.28 ",95,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,028.64 ",75,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,432.46 ",85,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,917.04 ",97,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,221.00 ",55,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,634.37 ",90,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,917.04 ",97,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,917.04 ",97,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,917.04 ",97,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,432.46 ",85,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,634.37 ",90,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,221.00 ",55,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,836.28 ",90,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,221.00 ",55,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,755.52 ",93,,,"$2,221.00 ","$3,917.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN ASF PS 14MM VE,8787026,CDM,270,RC,,HCPCS,outpatient,,,"$5,442.19 ","$4,081.64 ",,"$5,006.81 ",92,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,993.20 ",55,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,993.20 ","$5,278.92 ",other,,Not applicable. No negotiated rates per contract,"$4,680.28 ",86,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,353.75 ",80,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,993.20 ",55,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,170.08 ",95,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,170.08 ",95,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,081.64 ",75,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,625.86 ",85,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,278.92 ",97,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,993.20 ",55,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,897.97 ",90,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,278.92 ",97,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,278.92 ",97,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,278.92 ",97,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,625.86 ",85,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,897.97 ",90,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,993.20 ",55,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,170.08 ",90,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,993.20 ",55,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,061.24 ",93,,,"$2,993.20 ","$5,278.92 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN FEM PS CMT CCR STD SZ5 R,8787027,CDM,270,RC,,HCPCS,outpatient,,,"$9,784.91 ","$7,338.68 ",,"$9,002.12 ",92,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$5,381.70 ","$9,491.36 ",other,,Not applicable. No negotiated rates per contract,"$8,415.02 ",86,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$7,827.93 ",80,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,295.66 ",95,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$9,295.66 ",95,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,338.68 ",75,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$8,317.17 ",85,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$8,806.42 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,317.17 ",85,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$8,806.42 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,295.66 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,099.97 ",93,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN FEM PS CMT CCR STD SZ 7 L,8787033,CDM,270,RC,,HCPCS,outpatient,,,"$9,784.91 ","$7,338.68 ",,"$9,002.12 ",92,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$5,381.70 ","$9,491.36 ",other,,Not applicable. No negotiated rates per contract,"$8,415.02 ",86,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$7,827.93 ",80,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,295.66 ",95,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$9,295.66 ",95,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,338.68 ",75,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$8,317.17 ",85,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$8,806.42 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,491.36 ",97,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,317.17 ",85,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$8,806.42 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,295.66 ",90,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,381.70 ",55,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,099.97 ",93,,,"$5,381.70 ","$9,491.36 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN TIB STM 5 DEG SZ D R,8787029,CDM,270,RC,,HCPCS,outpatient,,,"$5,020.76 ","$3,765.57 ",,"$4,619.10 ",92,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,761.42 ","$4,870.14 ",other,,Not applicable. No negotiated rates per contract,"$4,317.85 ",86,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,016.61 ",80,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,769.72 ",95,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,769.72 ",95,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,765.57 ",75,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,267.65 ",85,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,518.68 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,267.65 ",85,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,518.68 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,769.72 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,669.31 ",93,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE PSN TIB STM 5 DEG SZ E L,8787032,CDM,270,RC,,HCPCS,outpatient,,,"$5,020.76 ","$3,765.57 ",,"$4,619.10 ",92,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,761.42 ","$4,870.14 ",other,,Not applicable. No negotiated rates per contract,"$4,317.85 ",86,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,016.61 ",80,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,769.72 ",95,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,769.72 ",95,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,765.57 ",75,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,267.65 ",85,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,518.68 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,870.14 ",97,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,267.65 ",85,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,518.68 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,769.72 ",90,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,761.42 ",55,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,669.31 ",93,,,"$2,761.42 ","$4,870.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE SPLINT/PNEUMATIC L4380,8971151,CDM,270,RC,,HCPCS,outpatient,,,$352.00 ,$264.00 ,,$323.84 ,92,,,$193.60 ,$341.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$193.60 ,55,,,$193.60 ,$341.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$193.60 ,$341.44 ,other,,Not applicable. No negotiated rates per contract,$302.72 ,86,,,$193.60 ,$341.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$281.60 ,80,,,$193.60 ,$341.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$193.60 ,55,,,$193.60 ,$341.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.40 ,95,,,$193.60 ,$341.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$334.40 ,95,,,$193.60 ,$341.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.00 ,75,,,$193.60 ,$341.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$299.20 ,85,,,$193.60 ,$341.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$341.44 ,97,,,$193.60 ,$341.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$193.60 ,55,,,$193.60 ,$341.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$316.80 ,90,,,$193.60 ,$341.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$341.44 ,97,,,$193.60 ,$341.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.44 ,97,,,$193.60 ,$341.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$341.44 ,97,,,$193.60 ,$341.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.20 ,85,,,$193.60 ,$341.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$316.80 ,90,,,$193.60 ,$341.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.60 ,55,,,$193.60 ,$341.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.40 ,90,,,$193.60 ,$341.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$193.60 ,55,,,$193.60 ,$341.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$327.36 ,93,,,$193.60 ,$341.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNIFE (MYRINGGOTOMY ) HANDLE BLADE 6/BX,8784141,CDM,270,RC,,HCPCS,outpatient,,,$78.38 ,$58.79 ,,$72.11 ,92,,,$43.11 ,$76.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.11 ,55,,,$43.11 ,$76.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.11 ,$76.03 ,other,,Not applicable. No negotiated rates per contract,$67.41 ,86,,,$43.11 ,$76.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.70 ,80,,,$43.11 ,$76.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.11 ,55,,,$43.11 ,$76.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.46 ,95,,,$43.11 ,$76.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.46 ,95,,,$43.11 ,$76.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.79 ,75,,,$43.11 ,$76.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.62 ,85,,,$43.11 ,$76.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.03 ,97,,,$43.11 ,$76.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.11 ,55,,,$43.11 ,$76.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.54 ,90,,,$43.11 ,$76.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.03 ,97,,,$43.11 ,$76.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.03 ,97,,,$43.11 ,$76.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.03 ,97,,,$43.11 ,$76.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.62 ,85,,,$43.11 ,$76.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.54 ,90,,,$43.11 ,$76.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.11 ,55,,,$43.11 ,$76.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.46 ,90,,,$43.11 ,$76.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.11 ,55,,,$43.11 ,$76.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.89 ,93,,,$43.11 ,$76.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"KNIFE HANDLE 5 1/4"" #4 S",8783642,CDM,270,RC,,HCPCS,outpatient,,,$40.00 ,$30.00 ,,$36.80 ,92,,,$22.00 ,$38.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.00 ,$38.80 ,other,,Not applicable. No negotiated rates per contract,$34.40 ,86,,,$22.00 ,$38.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.00 ,80,,,$22.00 ,$38.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.00 ,95,,,$22.00 ,$38.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.00 ,75,,,$22.00 ,$38.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.80 ,97,,,$22.00 ,$38.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.00 ,85,,,$22.00 ,$38.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.00 ,90,,,$22.00 ,$38.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.00 ,55,,,$22.00 ,$38.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.20 ,93,,,$22.00 ,$38.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNOT PUSHER/SUTURE CUTTER,8786666,CDM,270,RC,,HCPCS,outpatient,,,$807.50 ,$605.63 ,,$742.90 ,92,,,$444.13 ,$783.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$444.13 ,55,,,$444.13 ,$783.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$444.13 ,$783.28 ,other,,Not applicable. No negotiated rates per contract,$694.45 ,86,,,$444.13 ,$783.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$646.00 ,80,,,$444.13 ,$783.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$444.13 ,55,,,$444.13 ,$783.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$767.13 ,95,,,$444.13 ,$783.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$767.13 ,95,,,$444.13 ,$783.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$605.63 ,75,,,$444.13 ,$783.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$686.38 ,85,,,$444.13 ,$783.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$783.28 ,97,,,$444.13 ,$783.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$444.13 ,55,,,$444.13 ,$783.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$726.75 ,90,,,$444.13 ,$783.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$783.28 ,97,,,$444.13 ,$783.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$783.28 ,97,,,$444.13 ,$783.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$783.28 ,97,,,$444.13 ,$783.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$686.38 ,85,,,$444.13 ,$783.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$726.75 ,90,,,$444.13 ,$783.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$444.13 ,55,,,$444.13 ,$783.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$767.13 ,90,,,$444.13 ,$783.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$444.13 ,55,,,$444.13 ,$783.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$750.98 ,93,,,$444.13 ,$783.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNUCKLE BENDER SPLINT (S,8786178,CDM,270,RC,,HCPCS,outpatient,,,$139.50 ,$104.63 ,,$128.34 ,92,,,$76.73 ,$135.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.73 ,$135.32 ,other,,Not applicable. No negotiated rates per contract,$119.97 ,86,,,$76.73 ,$135.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$111.60 ,80,,,$76.73 ,$135.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.63 ,75,,,$76.73 ,$135.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.74 ,93,,,$76.73 ,$135.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNUCKLE BENDER SPLINT (X,8786179,CDM,270,RC,,HCPCS,outpatient,,,$103.85 ,$77.89 ,,$95.54 ,92,,,$57.12 ,$100.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.12 ,$100.73 ,other,,Not applicable. No negotiated rates per contract,$89.31 ,86,,,$57.12 ,$100.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$83.08 ,80,,,$57.12 ,$100.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.66 ,95,,,$57.12 ,$100.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.89 ,75,,,$57.12 ,$100.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.73 ,97,,,$57.12 ,$100.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.27 ,85,,,$57.12 ,$100.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.47 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.66 ,90,,,$57.12 ,$100.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.12 ,55,,,$57.12 ,$100.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.58 ,93,,,$57.12 ,$100.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNUCKLE BENDER SPLINT MEDIUM CA,8786183,CDM,270,RC,,HCPCS,outpatient,,,$139.50 ,$104.63 ,,$128.34 ,92,,,$76.73 ,$135.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.73 ,$135.32 ,other,,Not applicable. No negotiated rates per contract,$119.97 ,86,,,$76.73 ,$135.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$111.60 ,80,,,$76.73 ,$135.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.53 ,95,,,$76.73 ,$135.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.63 ,75,,,$76.73 ,$135.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.32 ,97,,,$76.73 ,$135.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.58 ,85,,,$76.73 ,$135.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.55 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,90,,,$76.73 ,$135.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.73 ,55,,,$76.73 ,$135.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.74 ,93,,,$76.73 ,$135.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KO adj jnt pos rigid support L1832,8971138,CDM,270,RC,L1832,HCPCS,outpatient,,,$360.00 ,$270.00 ,,$331.20 ,92,,,$198.00 ,$349.20 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$198.00 ,$349.20 ,other,,Not applicable. No negotiated rates per contract,$309.60 ,86,,,$198.00 ,$349.20 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$288.00 ,80,,,$198.00 ,$349.20 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.00 ,95,,,$198.00 ,$349.20 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.00 ,75,,,$198.00 ,$349.20 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.20 ,97,,,$198.00 ,$349.20 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.00 ,85,,,$198.00 ,$349.20 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.00 ,90,,,$198.00 ,$349.20 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.00 ,55,,,$198.00 ,$349.20 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.80 ,93,,,$198.00 ,$349.20 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KUGEL HERNIA LARGE OVAL,8782325,CDM,270,RC,,HCPCS,outpatient,,,"$1,700.00 ","$1,275.00 ",,"$1,564.00 ",92,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$935.00 ,"$1,649.00 ",other,,Not applicable. No negotiated rates per contract,"$1,462.00 ",86,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,360.00 ",80,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,615.00 ",95,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,615.00 ",95,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,275.00 ",75,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,445.00 ",85,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,530.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,445.00 ",85,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,530.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,615.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,581.00 ",93,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KUGEL HERNIA MEDIUM OVAL,8782327,CDM,270,RC,,HCPCS,outpatient,,,"$1,661.75 ","$1,246.31 ",,"$1,528.81 ",92,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$913.96 ,55,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$913.96 ,"$1,611.90 ",other,,Not applicable. No negotiated rates per contract,"$1,429.11 ",86,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,329.40 ",80,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$913.96 ,55,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,578.66 ",95,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,578.66 ",95,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,246.31 ",75,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,412.49 ",85,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,611.90 ",97,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$913.96 ,55,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,495.58 ",90,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,611.90 ",97,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.90 ",97,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.90 ",97,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,412.49 ",85,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,495.58 ",90,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$913.96 ,55,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,578.66 ",90,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$913.96 ,55,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,545.43 ",93,,,$913.96 ,"$1,611.90 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KUGEL HERNIA ONFLEX MESH,8782319,CDM,270,RC,,HCPCS,outpatient,,,"$1,891.25 ","$1,418.44 ",,"$1,739.95 ",92,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,040.19 ",55,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,040.19 ","$1,834.51 ",other,,Not applicable. No negotiated rates per contract,"$1,626.48 ",86,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,513.00 ",80,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,040.19 ",55,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,796.69 ",95,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,796.69 ",95,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,418.44 ",75,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,607.56 ",85,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,834.51 ",97,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,040.19 ",55,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,702.13 ",90,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,834.51 ",97,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,834.51 ",97,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,834.51 ",97,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,607.56 ",85,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,702.13 ",90,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,040.19 ",55,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,796.69 ",90,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,040.19 ",55,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,758.86 ",93,,,"$1,040.19 ","$1,834.51 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KUGEL HERNIA SMALL CIRCL,8782328,CDM,270,RC,,HCPCS,outpatient,,,"$1,432.25 ","$1,074.19 ",,"$1,317.67 ",92,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$787.74 ,55,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$787.74 ,"$1,389.28 ",other,,Not applicable. No negotiated rates per contract,"$1,231.74 ",86,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,145.80 ",80,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$787.74 ,55,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,360.64 ",95,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,360.64 ",95,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,074.19 ",75,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,217.41 ",85,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,389.28 ",97,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$787.74 ,55,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,289.03 ",90,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,389.28 ",97,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,389.28 ",97,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,389.28 ",97,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,217.41 ",85,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,289.03 ",90,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$787.74 ,55,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,360.64 ",90,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$787.74 ,55,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,331.99 ",93,,,$787.74 ,"$1,389.28 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KUMAR CATHETER(FOR CHOLA,8784663,CDM,270,RC,,HCPCS,outpatient,,,$244.69 ,$183.52 ,,$225.11 ,92,,,$134.58 ,$237.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$134.58 ,55,,,$134.58 ,$237.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$134.58 ,$237.35 ,other,,Not applicable. No negotiated rates per contract,$210.43 ,86,,,$134.58 ,$237.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$195.75 ,80,,,$134.58 ,$237.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$134.58 ,55,,,$134.58 ,$237.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.46 ,95,,,$134.58 ,$237.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$232.46 ,95,,,$134.58 ,$237.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.52 ,75,,,$134.58 ,$237.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$207.99 ,85,,,$134.58 ,$237.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$237.35 ,97,,,$134.58 ,$237.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.58 ,55,,,$134.58 ,$237.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.22 ,90,,,$134.58 ,$237.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.35 ,97,,,$134.58 ,$237.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.35 ,97,,,$134.58 ,$237.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.35 ,97,,,$134.58 ,$237.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.99 ,85,,,$134.58 ,$237.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$220.22 ,90,,,$134.58 ,$237.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.58 ,55,,,$134.58 ,$237.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.46 ,90,,,$134.58 ,$237.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.58 ,55,,,$134.58 ,$237.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$227.56 ,93,,,$134.58 ,$237.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KUMAR CHLOLANGIOGRAPHY C,8784662,CDM,270,RC,,HCPCS,outpatient,,,"$2,762.50 ","$2,071.88 ",,"$2,541.50 ",92,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,519.38 ","$2,679.63 ",other,,Not applicable. No negotiated rates per contract,"$2,375.75 ",86,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,210.00 ",80,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,071.88 ",75,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,569.13 ",93,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
KUUL: HONEY COMB CONTROL,8783260,CDM,270,RC,,HCPCS,outpatient,,,$464.95 ,$348.71 ,,$427.75 ,92,,,$255.72 ,$451.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$255.72 ,55,,,$255.72 ,$451.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$255.72 ,$451.00 ,other,,Not applicable. No negotiated rates per contract,$399.86 ,86,,,$255.72 ,$451.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$371.96 ,80,,,$255.72 ,$451.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$255.72 ,55,,,$255.72 ,$451.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.70 ,95,,,$255.72 ,$451.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$441.70 ,95,,,$255.72 ,$451.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$348.71 ,75,,,$255.72 ,$451.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$395.21 ,85,,,$255.72 ,$451.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$451.00 ,97,,,$255.72 ,$451.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$255.72 ,55,,,$255.72 ,$451.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$418.46 ,90,,,$255.72 ,$451.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$451.00 ,97,,,$255.72 ,$451.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$451.00 ,97,,,$255.72 ,$451.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$451.00 ,97,,,$255.72 ,$451.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$395.21 ,85,,,$255.72 ,$451.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$418.46 ,90,,,$255.72 ,$451.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.72 ,55,,,$255.72 ,$451.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.70 ,90,,,$255.72 ,$451.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$255.72 ,55,,,$255.72 ,$451.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$432.40 ,93,,,$255.72 ,$451.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Knee,8971139,CDM,270,RC,L1833,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
LABEL,8784661,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMB OSTEO CURVED 1 (OR),8783635,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMB OSTEO CURVED 1 1/2,8783637,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMB OSTEO CURVED 1 1/4,8783636,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMB OSTEO CURVED 3/4 (O,8783634,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMB OSTEO STRAIGHT CURV,8783621,CDM,270,RC,,HCPCS,outpatient,,,$240.70 ,$180.53 ,,$221.44 ,92,,,$132.39 ,$233.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.39 ,55,,,$132.39 ,$233.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.39 ,$233.48 ,other,,Not applicable. No negotiated rates per contract,$207.00 ,86,,,$132.39 ,$233.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.56 ,80,,,$132.39 ,$233.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.39 ,55,,,$132.39 ,$233.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.67 ,95,,,$132.39 ,$233.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.67 ,95,,,$132.39 ,$233.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.53 ,75,,,$132.39 ,$233.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.60 ,85,,,$132.39 ,$233.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.48 ,97,,,$132.39 ,$233.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.39 ,55,,,$132.39 ,$233.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.63 ,90,,,$132.39 ,$233.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.48 ,97,,,$132.39 ,$233.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.48 ,97,,,$132.39 ,$233.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.48 ,97,,,$132.39 ,$233.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.60 ,85,,,$132.39 ,$233.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.63 ,90,,,$132.39 ,$233.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.39 ,55,,,$132.39 ,$233.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.67 ,90,,,$132.39 ,$233.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.39 ,55,,,$132.39 ,$233.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.85 ,93,,,$132.39 ,$233.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"LAMBOTTE RACK-1103/4"" X",8783638,CDM,270,RC,,HCPCS,outpatient,,,"$2,120.75 ","$1,590.56 ",,"$1,951.09 ",92,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,166.41 ",55,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,166.41 ","$2,057.13 ",other,,Not applicable. No negotiated rates per contract,"$1,823.85 ",86,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,696.60 ",80,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,166.41 ",55,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,014.71 ",95,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,014.71 ",95,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,590.56 ",75,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,802.64 ",85,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,057.13 ",97,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,166.41 ",55,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,908.68 ",90,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,057.13 ",97,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,057.13 ",97,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,057.13 ",97,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,802.64 ",85,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,908.68 ",90,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.41 ",55,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,014.71 ",90,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,166.41 ",55,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,972.30 ",93,,,"$1,166.41 ","$2,057.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
LAMINATING POUCHES MENU,8784628,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMP RECYCLING KIT,8783456,CDM,270,RC,52719,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMP,8783458,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LAMP,8783457,CDM,270,RC,53281,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
LARGE ARM SUPPORT WRAP,8783948,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LARGE MALE POST OP SHOE( SIZE(11-13),8785126,CDM,270,RC,,HCPCS,outpatient,,,$46.86 ,$35.15 ,,$43.11 ,92,,,$25.77 ,$45.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.77 ,$45.45 ,other,,Not applicable. No negotiated rates per contract,$40.30 ,86,,,$25.77 ,$45.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.49 ,80,,,$25.77 ,$45.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.52 ,95,,,$25.77 ,$45.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.52 ,95,,,$25.77 ,$45.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,75,,,$25.77 ,$45.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.83 ,85,,,$25.77 ,$45.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.17 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.83 ,85,,,$25.77 ,$45.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.17 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.52 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.58 ,93,,,$25.77 ,$45.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LEG BAG W LARGE  32OZ (B,8784636,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LETTER W END TAB LABELS,8784565,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LG  FEMALE POST OP SHOE  (79-90197),8785129,CDM,270,RC,,HCPCS,outpatient,,,$75.32 ,$56.49 ,,$69.29 ,92,,,$41.43 ,$73.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.43 ,$73.06 ,other,,Not applicable. No negotiated rates per contract,$64.78 ,86,,,$41.43 ,$73.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.26 ,80,,,$41.43 ,$73.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.55 ,95,,,$41.43 ,$73.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.55 ,95,,,$41.43 ,$73.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.49 ,75,,,$41.43 ,$73.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.02 ,85,,,$41.43 ,$73.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.79 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.06 ,97,,,$41.43 ,$73.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.02 ,85,,,$41.43 ,$73.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.79 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.55 ,90,,,$41.43 ,$73.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.43 ,55,,,$41.43 ,$73.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.05 ,93,,,$41.43 ,$73.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LG SUPER MULTI-DVD+RW US,8782802,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LIGACLIP APPLIER ENDOSCO,8783806,CDM,270,RC,,HCPCS,outpatient,,,$471.73 ,$353.80 ,,$433.99 ,92,,,$259.45 ,$457.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$259.45 ,55,,,$259.45 ,$457.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$259.45 ,$457.58 ,other,,Not applicable. No negotiated rates per contract,$405.69 ,86,,,$259.45 ,$457.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$377.38 ,80,,,$259.45 ,$457.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$259.45 ,55,,,$259.45 ,$457.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.14 ,95,,,$259.45 ,$457.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$448.14 ,95,,,$259.45 ,$457.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.80 ,75,,,$259.45 ,$457.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$400.97 ,85,,,$259.45 ,$457.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$457.58 ,97,,,$259.45 ,$457.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.45 ,55,,,$259.45 ,$457.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.56 ,90,,,$259.45 ,$457.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$457.58 ,97,,,$259.45 ,$457.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$457.58 ,97,,,$259.45 ,$457.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$457.58 ,97,,,$259.45 ,$457.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$400.97 ,85,,,$259.45 ,$457.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$424.56 ,90,,,$259.45 ,$457.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.45 ,55,,,$259.45 ,$457.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.14 ,90,,,$259.45 ,$457.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.45 ,55,,,$259.45 ,$457.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.71 ,93,,,$259.45 ,$457.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LIMBHOLDER PERSONAL 40 P,8785655,CDM,270,RC,,HCPCS,outpatient,,,$29.14 ,$21.86 ,,$26.81 ,92,,,$16.03 ,$28.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.03 ,55,,,$16.03 ,$28.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.03 ,$28.27 ,other,,Not applicable. No negotiated rates per contract,$25.06 ,86,,,$16.03 ,$28.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.31 ,80,,,$16.03 ,$28.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.03 ,55,,,$16.03 ,$28.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.68 ,95,,,$16.03 ,$28.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.68 ,95,,,$16.03 ,$28.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.86 ,75,,,$16.03 ,$28.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.77 ,85,,,$16.03 ,$28.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.27 ,97,,,$16.03 ,$28.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.03 ,55,,,$16.03 ,$28.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.23 ,90,,,$16.03 ,$28.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.27 ,97,,,$16.03 ,$28.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.27 ,97,,,$16.03 ,$28.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.27 ,97,,,$16.03 ,$28.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.77 ,85,,,$16.03 ,$28.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.23 ,90,,,$16.03 ,$28.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.03 ,55,,,$16.03 ,$28.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.68 ,90,,,$16.03 ,$28.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.03 ,55,,,$16.03 ,$28.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.10 ,93,,,$16.03 ,$28.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LINEAR CUTTER 55MM (BLUE,8783807,CDM,270,RC,,HCPCS,outpatient,,,$308.41 ,$231.31 ,,$283.74 ,92,,,$169.63 ,$299.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$169.63 ,$299.16 ,other,,Not applicable. No negotiated rates per contract,$265.23 ,86,,,$169.63 ,$299.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$246.73 ,80,,,$169.63 ,$299.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.99 ,95,,,$169.63 ,$299.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$292.99 ,95,,,$169.63 ,$299.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.31 ,75,,,$169.63 ,$299.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$262.15 ,85,,,$169.63 ,$299.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$277.57 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$299.16 ,97,,,$169.63 ,$299.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.15 ,85,,,$169.63 ,$299.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.57 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.99 ,90,,,$169.63 ,$299.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.63 ,55,,,$169.63 ,$299.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.82 ,93,,,$169.63 ,$299.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LINEAR CUTTER 75MM RELOA,8783815,CDM,270,RC,,HCPCS,outpatient,,,$539.39 ,$404.54 ,,$496.24 ,92,,,$296.66 ,$523.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$296.66 ,55,,,$296.66 ,$523.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$296.66 ,$523.21 ,other,,Not applicable. No negotiated rates per contract,$463.88 ,86,,,$296.66 ,$523.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$431.51 ,80,,,$296.66 ,$523.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$296.66 ,55,,,$296.66 ,$523.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$512.42 ,95,,,$296.66 ,$523.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$512.42 ,95,,,$296.66 ,$523.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$404.54 ,75,,,$296.66 ,$523.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$458.48 ,85,,,$296.66 ,$523.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$523.21 ,97,,,$296.66 ,$523.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$296.66 ,55,,,$296.66 ,$523.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$485.45 ,90,,,$296.66 ,$523.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$523.21 ,97,,,$296.66 ,$523.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$523.21 ,97,,,$296.66 ,$523.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$523.21 ,97,,,$296.66 ,$523.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$458.48 ,85,,,$296.66 ,$523.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$485.45 ,90,,,$296.66 ,$523.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$296.66 ,55,,,$296.66 ,$523.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$512.42 ,90,,,$296.66 ,$523.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$296.66 ,55,,,$296.66 ,$523.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.63 ,93,,,$296.66 ,$523.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LINEAR CUTTER RELOAD,8785435,CDM,270,RC,,HCPCS,outpatient,,,$560.75 ,$420.56 ,,$515.89 ,92,,,$308.41 ,$543.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$308.41 ,$543.93 ,other,,Not applicable. No negotiated rates per contract,$482.25 ,86,,,$308.41 ,$543.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$448.60 ,80,,,$308.41 ,$543.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.71 ,95,,,$308.41 ,$543.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.71 ,95,,,$308.41 ,$543.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$420.56 ,75,,,$308.41 ,$543.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$476.64 ,85,,,$308.41 ,$543.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$504.68 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$543.93 ,97,,,$308.41 ,$543.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$476.64 ,85,,,$308.41 ,$543.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.68 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$532.71 ,90,,,$308.41 ,$543.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.41 ,55,,,$308.41 ,$543.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$521.50 ,93,,,$308.41 ,$543.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LINEAR CUTTER55MM RELOAD,8783814,CDM,270,RC,,HCPCS,outpatient,,,$432.44 ,$324.33 ,,$397.84 ,92,,,$237.84 ,$419.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$237.84 ,55,,,$237.84 ,$419.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$237.84 ,$419.47 ,other,,Not applicable. No negotiated rates per contract,$371.90 ,86,,,$237.84 ,$419.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$345.95 ,80,,,$237.84 ,$419.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$237.84 ,55,,,$237.84 ,$419.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.82 ,95,,,$237.84 ,$419.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.82 ,95,,,$237.84 ,$419.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.33 ,75,,,$237.84 ,$419.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$367.57 ,85,,,$237.84 ,$419.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.47 ,97,,,$237.84 ,$419.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.84 ,55,,,$237.84 ,$419.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.20 ,90,,,$237.84 ,$419.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.47 ,97,,,$237.84 ,$419.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.47 ,97,,,$237.84 ,$419.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.47 ,97,,,$237.84 ,$419.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.57 ,85,,,$237.84 ,$419.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$389.20 ,90,,,$237.84 ,$419.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.84 ,55,,,$237.84 ,$419.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.82 ,90,,,$237.84 ,$419.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$237.84 ,55,,,$237.84 ,$419.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$402.17 ,93,,,$237.84 ,$419.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LINEAR CUTTER75MM (BLUE,8783808,CDM,270,RC,,HCPCS,outpatient,,,$432.81 ,$324.61 ,,$398.19 ,92,,,$238.05 ,$419.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$238.05 ,55,,,$238.05 ,$419.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$238.05 ,$419.83 ,other,,Not applicable. No negotiated rates per contract,$372.22 ,86,,,$238.05 ,$419.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$346.25 ,80,,,$238.05 ,$419.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$238.05 ,55,,,$238.05 ,$419.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$411.17 ,95,,,$238.05 ,$419.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$411.17 ,95,,,$238.05 ,$419.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$324.61 ,75,,,$238.05 ,$419.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$367.89 ,85,,,$238.05 ,$419.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$419.83 ,97,,,$238.05 ,$419.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.05 ,55,,,$238.05 ,$419.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.53 ,90,,,$238.05 ,$419.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$419.83 ,97,,,$238.05 ,$419.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.83 ,97,,,$238.05 ,$419.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$419.83 ,97,,,$238.05 ,$419.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$367.89 ,85,,,$238.05 ,$419.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$389.53 ,90,,,$238.05 ,$419.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$238.05 ,55,,,$238.05 ,$419.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$411.17 ,90,,,$238.05 ,$419.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$238.05 ,55,,,$238.05 ,$419.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$402.51 ,93,,,$238.05 ,$419.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
LOANER FEE,8782945,CDM,270,RC,,HCPCS,outpatient,,,"$1,680.00 ","$1,260.00 ",,"$1,545.60 ",92,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$924.00 ,55,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$924.00 ,"$1,629.60 ",other,,Not applicable. No negotiated rates per contract,"$1,444.80 ",86,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,344.00 ",80,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$924.00 ,55,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,596.00 ",95,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,596.00 ",95,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,260.00 ",75,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,428.00 ",85,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,629.60 ",97,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$924.00 ,55,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,512.00 ",90,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,629.60 ",97,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,629.60 ",97,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,629.60 ",97,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,428.00 ",85,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,512.00 ",90,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$924.00 ,55,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,596.00 ",90,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$924.00 ,55,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,562.40 ",93,,,$924.00 ,"$1,629.60 ",percent of total billed charges,,93% of total billed charges for outpatient setting
LONESTAR RETRACTOR SYSTEM,8782904,CDM,270,RC,,HCPCS,outpatient,,,"$2,623.40 ","$1,967.55 ",,"$2,413.53 ",92,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,442.87 ",55,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,442.87 ","$2,544.70 ",other,,Not applicable. No negotiated rates per contract,"$2,256.12 ",86,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,098.72 ",80,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,442.87 ",55,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,492.23 ",95,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,492.23 ",95,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.55 ",75,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,229.89 ",85,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,544.70 ",97,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,442.87 ",55,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,361.06 ",90,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,544.70 ",97,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,544.70 ",97,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,544.70 ",97,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,229.89 ",85,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,361.06 ",90,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.87 ",55,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,492.23 ",90,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,442.87 ",55,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,439.76 ",93,,,"$1,442.87 ","$2,544.70 ",percent of total billed charges,,93% of total billed charges for outpatient setting
LOW VOLTAGE CONTROLLER 2,8783459,CDM,270,RC,,HCPCS,outpatient,,,$520.00 ,$390.00 ,,$478.40 ,92,,,$286.00 ,$504.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$286.00 ,$504.40 ,other,,Not applicable. No negotiated rates per contract,$447.20 ,86,,,$286.00 ,$504.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$416.00 ,80,,,$286.00 ,$504.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$494.00 ,95,,,$286.00 ,$504.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$390.00 ,75,,,$286.00 ,$504.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.40 ,97,,,$286.00 ,$504.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.00 ,85,,,$286.00 ,$504.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$468.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$494.00 ,90,,,$286.00 ,$504.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.00 ,55,,,$286.00 ,$504.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$483.60 ,93,,,$286.00 ,$504.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MAINTENANCE RENEWAL REMO,8782943,CDM,270,RC,,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MALLEABLE STYLET ADULT 15FR X 70CM,8786520,CDM,270,RC,,HCPCS,outpatient,,,$81.14 ,$60.86 ,,$74.65 ,92,,,$44.63 ,$78.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.63 ,$78.71 ,other,,Not applicable. No negotiated rates per contract,$69.78 ,86,,,$44.63 ,$78.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.91 ,80,,,$44.63 ,$78.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.08 ,95,,,$44.63 ,$78.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.08 ,95,,,$44.63 ,$78.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.86 ,75,,,$44.63 ,$78.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.97 ,85,,,$44.63 ,$78.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.03 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.97 ,85,,,$44.63 ,$78.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.03 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.08 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.46 ,93,,,$44.63 ,$78.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK  SZ 4 LMA -UNIQUE,8785328,CDM,270,RC,,HCPCS,outpatient,,,$226.78 ,$170.09 ,,$208.64 ,92,,,$124.73 ,$219.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.73 ,55,,,$124.73 ,$219.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.73 ,$219.98 ,other,,Not applicable. No negotiated rates per contract,$195.03 ,86,,,$124.73 ,$219.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$181.42 ,80,,,$124.73 ,$219.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.73 ,55,,,$124.73 ,$219.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.44 ,95,,,$124.73 ,$219.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$215.44 ,95,,,$124.73 ,$219.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$170.09 ,75,,,$124.73 ,$219.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$192.76 ,85,,,$124.73 ,$219.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.98 ,97,,,$124.73 ,$219.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.73 ,55,,,$124.73 ,$219.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.10 ,90,,,$124.73 ,$219.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.98 ,97,,,$124.73 ,$219.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.98 ,97,,,$124.73 ,$219.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.98 ,97,,,$124.73 ,$219.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$192.76 ,85,,,$124.73 ,$219.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.10 ,90,,,$124.73 ,$219.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.73 ,55,,,$124.73 ,$219.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.44 ,90,,,$124.73 ,$219.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.73 ,55,,,$124.73 ,$219.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.91 ,93,,,$124.73 ,$219.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8785584,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8785722,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8785581,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK CPAP BOUSSIGNAC SYS,8786970,CDM,270,RC,,HCPCS,outpatient,,,$456.06 ,$342.05 ,,$419.58 ,92,,,$250.83 ,$442.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$250.83 ,55,,,$250.83 ,$442.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$250.83 ,$442.38 ,other,,Not applicable. No negotiated rates per contract,$392.21 ,86,,,$250.83 ,$442.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$364.85 ,80,,,$250.83 ,$442.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$250.83 ,55,,,$250.83 ,$442.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.26 ,95,,,$250.83 ,$442.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$433.26 ,95,,,$250.83 ,$442.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.05 ,75,,,$250.83 ,$442.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$387.65 ,85,,,$250.83 ,$442.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$442.38 ,97,,,$250.83 ,$442.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.83 ,55,,,$250.83 ,$442.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$410.45 ,90,,,$250.83 ,$442.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$442.38 ,97,,,$250.83 ,$442.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.38 ,97,,,$250.83 ,$442.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$442.38 ,97,,,$250.83 ,$442.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.65 ,85,,,$250.83 ,$442.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$410.45 ,90,,,$250.83 ,$442.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.83 ,55,,,$250.83 ,$442.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$433.26 ,90,,,$250.83 ,$442.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$250.83 ,55,,,$250.83 ,$442.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$424.14 ,93,,,$250.83 ,$442.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK SZ 2 LMA -UNIQUE,8785326,CDM,270,RC,,HCPCS,outpatient,,,$257.09 ,$192.82 ,,$236.52 ,92,,,$141.40 ,$249.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.40 ,55,,,$141.40 ,$249.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$141.40 ,$249.38 ,other,,Not applicable. No negotiated rates per contract,$221.10 ,86,,,$141.40 ,$249.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$205.67 ,80,,,$141.40 ,$249.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.40 ,55,,,$141.40 ,$249.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.24 ,95,,,$141.40 ,$249.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$244.24 ,95,,,$141.40 ,$249.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.82 ,75,,,$141.40 ,$249.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$218.53 ,85,,,$141.40 ,$249.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$249.38 ,97,,,$141.40 ,$249.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.40 ,55,,,$141.40 ,$249.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.38 ,90,,,$141.40 ,$249.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.38 ,97,,,$141.40 ,$249.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.38 ,97,,,$141.40 ,$249.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.38 ,97,,,$141.40 ,$249.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.53 ,85,,,$141.40 ,$249.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$231.38 ,90,,,$141.40 ,$249.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.40 ,55,,,$141.40 ,$249.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.24 ,90,,,$141.40 ,$249.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.40 ,55,,,$141.40 ,$249.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.09 ,93,,,$141.40 ,$249.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK SZ 3  LMA -UNIQUE,8785327,CDM,270,RC,,HCPCS,outpatient,,,$147.10 ,$110.33 ,,$135.33 ,92,,,$80.91 ,$142.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.91 ,$142.69 ,other,,Not applicable. No negotiated rates per contract,$126.51 ,86,,,$80.91 ,$142.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.68 ,80,,,$80.91 ,$142.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.75 ,95,,,$80.91 ,$142.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.75 ,95,,,$80.91 ,$142.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.33 ,75,,,$80.91 ,$142.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.04 ,85,,,$80.91 ,$142.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.39 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.04 ,85,,,$80.91 ,$142.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.39 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.75 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,93,,,$80.91 ,$142.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK SZ 5  LMA-UNIQUE,8843982,CDM,270,RC,,HCPCS,outpatient,,,$147.10 ,$110.33 ,,$135.33 ,92,,,$80.91 ,$142.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.91 ,$142.69 ,other,,Not applicable. No negotiated rates per contract,$126.51 ,86,,,$80.91 ,$142.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.68 ,80,,,$80.91 ,$142.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.75 ,95,,,$80.91 ,$142.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.75 ,95,,,$80.91 ,$142.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.33 ,75,,,$80.91 ,$142.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.04 ,85,,,$80.91 ,$142.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.39 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.69 ,97,,,$80.91 ,$142.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.04 ,85,,,$80.91 ,$142.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.39 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.75 ,90,,,$80.91 ,$142.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.91 ,55,,,$80.91 ,$142.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.80 ,93,,,$80.91 ,$142.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8786253,CDM,270,RC,51628,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MASK,8785585,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8785582,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MASK,8786254,CDM,270,RC,51629,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MASK,8786256,CDM,270,RC,52946,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MASTISOL ADHESIVE 2/3CC,8785660,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MAXCORE DISP BIOPSY INST,8782331,CDM,270,RC,,HCPCS,outpatient,,,$274.27 ,$205.70 ,,$252.33 ,92,,,$150.85 ,$266.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$150.85 ,55,,,$150.85 ,$266.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$150.85 ,$266.04 ,other,,Not applicable. No negotiated rates per contract,$235.87 ,86,,,$150.85 ,$266.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$219.42 ,80,,,$150.85 ,$266.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$150.85 ,55,,,$150.85 ,$266.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.56 ,95,,,$150.85 ,$266.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.56 ,95,,,$150.85 ,$266.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$205.70 ,75,,,$150.85 ,$266.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$233.13 ,85,,,$150.85 ,$266.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$266.04 ,97,,,$150.85 ,$266.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.85 ,55,,,$150.85 ,$266.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.84 ,90,,,$150.85 ,$266.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$266.04 ,97,,,$150.85 ,$266.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.04 ,97,,,$150.85 ,$266.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$266.04 ,97,,,$150.85 ,$266.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.13 ,85,,,$150.85 ,$266.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.84 ,90,,,$150.85 ,$266.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.85 ,55,,,$150.85 ,$266.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.56 ,90,,,$150.85 ,$266.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.85 ,55,,,$150.85 ,$266.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.07 ,93,,,$150.85 ,$266.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MAXCORE DISP BIOPSY INSTRUMENT 14G X 10CM ultrasound (BARD PERF. VASCULAR),8782332,CDM,270,RC,,HCPCS,outpatient,,,$271.44 ,$203.58 ,,$249.72 ,92,,,$149.29 ,$263.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.29 ,55,,,$149.29 ,$263.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.29 ,$263.30 ,other,,Not applicable. No negotiated rates per contract,$233.44 ,86,,,$149.29 ,$263.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$217.15 ,80,,,$149.29 ,$263.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.29 ,55,,,$149.29 ,$263.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.87 ,95,,,$149.29 ,$263.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$257.87 ,95,,,$149.29 ,$263.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.58 ,75,,,$149.29 ,$263.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$230.72 ,85,,,$149.29 ,$263.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.30 ,97,,,$149.29 ,$263.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.29 ,55,,,$149.29 ,$263.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.30 ,90,,,$149.29 ,$263.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.30 ,97,,,$149.29 ,$263.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.30 ,97,,,$149.29 ,$263.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.30 ,97,,,$149.29 ,$263.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.72 ,85,,,$149.29 ,$263.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.30 ,90,,,$149.29 ,$263.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.29 ,55,,,$149.29 ,$263.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.87 ,90,,,$149.29 ,$263.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.29 ,55,,,$149.29 ,$263.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.44 ,93,,,$149.29 ,$263.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MAYO CATGUT 1/2 CIRCLE SUTURE NEEDLE,9085619,CDM,270,RC,54742,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MCFARLAND STANDARD 1.0,8782481,CDM,270,RC,,HCPCS,outpatient,,,$297.14 ,$222.86 ,,$273.37 ,92,,,$163.43 ,$288.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$163.43 ,55,,,$163.43 ,$288.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.43 ,$288.23 ,other,,Not applicable. No negotiated rates per contract,$255.54 ,86,,,$163.43 ,$288.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$237.71 ,80,,,$163.43 ,$288.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$163.43 ,55,,,$163.43 ,$288.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$282.28 ,95,,,$163.43 ,$288.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.28 ,95,,,$163.43 ,$288.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.86 ,75,,,$163.43 ,$288.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$252.57 ,85,,,$163.43 ,$288.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.23 ,97,,,$163.43 ,$288.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.43 ,55,,,$163.43 ,$288.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.43 ,90,,,$163.43 ,$288.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$288.23 ,97,,,$163.43 ,$288.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$288.23 ,97,,,$163.43 ,$288.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$288.23 ,97,,,$163.43 ,$288.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.57 ,85,,,$163.43 ,$288.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.43 ,90,,,$163.43 ,$288.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.43 ,55,,,$163.43 ,$288.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$282.28 ,90,,,$163.43 ,$288.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.43 ,55,,,$163.43 ,$288.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.34 ,93,,,$163.43 ,$288.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MECONIUM ASPIRATOR,8783055,CDM,270,RC,,HCPCS,outpatient,,,$41.04 ,$30.78 ,,$37.76 ,92,,,$22.57 ,$39.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.57 ,$39.81 ,other,,Not applicable. No negotiated rates per contract,$35.29 ,86,,,$22.57 ,$39.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.83 ,80,,,$22.57 ,$39.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.99 ,95,,,$22.57 ,$39.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.99 ,95,,,$22.57 ,$39.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.78 ,75,,,$22.57 ,$39.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.88 ,85,,,$22.57 ,$39.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.94 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.88 ,85,,,$22.57 ,$39.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.94 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.99 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.17 ,93,,,$22.57 ,$39.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10136168,CDM,272,RC,,HCPCS,outpatient,,,"$7,150.00 ","$5,362.50 ",,"$6,578.00 ",92,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,932.50 ","$6,935.50 ",other,,Not applicable. No negotiated rates per contract,"$6,149.00 ",86,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,720.00 ",80,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,362.50 ",75,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,649.50 ",93,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045532,CDM,278,RC,,HCPCS,both,,,"$5,625.00 ","$4,218.75 ",,"$5,175.00 ",92,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,093.75 ","$5,456.25 ",other,,Not applicable. No negotiated rates per contract,"$4,837.50 ",86,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,500.00 ",80,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,343.75 ",95,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,343.75 ",95,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,218.75 ",75,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,781.25 ",85,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,062.50 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,781.25 ",85,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,062.50 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,343.75 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,231.25 ",93,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045535,CDM,278,RC,,HCPCS,both,,,"$7,150.00 ","$5,362.50 ",,"$6,578.00 ",92,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,932.50 ","$6,935.50 ",other,,Not applicable. No negotiated rates per contract,"$6,149.00 ",86,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,720.00 ",80,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,362.50 ",75,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,649.50 ",93,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10058770,CDM,278,RC,,HCPCS,both,,,"$5,625.00 ","$4,218.75 ",,"$5,175.00 ",92,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,093.75 ","$5,456.25 ",other,,Not applicable. No negotiated rates per contract,"$4,837.50 ",86,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,500.00 ",80,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,343.75 ",95,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,343.75 ",95,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,218.75 ",75,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,781.25 ",85,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,062.50 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,456.25 ",97,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,781.25 ",85,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,062.50 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,343.75 ",90,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,093.75 ",55,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,231.25 ",93,,,"$3,093.75 ","$5,456.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10058772,CDM,278,RC,,HCPCS,both,,,"$7,150.00 ","$5,362.50 ",,"$6,578.00 ",92,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,932.50 ","$6,935.50 ",other,,Not applicable. No negotiated rates per contract,"$6,149.00 ",86,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,720.00 ",80,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,792.50 ",95,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,362.50 ",75,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,935.50 ",97,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,077.50 ",85,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,435.00 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,792.50 ",90,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,932.50 ",55,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,649.50 ",93,,,"$3,932.50 ","$6,935.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045534,CDM,278,RC,,HCPCS,both,,,"$3,400.00 ","$2,550.00 ",,"$3,128.00 ",92,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,870.00 ","$3,298.00 ",other,,Not applicable. No negotiated rates per contract,"$2,924.00 ",86,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,720.00 ",80,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,550.00 ",75,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,162.00 ",93,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10058771,CDM,278,RC,,HCPCS,both,,,"$3,400.00 ","$2,550.00 ",,"$3,128.00 ",92,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,870.00 ","$3,298.00 ",other,,Not applicable. No negotiated rates per contract,"$2,924.00 ",86,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,720.00 ",80,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,550.00 ",75,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,162.00 ",93,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10135105,CDM,272,RC,,HCPCS,outpatient,,,"$11,550.00 ","$8,662.50 ",,"$10,626.00 ",92,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$6,352.50 ","$11,203.50 ",other,,Not applicable. No negotiated rates per contract,"$9,933.00 ",86,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$9,240.00 ",80,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$10,972.50 ",95,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$8,662.50 ",75,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,203.50 ",97,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,817.50 ",85,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$10,395.00 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,972.50 ",90,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,352.50 ",55,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$10,741.50 ",93,,,"$6,352.50 ","$11,203.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045537,CDM,278,RC,,HCPCS,both,,,$656.25 ,$492.19 ,,$603.75 ,92,,,$360.94 ,$636.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$360.94 ,$636.56 ,other,,Not applicable. No negotiated rates per contract,$564.38 ,86,,,$360.94 ,$636.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$525.00 ,80,,,$360.94 ,$636.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$492.19 ,75,,,$360.94 ,$636.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.31 ,93,,,$360.94 ,$636.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10045540,CDM,278,RC,,HCPCS,both,,,$656.25 ,$492.19 ,,$603.75 ,92,,,$360.94 ,$636.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$360.94 ,$636.56 ,other,,Not applicable. No negotiated rates per contract,$564.38 ,86,,,$360.94 ,$636.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$525.00 ,80,,,$360.94 ,$636.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$492.19 ,75,,,$360.94 ,$636.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.31 ,93,,,$360.94 ,$636.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDACTA,10058773,CDM,278,RC,,HCPCS,both,,,$656.25 ,$492.19 ,,$603.75 ,92,,,$360.94 ,$636.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$360.94 ,$636.56 ,other,,Not applicable. No negotiated rates per contract,$564.38 ,86,,,$360.94 ,$636.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$525.00 ,80,,,$360.94 ,$636.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$492.19 ,75,,,$360.94 ,$636.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.31 ,93,,,$360.94 ,$636.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDELA SYMPHONY BREAST PUMP KIT (FROM AMAZON),10367360,CDM,270,RC,,HCPCS,outpatient,,,$356.81 ,$267.61 ,,$328.27 ,92,,,$196.25 ,$346.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$196.25 ,55,,,$196.25 ,$346.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$196.25 ,$346.11 ,other,,Not applicable. No negotiated rates per contract,$306.86 ,86,,,$196.25 ,$346.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$285.45 ,80,,,$196.25 ,$346.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$196.25 ,55,,,$196.25 ,$346.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.97 ,95,,,$196.25 ,$346.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$338.97 ,95,,,$196.25 ,$346.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$267.61 ,75,,,$196.25 ,$346.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$303.29 ,85,,,$196.25 ,$346.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$346.11 ,97,,,$196.25 ,$346.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.25 ,55,,,$196.25 ,$346.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.13 ,90,,,$196.25 ,$346.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.11 ,97,,,$196.25 ,$346.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.11 ,97,,,$196.25 ,$346.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.11 ,97,,,$196.25 ,$346.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$303.29 ,85,,,$196.25 ,$346.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.13 ,90,,,$196.25 ,$346.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.25 ,55,,,$196.25 ,$346.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$338.97 ,90,,,$196.25 ,$346.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.25 ,55,,,$196.25 ,$346.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$331.83 ,93,,,$196.25 ,$346.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDIPORE CLOTH PLUS PAD,8782497,CDM,270,RC,,HCPCS,outpatient,,,$76.56 ,$57.42 ,,$70.44 ,92,,,$42.11 ,$74.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.11 ,55,,,$42.11 ,$74.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.11 ,$74.26 ,other,,Not applicable. No negotiated rates per contract,$65.84 ,86,,,$42.11 ,$74.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.25 ,80,,,$42.11 ,$74.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.11 ,55,,,$42.11 ,$74.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.73 ,95,,,$42.11 ,$74.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.73 ,95,,,$42.11 ,$74.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.42 ,75,,,$42.11 ,$74.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.08 ,85,,,$42.11 ,$74.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.26 ,97,,,$42.11 ,$74.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.11 ,55,,,$42.11 ,$74.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.90 ,90,,,$42.11 ,$74.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.26 ,97,,,$42.11 ,$74.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.26 ,97,,,$42.11 ,$74.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.26 ,97,,,$42.11 ,$74.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.08 ,85,,,$42.11 ,$74.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.90 ,90,,,$42.11 ,$74.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.11 ,55,,,$42.11 ,$74.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.73 ,90,,,$42.11 ,$74.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.11 ,55,,,$42.11 ,$74.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.20 ,93,,,$42.11 ,$74.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDIUM FEMALE POST OP SHOE,8785128,CDM,270,RC,,HCPCS,outpatient,,,$44.63 ,$33.47 ,,$41.06 ,92,,,$24.55 ,$43.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.55 ,55,,,$24.55 ,$43.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.55 ,$43.29 ,other,,Not applicable. No negotiated rates per contract,$38.38 ,86,,,$24.55 ,$43.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.70 ,80,,,$24.55 ,$43.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.55 ,55,,,$24.55 ,$43.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.40 ,95,,,$24.55 ,$43.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.40 ,95,,,$24.55 ,$43.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.47 ,75,,,$24.55 ,$43.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.94 ,85,,,$24.55 ,$43.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.29 ,97,,,$24.55 ,$43.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.55 ,55,,,$24.55 ,$43.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.17 ,90,,,$24.55 ,$43.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.29 ,97,,,$24.55 ,$43.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.29 ,97,,,$24.55 ,$43.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.29 ,97,,,$24.55 ,$43.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.94 ,85,,,$24.55 ,$43.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.17 ,90,,,$24.55 ,$43.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.55 ,55,,,$24.55 ,$43.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.40 ,90,,,$24.55 ,$43.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.55 ,55,,,$24.55 ,$43.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.51 ,93,,,$24.55 ,$43.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEDIUM MALE POST OP SHOE ( SIZE 9-11),8785125,CDM,270,RC,,HCPCS,outpatient,,,$41.75 ,$31.31 ,,$38.41 ,92,,,$22.96 ,$40.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.96 ,$40.50 ,other,,Not applicable. No negotiated rates per contract,$35.91 ,86,,,$22.96 ,$40.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.40 ,80,,,$22.96 ,$40.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.66 ,95,,,$22.96 ,$40.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.66 ,95,,,$22.96 ,$40.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.31 ,75,,,$22.96 ,$40.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.49 ,85,,,$22.96 ,$40.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.58 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.49 ,85,,,$22.96 ,$40.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.58 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.66 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.83 ,93,,,$22.96 ,$40.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"MEPILEX 3"" X 3""  BOADER FLEX FOAM DRESSING WITH SAFETEC TECHNOLOGY",9858564,CDM,270,RC,,HCPCS,outpatient,,,$34.30 ,$25.73 ,,$31.56 ,92,,,$18.87 ,$33.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.87 ,$33.27 ,other,,Not applicable. No negotiated rates per contract,$29.50 ,86,,,$18.87 ,$33.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.44 ,80,,,$18.87 ,$33.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.59 ,95,,,$18.87 ,$33.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.73 ,75,,,$18.87 ,$33.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.27 ,97,,,$18.87 ,$33.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.16 ,85,,,$18.87 ,$33.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.87 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.59 ,90,,,$18.87 ,$33.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.87 ,55,,,$18.87 ,$33.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.90 ,93,,,$18.87 ,$33.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEPILEX BOARDER POST OP AG 4 X 6,8998373,CDM,270,RC,,HCPCS,outpatient,,,$287.28 ,$215.46 ,,$264.30 ,92,,,$158.00 ,$278.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$158.00 ,55,,,$158.00 ,$278.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$158.00 ,$278.66 ,other,,Not applicable. No negotiated rates per contract,$247.06 ,86,,,$158.00 ,$278.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$229.82 ,80,,,$158.00 ,$278.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$158.00 ,55,,,$158.00 ,$278.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.92 ,95,,,$158.00 ,$278.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.92 ,95,,,$158.00 ,$278.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$215.46 ,75,,,$158.00 ,$278.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$244.19 ,85,,,$158.00 ,$278.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$278.66 ,97,,,$158.00 ,$278.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.00 ,55,,,$158.00 ,$278.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.55 ,90,,,$158.00 ,$278.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$278.66 ,97,,,$158.00 ,$278.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.66 ,97,,,$158.00 ,$278.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$278.66 ,97,,,$158.00 ,$278.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.19 ,85,,,$158.00 ,$278.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$258.55 ,90,,,$158.00 ,$278.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.00 ,55,,,$158.00 ,$278.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.92 ,90,,,$158.00 ,$278.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.00 ,55,,,$158.00 ,$278.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.17 ,93,,,$158.00 ,$278.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEPILEX BOARDER POST-OP 4X8,9729341,CDM,272,RC,,HCPCS,outpatient,,,$53.21 ,$39.91 ,,$48.95 ,92,,,$29.27 ,$51.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.27 ,55,,,$29.27 ,$51.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.27 ,$51.61 ,other,,Not applicable. No negotiated rates per contract,$45.76 ,86,,,$29.27 ,$51.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.57 ,80,,,$29.27 ,$51.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.27 ,55,,,$29.27 ,$51.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.55 ,95,,,$29.27 ,$51.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.55 ,95,,,$29.27 ,$51.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.91 ,75,,,$29.27 ,$51.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.23 ,85,,,$29.27 ,$51.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.61 ,97,,,$29.27 ,$51.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.27 ,55,,,$29.27 ,$51.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.89 ,90,,,$29.27 ,$51.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.61 ,97,,,$29.27 ,$51.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.61 ,97,,,$29.27 ,$51.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.61 ,97,,,$29.27 ,$51.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.23 ,85,,,$29.27 ,$51.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.89 ,90,,,$29.27 ,$51.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.27 ,55,,,$29.27 ,$51.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.55 ,90,,,$29.27 ,$51.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.27 ,55,,,$29.27 ,$51.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.49 ,93,,,$29.27 ,$51.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MEPILEX SILVER SOFT SILICON FOAM AG 4 X 4 DRESSING,9036766,CDM,270,RC,,HCPCS,outpatient,,,$121.99 ,$91.49 ,,$112.23 ,92,,,$67.09 ,$118.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$67.09 ,55,,,$67.09 ,$118.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$67.09 ,$118.33 ,other,,Not applicable. No negotiated rates per contract,$104.91 ,86,,,$67.09 ,$118.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$97.59 ,80,,,$67.09 ,$118.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$67.09 ,55,,,$67.09 ,$118.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.89 ,95,,,$67.09 ,$118.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.89 ,95,,,$67.09 ,$118.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.49 ,75,,,$67.09 ,$118.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$103.69 ,85,,,$67.09 ,$118.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$118.33 ,97,,,$67.09 ,$118.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.09 ,55,,,$67.09 ,$118.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.79 ,90,,,$67.09 ,$118.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.33 ,97,,,$67.09 ,$118.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.33 ,97,,,$67.09 ,$118.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.33 ,97,,,$67.09 ,$118.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.69 ,85,,,$67.09 ,$118.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$109.79 ,90,,,$67.09 ,$118.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.09 ,55,,,$67.09 ,$118.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.89 ,90,,,$67.09 ,$118.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.09 ,55,,,$67.09 ,$118.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.45 ,93,,,$67.09 ,$118.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"MESH COMPOSIX ELLIPTICAL 4.2""X 6.2""(10.8CM X 15.9CM) 0314460 (OR)",8782315,CDM,270,RC,,HCPCS,outpatient,,,"$2,018.75 ","$1,514.06 ",,"$1,857.25 ",92,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,110.31 ",55,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,110.31 ","$1,958.19 ",other,,Not applicable. No negotiated rates per contract,"$1,736.13 ",86,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,615.00 ",80,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,110.31 ",55,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,917.81 ",95,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,917.81 ",95,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,514.06 ",75,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,715.94 ",85,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,958.19 ",97,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,110.31 ",55,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,816.88 ",90,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,958.19 ",97,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,958.19 ",97,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,958.19 ",97,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,715.94 ",85,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,816.88 ",90,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,110.31 ",55,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,917.81 ",90,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,110.31 ",55,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,877.44 ",93,,,"$1,110.31 ","$1,958.19 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"MESH COMPOSIX ELLIPTICAL 6.2"" X 8.2"" (15.9CM X 21.0CM)0134680(OR)",8782316,CDM,270,RC,,HCPCS,outpatient,,,"$3,761.25 ","$2,820.94 ",,"$3,460.35 ",92,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,068.69 ",55,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,068.69 ","$3,648.41 ",other,,Not applicable. No negotiated rates per contract,"$3,234.68 ",86,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,009.00 ",80,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,068.69 ",55,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,573.19 ",95,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,573.19 ",95,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,820.94 ",75,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,197.06 ",85,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,648.41 ",97,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,068.69 ",55,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,385.13 ",90,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,648.41 ",97,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,648.41 ",97,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,648.41 ",97,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,197.06 ",85,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,385.13 ",90,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,068.69 ",55,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,573.19 ",90,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,068.69 ",55,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,497.96 ",93,,,"$2,068.69 ","$3,648.41 ",percent of total billed charges,,93% of total billed charges for outpatient setting
"MESH COMPOSIX OVAL 6.2""",8782317,CDM,270,RC,,HCPCS,outpatient,,,"$4,781.25 ","$3,585.94 ",,"$4,398.75 ",92,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,629.69 ",55,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,629.69 ","$4,637.81 ",other,,Not applicable. No negotiated rates per contract,"$4,111.88 ",86,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,825.00 ",80,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,629.69 ",55,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,542.19 ",95,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,542.19 ",95,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,585.94 ",75,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,064.06 ",85,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,637.81 ",97,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,629.69 ",55,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,303.13 ",90,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,637.81 ",97,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,637.81 ",97,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,637.81 ",97,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,064.06 ",85,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,303.13 ",90,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,629.69 ",55,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,542.19 ",90,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,629.69 ",55,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,446.56 ",93,,,"$2,629.69 ","$4,637.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MESH SURGICAL 3 X6 PMII,8785249,CDM,270,RC,,HCPCS,outpatient,,,$661.34 ,$496.01 ,,$608.43 ,92,,,$363.74 ,$641.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$363.74 ,55,,,$363.74 ,$641.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$363.74 ,$641.50 ,other,,Not applicable. No negotiated rates per contract,$568.75 ,86,,,$363.74 ,$641.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$529.07 ,80,,,$363.74 ,$641.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$363.74 ,55,,,$363.74 ,$641.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$628.27 ,95,,,$363.74 ,$641.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$628.27 ,95,,,$363.74 ,$641.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$496.01 ,75,,,$363.74 ,$641.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$562.14 ,85,,,$363.74 ,$641.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$641.50 ,97,,,$363.74 ,$641.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.74 ,55,,,$363.74 ,$641.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$595.21 ,90,,,$363.74 ,$641.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$641.50 ,97,,,$363.74 ,$641.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$641.50 ,97,,,$363.74 ,$641.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$641.50 ,97,,,$363.74 ,$641.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$562.14 ,85,,,$363.74 ,$641.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$595.21 ,90,,,$363.74 ,$641.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$363.74 ,55,,,$363.74 ,$641.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$628.27 ,90,,,$363.74 ,$641.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$363.74 ,55,,,$363.74 ,$641.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$615.05 ,93,,,$363.74 ,$641.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MICRO DUAL CUT BLADE,8786804,CDM,270,RC,,HCPCS,outpatient,,,$253.75 ,$190.31 ,,$233.45 ,92,,,$139.56 ,$246.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$139.56 ,$246.14 ,other,,Not applicable. No negotiated rates per contract,$218.23 ,86,,,$139.56 ,$246.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$203.00 ,80,,,$139.56 ,$246.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$241.06 ,95,,,$139.56 ,$246.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$190.31 ,75,,,$139.56 ,$246.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.14 ,97,,,$139.56 ,$246.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$215.69 ,85,,,$139.56 ,$246.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.38 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.06 ,90,,,$139.56 ,$246.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$139.56 ,55,,,$139.56 ,$246.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$235.99 ,93,,,$139.56 ,$246.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MICRO DUAL CUT BLADE (9,8786816,CDM,270,RC,,HCPCS,outpatient,,,$347.96 ,$260.97 ,,$320.12 ,92,,,$191.38 ,$337.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$191.38 ,55,,,$191.38 ,$337.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$191.38 ,$337.52 ,other,,Not applicable. No negotiated rates per contract,$299.25 ,86,,,$191.38 ,$337.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$278.37 ,80,,,$191.38 ,$337.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$191.38 ,55,,,$191.38 ,$337.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.56 ,95,,,$191.38 ,$337.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.56 ,95,,,$191.38 ,$337.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.97 ,75,,,$191.38 ,$337.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$295.77 ,85,,,$191.38 ,$337.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.52 ,97,,,$191.38 ,$337.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.38 ,55,,,$191.38 ,$337.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.16 ,90,,,$191.38 ,$337.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.52 ,97,,,$191.38 ,$337.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.52 ,97,,,$191.38 ,$337.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.52 ,97,,,$191.38 ,$337.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.77 ,85,,,$191.38 ,$337.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$313.16 ,90,,,$191.38 ,$337.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.38 ,55,,,$191.38 ,$337.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.56 ,90,,,$191.38 ,$337.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.38 ,55,,,$191.38 ,$337.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.60 ,93,,,$191.38 ,$337.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MICROFRACTURE AWL,8782884,CDM,270,RC,,HCPCS,outpatient,,,"$1,870.04 ","$1,402.53 ",,"$1,720.44 ",92,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,028.52 ","$1,813.94 ",other,,Not applicable. No negotiated rates per contract,"$1,608.23 ",86,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,496.03 ",80,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.54 ",95,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,776.54 ",95,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,402.53 ",75,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,589.53 ",85,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,683.04 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,589.53 ",85,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,683.04 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.54 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,739.14 ",93,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROFRACTURE AWL,8782885,CDM,270,RC,,HCPCS,outpatient,,,"$1,870.04 ","$1,402.53 ",,"$1,720.44 ",92,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,028.52 ","$1,813.94 ",other,,Not applicable. No negotiated rates per contract,"$1,608.23 ",86,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,496.03 ",80,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.54 ",95,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,776.54 ",95,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,402.53 ",75,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,589.53 ",85,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,683.04 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.94 ",97,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,589.53 ",85,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,683.04 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.54 ",90,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.52 ",55,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,739.14 ",93,,,"$1,028.52 ","$1,813.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS INSRT IMP SZ 6 LEFT 10MM,8942835,CDM,270,RC,,HCPCS,outpatient,,,"$4,875.00 ","$3,656.25 ",,"$4,485.00 ",92,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,681.25 ","$4,728.75 ",other,,Not applicable. No negotiated rates per contract,"$4,192.50 ",86,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,900.00 ",80,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,656.25 ",75,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,533.75 ",93,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS INSRT IMPL SZ 6 RI,8786498,CDM,270,RC,,HCPCS,outpatient,,,"$4,875.00 ","$3,656.25 ",,"$4,485.00 ",92,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,681.25 ","$4,728.75 ",other,,Not applicable. No negotiated rates per contract,"$4,192.50 ",86,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,900.00 ",80,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,656.25 ",75,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,533.75 ",93,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS INSRT IMPL SZ 5 LEFT 10MM,8942837,CDM,270,RC,,HCPCS,outpatient,,,"$4,875.00 ","$3,656.25 ",,"$4,485.00 ",92,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,681.25 ","$4,728.75 ",other,,Not applicable. No negotiated rates per contract,"$4,192.50 ",86,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,900.00 ",80,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,656.25 ",75,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,533.75 ",93,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS/CR FEM SIZE,8942838,CDM,270,RC,,HCPCS,outpatient,,,"$7,012.50 ","$5,259.38 ",,"$6,451.50 ",92,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,856.88 ","$6,802.13 ",other,,Not applicable. No negotiated rates per contract,"$6,030.75 ",86,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,610.00 ",80,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,259.38 ",75,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,521.63 ",93,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS/CR FEM SIZE 6 PRIM,8786496,CDM,270,RC,,HCPCS,outpatient,,,"$7,012.50 ","$5,259.38 ",,"$6,451.50 ",92,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,856.88 ","$6,802.13 ",other,,Not applicable. No negotiated rates per contract,"$6,030.75 ",86,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,610.00 ",80,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,259.38 ",75,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,521.63 ",93,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT CS/CR FEM SIZE 6 PRIMARY LEFT,8942833,CDM,270,RC,,HCPCS,outpatient,,,"$7,012.50 ","$5,259.38 ",,"$6,451.50 ",92,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,856.88 ","$6,802.13 ",other,,Not applicable. No negotiated rates per contract,"$6,030.75 ",86,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,610.00 ",80,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,259.38 ",75,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,521.63 ",93,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT EVOLUTION MP CS SIZE/STYLE 7 LEFT,10400704,CDM,278,RC,,HCPCS,both,,,"$4,875.00 ","$3,656.25 ",,"$4,485.00 ",92,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,681.25 ","$4,728.75 ",other,,Not applicable. No negotiated rates per contract,"$4,192.50 ",86,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,900.00 ",80,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,656.25 ",75,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,533.75 ",93,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT EVOLUTION MP CS/CR COMPONRNT 7 LEFT,10400700,CDM,278,RC,,HCPCS,both,,,"$7,012.50 ","$5,259.38 ",,"$6,451.50 ",92,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,856.88 ","$6,802.13 ",other,,Not applicable. No negotiated rates per contract,"$6,030.75 ",86,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,610.00 ",80,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,259.38 ",75,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,521.63 ",93,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT EVOLUTION MP KEELED TIBIAL BASE 7 FEET,10400702,CDM,278,RC,,HCPCS,both,,,"$7,500.00 ","$5,625.00 ",,"$6,900.00 ",92,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$4,125.00 ","$7,275.00 ",other,,Not applicable. No negotiated rates per contract,"$6,450.00 ",86,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$6,000.00 ",80,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,125.00 ",95,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,125.00 ",95,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,625.00 ",75,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,375.00 ",85,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,750.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,375.00 ",85,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,750.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,125.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,975.00 ",93,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT MICROPRT TRI-P,8942839,CDM,270,RC,,HCPCS,outpatient,,,"$3,400.00 ","$2,550.00 ",,"$3,128.00 ",92,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,870.00 ","$3,298.00 ",other,,Not applicable. No negotiated rates per contract,"$2,924.00 ",86,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,720.00 ",80,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,550.00 ",75,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,162.00 ",93,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT MICROPRT TRI-PEG PATE,8786499,CDM,270,RC,,HCPCS,outpatient,,,"$3,400.00 ","$2,550.00 ",,"$3,128.00 ",92,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,870.00 ","$3,298.00 ",other,,Not applicable. No negotiated rates per contract,"$2,924.00 ",86,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,720.00 ",80,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,550.00 ",75,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,162.00 ",93,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT ORTHO,9803766,CDM,278,RC,55422,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MICROPORT ORTHO,9803672,CDM,278,RC,55418,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MICROPORT ORTHO,9803762,CDM,278,RC,,HCPCS,both,,,"$1,275.00 ",$956.25 ,,"$1,173.00 ",92,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$701.25 ,"$1,236.75 ",other,,Not applicable. No negotiated rates per contract,"$1,096.50 ",86,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,020.00 ",80,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,211.25 ",95,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,211.25 ",95,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$956.25 ,75,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,083.75 ",85,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,147.50 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,083.75 ",85,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,147.50 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,211.25 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,185.75 ",93,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT ORTHO,10430209,CDM,278,RC,55917,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
MICROPORT ORTHO,10931965,CDM,278,RC,,HCPCS,both,,,"$7,012.50 ","$5,259.38 ",,"$6,451.50 ",92,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,856.88 ","$6,802.13 ",other,,Not applicable. No negotiated rates per contract,"$6,030.75 ",86,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,610.00 ",80,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,661.88 ",95,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,259.38 ",75,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,802.13 ",97,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,960.63 ",85,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,311.25 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,661.88 ",90,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,856.88 ",55,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,521.63 ",93,,,"$3,856.88 ","$6,802.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT ORTHO,10931966,CDM,278,RC,,HCPCS,both,,,"$4,875.00 ","$3,656.25 ",,"$4,485.00 ",92,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,681.25 ","$4,728.75 ",other,,Not applicable. No negotiated rates per contract,"$4,192.50 ",86,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,900.00 ",80,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,631.25 ",95,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,656.25 ",75,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,728.75 ",97,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,143.75 ",85,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,387.50 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,631.25 ",90,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,681.25 ",55,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,533.75 ",93,,,"$2,681.25 ","$4,728.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT ORTHO,10931967,CDM,278,RC,,HCPCS,both,,,"$7,500.00 ","$5,625.00 ",,"$6,900.00 ",92,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$4,125.00 ","$7,275.00 ",other,,Not applicable. No negotiated rates per contract,"$6,450.00 ",86,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$6,000.00 ",80,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,125.00 ",95,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,125.00 ",95,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,625.00 ",75,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$6,375.00 ",85,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,750.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,275.00 ",97,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,375.00 ",85,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,750.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$7,125.00 ",90,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,125.00 ",55,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,975.00 ",93,,,"$4,125.00 ","$7,275.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT TIB BASE COCR,8942840,CDM,270,RC,,HCPCS,outpatient,,,"$6,750.00 ","$5,062.50 ",,"$6,210.00 ",92,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,712.50 ","$6,547.50 ",other,,Not applicable. No negotiated rates per contract,"$5,805.00 ",86,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,400.00 ",80,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,062.50 ",75,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,277.50 ",93,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT TIB BASE COCR NON POR,8786497,CDM,270,RC,,HCPCS,outpatient,,,"$6,750.00 ","$5,062.50 ",,"$6,210.00 ",92,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,712.50 ","$6,547.50 ",other,,Not applicable. No negotiated rates per contract,"$5,805.00 ",86,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,400.00 ",80,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,062.50 ",75,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,277.50 ",93,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROPORT,10400705,CDM,278,RC,55914,HCPCS,both,,,"$3,400.00 ","$2,550.00 ",,"$3,128.00 ",92,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,870.00 ","$3,298.00 ",other,,Not applicable. No negotiated rates per contract,"$2,924.00 ",86,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,720.00 ",80,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,230.00 ",95,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,550.00 ",75,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,298.00 ",97,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,890.00 ",85,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,060.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,230.00 ",90,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,870.00 ",55,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,162.00 ",93,,,"$1,870.00 ","$3,298.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MICROSTREAM ETCO2 FILTER,8786265,CDM,270,RC,,HCPCS,outpatient,,,$112.76 ,$84.57 ,,$103.74 ,92,,,$62.02 ,$109.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$62.02 ,55,,,$62.02 ,$109.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$62.02 ,$109.38 ,other,,Not applicable. No negotiated rates per contract,$96.97 ,86,,,$62.02 ,$109.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$90.21 ,80,,,$62.02 ,$109.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$62.02 ,55,,,$62.02 ,$109.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.12 ,95,,,$62.02 ,$109.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$107.12 ,95,,,$62.02 ,$109.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.57 ,75,,,$62.02 ,$109.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$95.85 ,85,,,$62.02 ,$109.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$109.38 ,97,,,$62.02 ,$109.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.02 ,55,,,$62.02 ,$109.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$101.48 ,90,,,$62.02 ,$109.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$109.38 ,97,,,$62.02 ,$109.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.38 ,97,,,$62.02 ,$109.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.38 ,97,,,$62.02 ,$109.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.85 ,85,,,$62.02 ,$109.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.48 ,90,,,$62.02 ,$109.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.02 ,55,,,$62.02 ,$109.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.12 ,90,,,$62.02 ,$109.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.02 ,55,,,$62.02 ,$109.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.87 ,93,,,$62.02 ,$109.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MILAGRO ADVANCE INTERFER,8783765,CDM,270,RC,,HCPCS,outpatient,,,"$2,006.00 ","$1,504.50 ",,"$1,845.52 ",92,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,103.30 ",55,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,103.30 ","$1,945.82 ",other,,Not applicable. No negotiated rates per contract,"$1,725.16 ",86,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,604.80 ",80,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,103.30 ",55,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,905.70 ",95,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,905.70 ",95,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,504.50 ",75,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,705.10 ",85,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,945.82 ",97,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,103.30 ",55,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,805.40 ",90,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,945.82 ",97,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,945.82 ",97,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,945.82 ",97,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,705.10 ",85,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,805.40 ",90,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,103.30 ",55,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,905.70 ",90,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,103.30 ",55,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,865.58 ",93,,,"$1,103.30 ","$1,945.82 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MILLIPORE Q- GARD A2 POLISHING CARTRIDGE,8784200,CDM,270,RC,,HCPCS,outpatient,,,"$1,048.05 ",$786.04 ,,$964.21 ,92,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$576.43 ,55,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$576.43 ,"$1,016.61 ",other,,Not applicable. No negotiated rates per contract,$901.32 ,86,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$838.44 ,80,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$576.43 ,55,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$995.65 ,95,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$995.65 ,95,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$786.04 ,75,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$890.84 ,85,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,016.61 ",97,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$576.43 ,55,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$943.25 ,90,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,016.61 ",97,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,016.61 ",97,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,016.61 ",97,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$890.84 ,85,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$943.25 ,90,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.43 ,55,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$995.65 ,90,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$576.43 ,55,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$974.69 ,93,,,$576.43 ,"$1,016.61 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MINITAC Ti 2.0 PRELOADED WITH  #3-0 DURABRAID SUTURES AND NEEDLESM INCLUDES DISP. DRILL GUIDE AND DI,8786671,CDM,270,RC,,HCPCS,outpatient,,,"$1,800.73 ","$1,350.55 ",,"$1,656.67 ",92,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$990.40 ,55,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$990.40 ,"$1,746.71 ",other,,Not applicable. No negotiated rates per contract,"$1,548.63 ",86,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,440.58 ",80,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$990.40 ,55,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,710.69 ",95,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,710.69 ",95,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,350.55 ",75,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,530.62 ",85,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,746.71 ",97,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$990.40 ,55,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,620.66 ",90,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,746.71 ",97,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,746.71 ",97,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,746.71 ",97,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,530.62 ",85,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,620.66 ",90,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$990.40 ,55,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,710.69 ",90,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$990.40 ,55,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,674.68 ",93,,,$990.40 ,"$1,746.71 ",percent of total billed charges,,93% of total billed charges for outpatient setting
MIS HEADED SCREW 48MM (O,8787039,CDM,270,RC,,HCPCS,outpatient,,,$427.50 ,$320.63 ,,$393.30 ,92,,,$235.13 ,$414.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$235.13 ,55,,,$235.13 ,$414.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$235.13 ,$414.68 ,other,,Not applicable. No negotiated rates per contract,$367.65 ,86,,,$235.13 ,$414.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$342.00 ,80,,,$235.13 ,$414.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$235.13 ,55,,,$235.13 ,$414.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$406.13 ,95,,,$235.13 ,$414.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$406.13 ,95,,,$235.13 ,$414.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$320.63 ,75,,,$235.13 ,$414.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$363.38 ,85,,,$235.13 ,$414.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$414.68 ,97,,,$235.13 ,$414.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.13 ,55,,,$235.13 ,$414.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$235.13 ,$414.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$414.68 ,97,,,$235.13 ,$414.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$414.68 ,97,,,$235.13 ,$414.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$414.68 ,97,,,$235.13 ,$414.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$363.38 ,85,,,$235.13 ,$414.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$384.75 ,90,,,$235.13 ,$414.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.13 ,55,,,$235.13 ,$414.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$406.13 ,90,,,$235.13 ,$414.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.13 ,55,,,$235.13 ,$414.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$397.58 ,93,,,$235.13 ,$414.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MISCARRIAGE MANAGEMENT KIT(MMK-SU),8783680,CDM,270,RC,,HCPCS,outpatient,,,$557.75 ,$418.31 ,,$513.13 ,92,,,$306.76 ,$541.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$306.76 ,55,,,$306.76 ,$541.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$306.76 ,$541.02 ,other,,Not applicable. No negotiated rates per contract,$479.67 ,86,,,$306.76 ,$541.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$446.20 ,80,,,$306.76 ,$541.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$306.76 ,55,,,$306.76 ,$541.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$529.86 ,95,,,$306.76 ,$541.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$529.86 ,95,,,$306.76 ,$541.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$418.31 ,75,,,$306.76 ,$541.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$474.09 ,85,,,$306.76 ,$541.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$541.02 ,97,,,$306.76 ,$541.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.76 ,55,,,$306.76 ,$541.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.98 ,90,,,$306.76 ,$541.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$541.02 ,97,,,$306.76 ,$541.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$541.02 ,97,,,$306.76 ,$541.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$541.02 ,97,,,$306.76 ,$541.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$474.09 ,85,,,$306.76 ,$541.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$501.98 ,90,,,$306.76 ,$541.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.76 ,55,,,$306.76 ,$541.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$529.86 ,90,,,$306.76 ,$541.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.76 ,55,,,$306.76 ,$541.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$518.71 ,93,,,$306.76 ,$541.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MORGAN MEDI FLOW LENS,8785471,CDM,270,RC,,HCPCS,outpatient,,,$396.09 ,$297.07 ,,$364.40 ,92,,,$217.85 ,$384.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$217.85 ,55,,,$217.85 ,$384.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$217.85 ,$384.21 ,other,,Not applicable. No negotiated rates per contract,$340.64 ,86,,,$217.85 ,$384.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$316.87 ,80,,,$217.85 ,$384.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$217.85 ,55,,,$217.85 ,$384.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.29 ,95,,,$217.85 ,$384.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$376.29 ,95,,,$217.85 ,$384.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$297.07 ,75,,,$217.85 ,$384.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$336.68 ,85,,,$217.85 ,$384.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$384.21 ,97,,,$217.85 ,$384.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$217.85 ,55,,,$217.85 ,$384.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$356.48 ,90,,,$217.85 ,$384.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$384.21 ,97,,,$217.85 ,$384.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.21 ,97,,,$217.85 ,$384.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.21 ,97,,,$217.85 ,$384.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$336.68 ,85,,,$217.85 ,$384.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$356.48 ,90,,,$217.85 ,$384.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.85 ,55,,,$217.85 ,$384.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.29 ,90,,,$217.85 ,$384.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$217.85 ,55,,,$217.85 ,$384.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$368.36 ,93,,,$217.85 ,$384.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MOUTHPIECE SPIROMET DISP (FLOW TRANDUCERS),8782547,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
MULTIVAC SUPER 90 (OR),8786660,CDM,270,RC,,HCPCS,outpatient,,,$950.00 ,$712.50 ,,$874.00 ,92,,,$522.50 ,$921.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$522.50 ,$921.50 ,other,,Not applicable. No negotiated rates per contract,$817.00 ,86,,,$522.50 ,$921.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$760.00 ,80,,,$522.50 ,$921.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$712.50 ,75,,,$522.50 ,$921.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$883.50 ,93,,,$522.50 ,$921.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NASAL PK 4.5 RAPID RHINO,8782105,CDM,270,RC,,HCPCS,outpatient,,,$279.38 ,$209.54 ,,$257.03 ,92,,,$153.66 ,$271.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.66 ,55,,,$153.66 ,$271.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.66 ,$271.00 ,other,,Not applicable. No negotiated rates per contract,$240.27 ,86,,,$153.66 ,$271.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$223.50 ,80,,,$153.66 ,$271.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.66 ,55,,,$153.66 ,$271.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.41 ,95,,,$153.66 ,$271.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$265.41 ,95,,,$153.66 ,$271.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.54 ,75,,,$153.66 ,$271.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$237.47 ,85,,,$153.66 ,$271.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$271.00 ,97,,,$153.66 ,$271.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.66 ,55,,,$153.66 ,$271.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.44 ,90,,,$153.66 ,$271.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.00 ,97,,,$153.66 ,$271.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.00 ,97,,,$153.66 ,$271.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.00 ,97,,,$153.66 ,$271.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$237.47 ,85,,,$153.66 ,$271.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.44 ,90,,,$153.66 ,$271.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.66 ,55,,,$153.66 ,$271.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.41 ,90,,,$153.66 ,$271.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.66 ,55,,,$153.66 ,$271.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.82 ,93,,,$153.66 ,$271.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NASAL PK 5.5 RAPID RHINO,8782104,CDM,270,RC,,HCPCS,outpatient,,,$275.87 ,$206.90 ,,$253.80 ,92,,,$151.73 ,$267.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$151.73 ,55,,,$151.73 ,$267.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$151.73 ,$267.59 ,other,,Not applicable. No negotiated rates per contract,$237.25 ,86,,,$151.73 ,$267.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$220.70 ,80,,,$151.73 ,$267.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$151.73 ,55,,,$151.73 ,$267.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.08 ,95,,,$151.73 ,$267.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$262.08 ,95,,,$151.73 ,$267.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$206.90 ,75,,,$151.73 ,$267.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$234.49 ,85,,,$151.73 ,$267.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.59 ,97,,,$151.73 ,$267.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.73 ,55,,,$151.73 ,$267.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.28 ,90,,,$151.73 ,$267.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.59 ,97,,,$151.73 ,$267.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.59 ,97,,,$151.73 ,$267.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.59 ,97,,,$151.73 ,$267.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$234.49 ,85,,,$151.73 ,$267.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$248.28 ,90,,,$151.73 ,$267.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.73 ,55,,,$151.73 ,$267.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.08 ,90,,,$151.73 ,$267.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.73 ,55,,,$151.73 ,$267.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.56 ,93,,,$151.73 ,$267.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NASAL PK 7.5 RAPID RHINO,8782103,CDM,270,RC,,HCPCS,outpatient,,,$296.26 ,$222.20 ,,$272.56 ,92,,,$162.94 ,$287.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$162.94 ,55,,,$162.94 ,$287.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$162.94 ,$287.37 ,other,,Not applicable. No negotiated rates per contract,$254.78 ,86,,,$162.94 ,$287.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$237.01 ,80,,,$162.94 ,$287.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$162.94 ,55,,,$162.94 ,$287.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.45 ,95,,,$162.94 ,$287.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$281.45 ,95,,,$162.94 ,$287.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.20 ,75,,,$162.94 ,$287.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$251.82 ,85,,,$162.94 ,$287.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$287.37 ,97,,,$162.94 ,$287.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.94 ,55,,,$162.94 ,$287.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.63 ,90,,,$162.94 ,$287.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$287.37 ,97,,,$162.94 ,$287.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.37 ,97,,,$162.94 ,$287.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$287.37 ,97,,,$162.94 ,$287.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.82 ,85,,,$162.94 ,$287.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$266.63 ,90,,,$162.94 ,$287.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.94 ,55,,,$162.94 ,$287.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$281.45 ,90,,,$162.94 ,$287.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.94 ,55,,,$162.94 ,$287.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.52 ,93,,,$162.94 ,$287.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE,8992681,CDM,270,RC,,HCPCS,outpatient,,,$95.09 ,$71.32 ,,$87.48 ,92,,,$52.30 ,$92.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.30 ,55,,,$52.30 ,$92.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.30 ,$92.24 ,other,,Not applicable. No negotiated rates per contract,$81.78 ,86,,,$52.30 ,$92.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.07 ,80,,,$52.30 ,$92.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.30 ,55,,,$52.30 ,$92.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.34 ,95,,,$52.30 ,$92.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.34 ,95,,,$52.30 ,$92.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.32 ,75,,,$52.30 ,$92.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$80.83 ,85,,,$52.30 ,$92.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.24 ,97,,,$52.30 ,$92.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.30 ,55,,,$52.30 ,$92.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.58 ,90,,,$52.30 ,$92.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.24 ,97,,,$52.30 ,$92.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.24 ,97,,,$52.30 ,$92.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.24 ,97,,,$52.30 ,$92.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.83 ,85,,,$52.30 ,$92.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.58 ,90,,,$52.30 ,$92.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.30 ,55,,,$52.30 ,$92.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.34 ,90,,,$52.30 ,$92.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.30 ,55,,,$52.30 ,$92.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.43 ,93,,,$52.30 ,$92.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 18X3 1/2 SPINAL,8785569,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 18X3 SPINAL,8785563,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 20G X 3 1/2 SPINA,8785565,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 20GX3 SPINAL,8785562,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 22G X 1.5 SPINAL,8785560,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 22G X 3.5 SPINAL,8784078,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 25G X 3 1/2 SPINAL,8785564,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE 25G X3 SPINAL,8785561,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE ADULT 25MM EZ IO,8786891,CDM,270,RC,,HCPCS,outpatient,,,$759.15 ,$569.36 ,,$698.42 ,92,,,$417.53 ,$736.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$417.53 ,55,,,$417.53 ,$736.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$417.53 ,$736.38 ,other,,Not applicable. No negotiated rates per contract,$652.87 ,86,,,$417.53 ,$736.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$607.32 ,80,,,$417.53 ,$736.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$417.53 ,55,,,$417.53 ,$736.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.19 ,95,,,$417.53 ,$736.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$721.19 ,95,,,$417.53 ,$736.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$569.36 ,75,,,$417.53 ,$736.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$645.28 ,85,,,$417.53 ,$736.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$736.38 ,97,,,$417.53 ,$736.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$417.53 ,55,,,$417.53 ,$736.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$683.24 ,90,,,$417.53 ,$736.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$736.38 ,97,,,$417.53 ,$736.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.38 ,97,,,$417.53 ,$736.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$736.38 ,97,,,$417.53 ,$736.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$645.28 ,85,,,$417.53 ,$736.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$683.24 ,90,,,$417.53 ,$736.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.53 ,55,,,$417.53 ,$736.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$721.19 ,90,,,$417.53 ,$736.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$417.53 ,55,,,$417.53 ,$736.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$706.01 ,93,,,$417.53 ,$736.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE ARTICULATOR INJEC,8786960,CDM,270,RC,,HCPCS,outpatient,,,$357.75 ,$268.31 ,,$329.13 ,92,,,$196.76 ,$347.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$196.76 ,55,,,$196.76 ,$347.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$196.76 ,$347.02 ,other,,Not applicable. No negotiated rates per contract,$307.67 ,86,,,$196.76 ,$347.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$286.20 ,80,,,$196.76 ,$347.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$196.76 ,55,,,$196.76 ,$347.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.86 ,95,,,$196.76 ,$347.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$339.86 ,95,,,$196.76 ,$347.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$268.31 ,75,,,$196.76 ,$347.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$304.09 ,85,,,$196.76 ,$347.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$347.02 ,97,,,$196.76 ,$347.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$196.76 ,55,,,$196.76 ,$347.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.98 ,90,,,$196.76 ,$347.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$347.02 ,97,,,$196.76 ,$347.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$347.02 ,97,,,$196.76 ,$347.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$347.02 ,97,,,$196.76 ,$347.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$304.09 ,85,,,$196.76 ,$347.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.98 ,90,,,$196.76 ,$347.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.76 ,55,,,$196.76 ,$347.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$339.86 ,90,,,$196.76 ,$347.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$196.76 ,55,,,$196.76 ,$347.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.71 ,93,,,$196.76 ,$347.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE ARTICULATOR NEEDL,8786961,CDM,270,RC,,HCPCS,outpatient,,,$337.50 ,$253.13 ,,$310.50 ,92,,,$185.63 ,$327.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$185.63 ,55,,,$185.63 ,$327.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$185.63 ,$327.38 ,other,,Not applicable. No negotiated rates per contract,$290.25 ,86,,,$185.63 ,$327.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$270.00 ,80,,,$185.63 ,$327.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$185.63 ,55,,,$185.63 ,$327.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.63 ,95,,,$185.63 ,$327.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$320.63 ,95,,,$185.63 ,$327.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$253.13 ,75,,,$185.63 ,$327.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$286.88 ,85,,,$185.63 ,$327.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$327.38 ,97,,,$185.63 ,$327.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.63 ,55,,,$185.63 ,$327.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$303.75 ,90,,,$185.63 ,$327.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$327.38 ,97,,,$185.63 ,$327.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$327.38 ,97,,,$185.63 ,$327.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$327.38 ,97,,,$185.63 ,$327.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.88 ,85,,,$185.63 ,$327.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$303.75 ,90,,,$185.63 ,$327.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.63 ,55,,,$185.63 ,$327.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$320.63 ,90,,,$185.63 ,$327.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.63 ,55,,,$185.63 ,$327.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.88 ,93,,,$185.63 ,$327.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE BARIATRIC 45MM EZ -IO,8782086,CDM,270,RC,,HCPCS,outpatient,,,$712.37 ,$534.28 ,,$655.38 ,92,,,$391.80 ,$691.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$391.80 ,55,,,$391.80 ,$691.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$391.80 ,$691.00 ,other,,Not applicable. No negotiated rates per contract,$612.64 ,86,,,$391.80 ,$691.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$569.90 ,80,,,$391.80 ,$691.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$391.80 ,55,,,$391.80 ,$691.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$676.75 ,95,,,$391.80 ,$691.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$676.75 ,95,,,$391.80 ,$691.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$534.28 ,75,,,$391.80 ,$691.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$605.51 ,85,,,$391.80 ,$691.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$691.00 ,97,,,$391.80 ,$691.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.80 ,55,,,$391.80 ,$691.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$641.13 ,90,,,$391.80 ,$691.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$691.00 ,97,,,$391.80 ,$691.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$691.00 ,97,,,$391.80 ,$691.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$691.00 ,97,,,$391.80 ,$691.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$605.51 ,85,,,$391.80 ,$691.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$641.13 ,90,,,$391.80 ,$691.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.80 ,55,,,$391.80 ,$691.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$676.75 ,90,,,$391.80 ,$691.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.80 ,55,,,$391.80 ,$691.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$662.50 ,93,,,$391.80 ,$691.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE ELECTRODE,8785751,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE EPIDURAL TUOHY 20GA.,8785566,CDM,270,RC,,HCPCS,outpatient,,,$55.77 ,$41.83 ,,$51.31 ,92,,,$30.67 ,$54.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.67 ,55,,,$30.67 ,$54.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.67 ,$54.10 ,other,,Not applicable. No negotiated rates per contract,$47.96 ,86,,,$30.67 ,$54.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$44.62 ,80,,,$30.67 ,$54.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.67 ,55,,,$30.67 ,$54.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.98 ,95,,,$30.67 ,$54.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.98 ,95,,,$30.67 ,$54.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.83 ,75,,,$30.67 ,$54.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.40 ,85,,,$30.67 ,$54.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.10 ,97,,,$30.67 ,$54.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.67 ,55,,,$30.67 ,$54.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.19 ,90,,,$30.67 ,$54.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.10 ,97,,,$30.67 ,$54.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.10 ,97,,,$30.67 ,$54.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.10 ,97,,,$30.67 ,$54.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.40 ,85,,,$30.67 ,$54.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.19 ,90,,,$30.67 ,$54.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.67 ,55,,,$30.67 ,$54.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.98 ,90,,,$30.67 ,$54.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.67 ,55,,,$30.67 ,$54.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.87 ,93,,,$30.67 ,$54.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE FILTER 18GA 1 1/2,8785825,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE GRIPPER PLUS 19G,8785430,CDM,270,RC,,HCPCS,outpatient,,,$44.88 ,$33.66 ,,$41.29 ,92,,,$24.68 ,$43.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.68 ,55,,,$24.68 ,$43.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.68 ,$43.53 ,other,,Not applicable. No negotiated rates per contract,$38.60 ,86,,,$24.68 ,$43.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.90 ,80,,,$24.68 ,$43.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.68 ,55,,,$24.68 ,$43.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.64 ,95,,,$24.68 ,$43.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.64 ,95,,,$24.68 ,$43.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.66 ,75,,,$24.68 ,$43.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.15 ,85,,,$24.68 ,$43.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.53 ,97,,,$24.68 ,$43.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.68 ,55,,,$24.68 ,$43.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.39 ,90,,,$24.68 ,$43.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.53 ,97,,,$24.68 ,$43.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.53 ,97,,,$24.68 ,$43.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.53 ,97,,,$24.68 ,$43.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.15 ,85,,,$24.68 ,$43.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.39 ,90,,,$24.68 ,$43.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.68 ,55,,,$24.68 ,$43.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.64 ,90,,,$24.68 ,$43.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.68 ,55,,,$24.68 ,$43.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.74 ,93,,,$24.68 ,$43.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE HAWKINS II 20GAUGE X 5.0 CM FLEXSTRAND,8785303,CDM,270,RC,,HCPCS,outpatient,,,$273.91 ,$205.43 ,,$252.00 ,92,,,$150.65 ,$265.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$150.65 ,55,,,$150.65 ,$265.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$150.65 ,$265.69 ,other,,Not applicable. No negotiated rates per contract,$235.56 ,86,,,$150.65 ,$265.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$219.13 ,80,,,$150.65 ,$265.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$150.65 ,55,,,$150.65 ,$265.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.21 ,95,,,$150.65 ,$265.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.21 ,95,,,$150.65 ,$265.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$205.43 ,75,,,$150.65 ,$265.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$232.82 ,85,,,$150.65 ,$265.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$265.69 ,97,,,$150.65 ,$265.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.65 ,55,,,$150.65 ,$265.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.52 ,90,,,$150.65 ,$265.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.69 ,97,,,$150.65 ,$265.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.69 ,97,,,$150.65 ,$265.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.69 ,97,,,$150.65 ,$265.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.82 ,85,,,$150.65 ,$265.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.52 ,90,,,$150.65 ,$265.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.65 ,55,,,$150.65 ,$265.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.21 ,90,,,$150.65 ,$265.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.65 ,55,,,$150.65 ,$265.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.74 ,93,,,$150.65 ,$265.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE HAWKINS II 20GAUGE X7.5 CM FLEXSTRAND(252075),8785304,CDM,270,RC,,HCPCS,outpatient,,,$278.24 ,$208.68 ,,$255.98 ,92,,,$153.03 ,$269.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.03 ,$269.89 ,other,,Not applicable. No negotiated rates per contract,$239.29 ,86,,,$153.03 ,$269.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$222.59 ,80,,,$153.03 ,$269.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.33 ,95,,,$153.03 ,$269.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.33 ,95,,,$153.03 ,$269.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.68 ,75,,,$153.03 ,$269.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$236.50 ,85,,,$153.03 ,$269.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.42 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.50 ,85,,,$153.03 ,$269.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.42 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.33 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.76 ,93,,,$153.03 ,$269.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE HAWKINS II 20GAUGE X10CM FLEXSTRAND(252100),8785305,CDM,270,RC,,HCPCS,outpatient,,,$278.24 ,$208.68 ,,$255.98 ,92,,,$153.03 ,$269.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$153.03 ,$269.89 ,other,,Not applicable. No negotiated rates per contract,$239.29 ,86,,,$153.03 ,$269.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$222.59 ,80,,,$153.03 ,$269.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.33 ,95,,,$153.03 ,$269.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$264.33 ,95,,,$153.03 ,$269.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.68 ,75,,,$153.03 ,$269.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$236.50 ,85,,,$153.03 ,$269.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.42 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.89 ,97,,,$153.03 ,$269.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.50 ,85,,,$153.03 ,$269.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$250.42 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$264.33 ,90,,,$153.03 ,$269.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$153.03 ,55,,,$153.03 ,$269.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.76 ,93,,,$153.03 ,$269.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE HYPO SAFETY 25G 1,8785034,CDM,270,RC,,HCPCS,outpatient,,,$121.60 ,$91.20 ,,$111.87 ,92,,,$66.88 ,$117.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.88 ,55,,,$66.88 ,$117.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.88 ,$117.95 ,other,,Not applicable. No negotiated rates per contract,$104.58 ,86,,,$66.88 ,$117.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$97.28 ,80,,,$66.88 ,$117.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.88 ,55,,,$66.88 ,$117.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.52 ,95,,,$66.88 ,$117.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.52 ,95,,,$66.88 ,$117.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,75,,,$66.88 ,$117.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$103.36 ,85,,,$66.88 ,$117.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.95 ,97,,,$66.88 ,$117.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.88 ,55,,,$66.88 ,$117.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.44 ,90,,,$66.88 ,$117.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.95 ,97,,,$66.88 ,$117.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.95 ,97,,,$66.88 ,$117.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.95 ,97,,,$66.88 ,$117.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.36 ,85,,,$66.88 ,$117.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$109.44 ,90,,,$66.88 ,$117.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.88 ,55,,,$66.88 ,$117.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.52 ,90,,,$66.88 ,$117.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.88 ,55,,,$66.88 ,$117.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.09 ,93,,,$66.88 ,$117.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE PED. 15MM EZ IO,8786890,CDM,270,RC,,HCPCS,outpatient,,,$717.15 ,$537.86 ,,$659.78 ,92,,,$394.43 ,$695.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$394.43 ,55,,,$394.43 ,$695.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$394.43 ,$695.64 ,other,,Not applicable. No negotiated rates per contract,$616.75 ,86,,,$394.43 ,$695.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$573.72 ,80,,,$394.43 ,$695.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$394.43 ,55,,,$394.43 ,$695.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$681.29 ,95,,,$394.43 ,$695.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$681.29 ,95,,,$394.43 ,$695.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$537.86 ,75,,,$394.43 ,$695.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$609.58 ,85,,,$394.43 ,$695.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$695.64 ,97,,,$394.43 ,$695.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$394.43 ,55,,,$394.43 ,$695.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$645.44 ,90,,,$394.43 ,$695.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$695.64 ,97,,,$394.43 ,$695.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$695.64 ,97,,,$394.43 ,$695.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$695.64 ,97,,,$394.43 ,$695.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$609.58 ,85,,,$394.43 ,$695.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$645.44 ,90,,,$394.43 ,$695.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$394.43 ,55,,,$394.43 ,$695.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$681.29 ,90,,,$394.43 ,$695.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$394.43 ,55,,,$394.43 ,$695.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$666.95 ,93,,,$394.43 ,$695.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE PUNCTURE NEEDLE 1,8782741,CDM,270,RC,,HCPCS,outpatient,,,$713.55 ,$535.16 ,,$656.47 ,92,,,$392.45 ,$692.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$392.45 ,55,,,$392.45 ,$692.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$392.45 ,$692.14 ,other,,Not applicable. No negotiated rates per contract,$613.65 ,86,,,$392.45 ,$692.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$570.84 ,80,,,$392.45 ,$692.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$392.45 ,55,,,$392.45 ,$692.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$677.87 ,95,,,$392.45 ,$692.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$677.87 ,95,,,$392.45 ,$692.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.16 ,75,,,$392.45 ,$692.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$606.52 ,85,,,$392.45 ,$692.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$692.14 ,97,,,$392.45 ,$692.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.45 ,55,,,$392.45 ,$692.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$642.20 ,90,,,$392.45 ,$692.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$692.14 ,97,,,$392.45 ,$692.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.14 ,97,,,$392.45 ,$692.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.14 ,97,,,$392.45 ,$692.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$606.52 ,85,,,$392.45 ,$692.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$642.20 ,90,,,$392.45 ,$692.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.45 ,55,,,$392.45 ,$692.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$677.87 ,90,,,$392.45 ,$692.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.45 ,55,,,$392.45 ,$692.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$663.60 ,93,,,$392.45 ,$692.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE SAFETY NEEDLE INTRODUCER,8783949,CDM,270,RC,,HCPCS,outpatient,,,$286.38 ,$214.79 ,,$263.47 ,92,,,$157.51 ,$277.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$157.51 ,55,,,$157.51 ,$277.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$157.51 ,$277.79 ,other,,Not applicable. No negotiated rates per contract,$246.29 ,86,,,$157.51 ,$277.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$229.10 ,80,,,$157.51 ,$277.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$157.51 ,55,,,$157.51 ,$277.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.06 ,95,,,$157.51 ,$277.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$272.06 ,95,,,$157.51 ,$277.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.79 ,75,,,$157.51 ,$277.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$243.42 ,85,,,$157.51 ,$277.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.79 ,97,,,$157.51 ,$277.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.51 ,55,,,$157.51 ,$277.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.74 ,90,,,$157.51 ,$277.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.79 ,97,,,$157.51 ,$277.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.79 ,97,,,$157.51 ,$277.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.79 ,97,,,$157.51 ,$277.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.42 ,85,,,$157.51 ,$277.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.74 ,90,,,$157.51 ,$277.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.51 ,55,,,$157.51 ,$277.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$272.06 ,90,,,$157.51 ,$277.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.51 ,55,,,$157.51 ,$277.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.33 ,93,,,$157.51 ,$277.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE SPECTRUM AUTOPASS,8782875,CDM,270,RC,,HCPCS,outpatient,,,"$1,547.00 ","$1,160.25 ",,"$1,423.24 ",92,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$850.85 ,55,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$850.85 ,"$1,500.59 ",other,,Not applicable. No negotiated rates per contract,"$1,330.42 ",86,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,237.60 ",80,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$850.85 ,55,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,469.65 ",95,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,469.65 ",95,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,160.25 ",75,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,314.95 ",85,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,500.59 ",97,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$850.85 ,55,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,392.30 ",90,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,500.59 ",97,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,500.59 ",97,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,500.59 ",97,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,314.95 ",85,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,392.30 ",90,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.85 ,55,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,469.65 ",90,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$850.85 ,55,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,438.71 ",93,,,$850.85 ,"$1,500.59 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE SURGICAL  MARTIN,8785513,CDM,270,RC,,HCPCS,outpatient,,,$42.08 ,$31.56 ,,$38.71 ,92,,,$23.14 ,$40.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.14 ,55,,,$23.14 ,$40.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.14 ,$40.82 ,other,,Not applicable. No negotiated rates per contract,$36.19 ,86,,,$23.14 ,$40.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.66 ,80,,,$23.14 ,$40.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.14 ,55,,,$23.14 ,$40.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.98 ,95,,,$23.14 ,$40.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.98 ,95,,,$23.14 ,$40.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.56 ,75,,,$23.14 ,$40.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.77 ,85,,,$23.14 ,$40.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.82 ,97,,,$23.14 ,$40.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.14 ,55,,,$23.14 ,$40.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.87 ,90,,,$23.14 ,$40.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.82 ,97,,,$23.14 ,$40.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,97,,,$23.14 ,$40.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.82 ,97,,,$23.14 ,$40.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.77 ,85,,,$23.14 ,$40.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.87 ,90,,,$23.14 ,$40.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.14 ,55,,,$23.14 ,$40.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.98 ,90,,,$23.14 ,$40.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.14 ,55,,,$23.14 ,$40.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.13 ,93,,,$23.14 ,$40.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE TUOPHY EPIDURAL,8786516,CDM,270,RC,,HCPCS,outpatient,,,$152.29 ,$114.22 ,,$140.11 ,92,,,$83.76 ,$147.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.76 ,55,,,$83.76 ,$147.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.76 ,$147.72 ,other,,Not applicable. No negotiated rates per contract,$130.97 ,86,,,$83.76 ,$147.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.83 ,80,,,$83.76 ,$147.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.76 ,55,,,$83.76 ,$147.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.68 ,95,,,$83.76 ,$147.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.68 ,95,,,$83.76 ,$147.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.22 ,75,,,$83.76 ,$147.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.45 ,85,,,$83.76 ,$147.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.72 ,97,,,$83.76 ,$147.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.76 ,55,,,$83.76 ,$147.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.06 ,90,,,$83.76 ,$147.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.72 ,97,,,$83.76 ,$147.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.72 ,97,,,$83.76 ,$147.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.72 ,97,,,$83.76 ,$147.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.45 ,85,,,$83.76 ,$147.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.06 ,90,,,$83.76 ,$147.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.76 ,55,,,$83.76 ,$147.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.68 ,90,,,$83.76 ,$147.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.76 ,55,,,$83.76 ,$147.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.63 ,93,,,$83.76 ,$147.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE,8785727,CDM,270,RC,,HCPCS,outpatient,,,$28.35 ,$21.26 ,,$26.08 ,92,,,$15.59 ,$27.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.59 ,$27.50 ,other,,Not applicable. No negotiated rates per contract,$24.38 ,86,,,$15.59 ,$27.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.68 ,80,,,$15.59 ,$27.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.93 ,95,,,$15.59 ,$27.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.26 ,75,,,$15.59 ,$27.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.50 ,97,,,$15.59 ,$27.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.10 ,85,,,$15.59 ,$27.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.52 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.93 ,90,,,$15.59 ,$27.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.59 ,55,,,$15.59 ,$27.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.37 ,93,,,$15.59 ,$27.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE,8784172,CDM,270,RC,,HCPCS,outpatient,,,$150.74 ,$113.06 ,,$138.68 ,92,,,$82.91 ,$146.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.91 ,55,,,$82.91 ,$146.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.91 ,$146.22 ,other,,Not applicable. No negotiated rates per contract,$129.64 ,86,,,$82.91 ,$146.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.59 ,80,,,$82.91 ,$146.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.91 ,55,,,$82.91 ,$146.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.20 ,95,,,$82.91 ,$146.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.20 ,95,,,$82.91 ,$146.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.06 ,75,,,$82.91 ,$146.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.13 ,85,,,$82.91 ,$146.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.22 ,97,,,$82.91 ,$146.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.91 ,55,,,$82.91 ,$146.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.67 ,90,,,$82.91 ,$146.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.22 ,97,,,$82.91 ,$146.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.22 ,97,,,$82.91 ,$146.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.22 ,97,,,$82.91 ,$146.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.13 ,85,,,$82.91 ,$146.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.67 ,90,,,$82.91 ,$146.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.91 ,55,,,$82.91 ,$146.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.20 ,90,,,$82.91 ,$146.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.91 ,55,,,$82.91 ,$146.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.19 ,93,,,$82.91 ,$146.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLE,8784125,CDM,270,RC,,HCPCS,outpatient,,,$39.73 ,$29.80 ,,$36.55 ,92,,,$21.85 ,$38.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.85 ,55,,,$21.85 ,$38.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.85 ,$38.54 ,other,,Not applicable. No negotiated rates per contract,$34.17 ,86,,,$21.85 ,$38.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.78 ,80,,,$21.85 ,$38.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.85 ,55,,,$21.85 ,$38.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.74 ,95,,,$21.85 ,$38.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.74 ,95,,,$21.85 ,$38.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.80 ,75,,,$21.85 ,$38.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.77 ,85,,,$21.85 ,$38.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.54 ,97,,,$21.85 ,$38.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.85 ,55,,,$21.85 ,$38.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.76 ,90,,,$21.85 ,$38.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.54 ,97,,,$21.85 ,$38.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.54 ,97,,,$21.85 ,$38.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.54 ,97,,,$21.85 ,$38.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.77 ,85,,,$21.85 ,$38.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.76 ,90,,,$21.85 ,$38.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.85 ,55,,,$21.85 ,$38.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.74 ,90,,,$21.85 ,$38.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.85 ,55,,,$21.85 ,$38.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.95 ,93,,,$21.85 ,$38.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEDLES,8786198,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEEEDLE SPINAL S/U 22G X,8785314,CDM,270,RC,,HCPCS,outpatient,,,$58.08 ,$43.56 ,,$53.43 ,92,,,$31.94 ,$56.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.94 ,$56.34 ,other,,Not applicable. No negotiated rates per contract,$49.95 ,86,,,$31.94 ,$56.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.46 ,80,,,$31.94 ,$56.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.18 ,95,,,$31.94 ,$56.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.18 ,95,,,$31.94 ,$56.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.56 ,75,,,$31.94 ,$56.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.37 ,85,,,$31.94 ,$56.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.27 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.34 ,97,,,$31.94 ,$56.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.37 ,85,,,$31.94 ,$56.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.27 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.18 ,90,,,$31.94 ,$56.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.94 ,55,,,$31.94 ,$56.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.01 ,93,,,$31.94 ,$56.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE  XLG HINGED KNEE BRACE,8785091,CDM,270,RC,,HCPCS,outpatient,,,$153.99 ,$115.49 ,,$141.67 ,92,,,$84.69 ,$149.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.69 ,55,,,$84.69 ,$149.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.69 ,$149.37 ,other,,Not applicable. No negotiated rates per contract,$132.43 ,86,,,$84.69 ,$149.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.19 ,80,,,$84.69 ,$149.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.69 ,55,,,$84.69 ,$149.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.29 ,95,,,$84.69 ,$149.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.29 ,95,,,$84.69 ,$149.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.49 ,75,,,$84.69 ,$149.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.89 ,85,,,$84.69 ,$149.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.37 ,97,,,$84.69 ,$149.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.69 ,55,,,$84.69 ,$149.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.59 ,90,,,$84.69 ,$149.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.37 ,97,,,$84.69 ,$149.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.37 ,97,,,$84.69 ,$149.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.37 ,97,,,$84.69 ,$149.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.89 ,85,,,$84.69 ,$149.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.59 ,90,,,$84.69 ,$149.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.69 ,55,,,$84.69 ,$149.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.29 ,90,,,$84.69 ,$149.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.69 ,55,,,$84.69 ,$149.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.21 ,93,,,$84.69 ,$149.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE ANKLE SUPPORT WITHOUT STRAPS LARGE,8786165,CDM,270,RC,,HCPCS,outpatient,,,$71.86 ,$53.90 ,,$66.11 ,92,,,$39.52 ,$69.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.52 ,$69.70 ,other,,Not applicable. No negotiated rates per contract,$61.80 ,86,,,$39.52 ,$69.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.49 ,80,,,$39.52 ,$69.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.90 ,75,,,$39.52 ,$69.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,93,,,$39.52 ,$69.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE ANKLE SUPPORT WITHOUT STRAPS MEDIUM,8786166,CDM,270,RC,,HCPCS,outpatient,,,$71.86 ,$53.90 ,,$66.11 ,92,,,$39.52 ,$69.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.52 ,$69.70 ,other,,Not applicable. No negotiated rates per contract,$61.80 ,86,,,$39.52 ,$69.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.49 ,80,,,$39.52 ,$69.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.90 ,75,,,$39.52 ,$69.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,93,,,$39.52 ,$69.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE ANKLE SUPPORT WITHOUT STRAPS SMALL,8786167,CDM,270,RC,,HCPCS,outpatient,,,$71.86 ,$53.90 ,,$66.11 ,92,,,$39.52 ,$69.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.52 ,$69.70 ,other,,Not applicable. No negotiated rates per contract,$61.80 ,86,,,$39.52 ,$69.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.49 ,80,,,$39.52 ,$69.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.90 ,75,,,$39.52 ,$69.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,93,,,$39.52 ,$69.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE ANKLE SUPPORT WITHOUT STRAPS X-LARGE,8786168,CDM,270,RC,,HCPCS,outpatient,,,$71.86 ,$53.90 ,,$66.11 ,92,,,$39.52 ,$69.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$39.52 ,$69.70 ,other,,Not applicable. No negotiated rates per contract,$61.80 ,86,,,$39.52 ,$69.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$57.49 ,80,,,$39.52 ,$69.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.27 ,95,,,$39.52 ,$69.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.90 ,75,,,$39.52 ,$69.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,97,,,$39.52 ,$69.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.08 ,85,,,$39.52 ,$69.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.67 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.27 ,90,,,$39.52 ,$69.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.52 ,55,,,$39.52 ,$69.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.83 ,93,,,$39.52 ,$69.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEOPRENE XXLG HINGED KNEE BRACE,8785092,CDM,270,RC,,HCPCS,outpatient,,,$146.40 ,$109.80 ,,$134.69 ,92,,,$80.52 ,$142.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.52 ,55,,,$80.52 ,$142.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.52 ,$142.01 ,other,,Not applicable. No negotiated rates per contract,$125.90 ,86,,,$80.52 ,$142.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.12 ,80,,,$80.52 ,$142.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.52 ,55,,,$80.52 ,$142.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.08 ,95,,,$80.52 ,$142.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.08 ,95,,,$80.52 ,$142.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.80 ,75,,,$80.52 ,$142.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$124.44 ,85,,,$80.52 ,$142.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.01 ,97,,,$80.52 ,$142.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.52 ,55,,,$80.52 ,$142.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.76 ,90,,,$80.52 ,$142.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.01 ,97,,,$80.52 ,$142.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.01 ,97,,,$80.52 ,$142.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.01 ,97,,,$80.52 ,$142.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.44 ,85,,,$80.52 ,$142.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.76 ,90,,,$80.52 ,$142.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.52 ,55,,,$80.52 ,$142.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.08 ,90,,,$80.52 ,$142.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.52 ,55,,,$80.52 ,$142.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.15 ,93,,,$80.52 ,$142.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEUTRAL THUMB RESTING HA,8786177,CDM,270,RC,,HCPCS,outpatient,,,$397.78 ,$298.34 ,,$365.96 ,92,,,$218.78 ,$385.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$218.78 ,55,,,$218.78 ,$385.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$218.78 ,$385.85 ,other,,Not applicable. No negotiated rates per contract,$342.09 ,86,,,$218.78 ,$385.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.22 ,80,,,$218.78 ,$385.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$218.78 ,55,,,$218.78 ,$385.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.89 ,95,,,$218.78 ,$385.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$377.89 ,95,,,$218.78 ,$385.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.34 ,75,,,$218.78 ,$385.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.11 ,85,,,$218.78 ,$385.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$385.85 ,97,,,$218.78 ,$385.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.78 ,55,,,$218.78 ,$385.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.00 ,90,,,$218.78 ,$385.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$385.85 ,97,,,$218.78 ,$385.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.85 ,97,,,$218.78 ,$385.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$385.85 ,97,,,$218.78 ,$385.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.11 ,85,,,$218.78 ,$385.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.00 ,90,,,$218.78 ,$385.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.78 ,55,,,$218.78 ,$385.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.89 ,90,,,$218.78 ,$385.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.78 ,55,,,$218.78 ,$385.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$369.94 ,93,,,$218.78 ,$385.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEW IMAGE,8781915,CDM,270,RC,,HCPCS,outpatient,,,$94.32 ,$70.74 ,,$86.77 ,92,,,$51.88 ,$91.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$51.88 ,55,,,$51.88 ,$91.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$51.88 ,$91.49 ,other,,Not applicable. No negotiated rates per contract,$81.12 ,86,,,$51.88 ,$91.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$75.46 ,80,,,$51.88 ,$91.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$51.88 ,55,,,$51.88 ,$91.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.60 ,95,,,$51.88 ,$91.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.60 ,95,,,$51.88 ,$91.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.74 ,75,,,$51.88 ,$91.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$80.17 ,85,,,$51.88 ,$91.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$91.49 ,97,,,$51.88 ,$91.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.88 ,55,,,$51.88 ,$91.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.89 ,90,,,$51.88 ,$91.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.49 ,97,,,$51.88 ,$91.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.49 ,97,,,$51.88 ,$91.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.49 ,97,,,$51.88 ,$91.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.17 ,85,,,$51.88 ,$91.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.89 ,90,,,$51.88 ,$91.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.88 ,55,,,$51.88 ,$91.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.60 ,90,,,$51.88 ,$91.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.88 ,55,,,$51.88 ,$91.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.72 ,93,,,$51.88 ,$91.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
NEXPLANON 680MG,8786883,CDM,270,RC,,HCPCS,outpatient,,,"$2,802.54 ","$2,101.91 ",,"$2,578.34 ",92,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,541.40 ",55,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,541.40 ","$2,718.46 ",other,,Not applicable. No negotiated rates per contract,"$2,410.18 ",86,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,242.03 ",80,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,541.40 ",55,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,662.41 ",95,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,662.41 ",95,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,101.91 ",75,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,382.16 ",85,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,718.46 ",97,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,541.40 ",55,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,522.29 ",90,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,718.46 ",97,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,718.46 ",97,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,718.46 ",97,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,382.16 ",85,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,522.29 ",90,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,541.40 ",55,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,662.41 ",90,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,541.40 ",55,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,606.36 ",93,,,"$1,541.40 ","$2,718.46 ",percent of total billed charges,,93% of total billed charges for outpatient setting
NOMO NAUSEA WRIST BANDS (ADULT GREEN),8786521,CDM,270,RC,,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.80 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"NONCOR GRIPPER PLUS 20G X 3/4""",8785429,CDM,270,RC,,HCPCS,outpatient,,,$46.20 ,$34.65 ,,$42.50 ,92,,,$25.41 ,$44.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.41 ,$44.81 ,other,,Not applicable. No negotiated rates per contract,$39.73 ,86,,,$25.41 ,$44.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.96 ,80,,,$25.41 ,$44.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,95,,,$25.41 ,$44.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.89 ,95,,,$25.41 ,$44.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.65 ,75,,,$25.41 ,$44.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.27 ,85,,,$25.41 ,$44.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.58 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.81 ,97,,,$25.41 ,$44.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.27 ,85,,,$25.41 ,$44.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.58 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,90,,,$25.41 ,$44.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.41 ,55,,,$25.41 ,$44.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.97 ,93,,,$25.41 ,$44.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Neopreme Knee Support L1820,8971136,CDM,270,RC,L1820,HCPCS,outpatient,,,$118.00 ,$88.50 ,,$108.56 ,92,,,$64.90 ,$114.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$64.90 ,$114.46 ,other,,Not applicable. No negotiated rates per contract,$101.48 ,86,,,$64.90 ,$114.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$94.40 ,80,,,$64.90 ,$114.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,95,,,$64.90 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.10 ,95,,,$64.90 ,$114.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$88.50 ,75,,,$64.90 ,$114.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$100.30 ,85,,,$64.90 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.20 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.46 ,97,,,$64.90 ,$114.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.30 ,85,,,$64.90 ,$114.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.20 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.10 ,90,,,$64.90 ,$114.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.90 ,55,,,$64.90 ,$114.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.74 ,93,,,$64.90 ,$114.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Non-pneum walk boot pre ots L4387,8971153,CDM,270,RC,L4387,HCPCS,outpatient,,,$234.00 ,$175.50 ,,$215.28 ,92,,,$128.70 ,$226.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.70 ,$226.98 ,other,,Not applicable. No negotiated rates per contract,$201.24 ,86,,,$128.70 ,$226.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$187.20 ,80,,,$128.70 ,$226.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,95,,,$128.70 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.30 ,95,,,$128.70 ,$226.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.50 ,75,,,$128.70 ,$226.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.90 ,85,,,$128.70 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.60 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.98 ,97,,,$128.70 ,$226.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.90 ,85,,,$128.70 ,$226.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.60 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.30 ,90,,,$128.70 ,$226.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.70 ,55,,,$128.70 ,$226.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$217.62 ,93,,,$128.70 ,$226.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O-TWO VENTILATION CIRCUI,8783087,CDM,270,RC,,HCPCS,outpatient,,,$147.17 ,$110.38 ,,$135.40 ,92,,,$80.94 ,$142.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.94 ,55,,,$80.94 ,$142.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.94 ,$142.75 ,other,,Not applicable. No negotiated rates per contract,$126.57 ,86,,,$80.94 ,$142.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.74 ,80,,,$80.94 ,$142.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.94 ,55,,,$80.94 ,$142.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.81 ,95,,,$80.94 ,$142.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.81 ,95,,,$80.94 ,$142.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.38 ,75,,,$80.94 ,$142.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.09 ,85,,,$80.94 ,$142.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.75 ,97,,,$80.94 ,$142.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.94 ,55,,,$80.94 ,$142.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.45 ,90,,,$80.94 ,$142.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.75 ,97,,,$80.94 ,$142.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.75 ,97,,,$80.94 ,$142.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.75 ,97,,,$80.94 ,$142.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.09 ,85,,,$80.94 ,$142.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.45 ,90,,,$80.94 ,$142.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.94 ,55,,,$80.94 ,$142.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.81 ,90,,,$80.94 ,$142.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.94 ,55,,,$80.94 ,$142.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.87 ,93,,,$80.94 ,$142.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2  ADULT NON-REBREATHER MASK,8785731,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2  CONNECTOR,8785037,CDM,270,RC,,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2  PED. NON-REBREATHER MASK,8785730,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 ADULT AEROSOL MASK (HUD1083),8785732,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 ADULT AMBU BAG,8783089,CDM,270,RC,,HCPCS,outpatient,,,$116.25 ,$87.19 ,,$106.95 ,92,,,$63.94 ,$112.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.94 ,$112.76 ,other,,Not applicable. No negotiated rates per contract,$99.98 ,86,,,$63.94 ,$112.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$93.00 ,80,,,$63.94 ,$112.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.44 ,95,,,$63.94 ,$112.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.44 ,95,,,$63.94 ,$112.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.19 ,75,,,$63.94 ,$112.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$98.81 ,85,,,$63.94 ,$112.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.63 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.76 ,97,,,$63.94 ,$112.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.81 ,85,,,$63.94 ,$112.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.63 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.44 ,90,,,$63.94 ,$112.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.94 ,55,,,$63.94 ,$112.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.11 ,93,,,$63.94 ,$112.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 ADULT OXYGEN MASK,8785728,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 ADULT PULSE OX SENSOR,8783017,CDM,270,RC,,HCPCS,outpatient,,,$192.56 ,$144.42 ,,$177.16 ,92,,,$105.91 ,$186.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.91 ,55,,,$105.91 ,$186.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.91 ,$186.78 ,other,,Not applicable. No negotiated rates per contract,$165.60 ,86,,,$105.91 ,$186.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.05 ,80,,,$105.91 ,$186.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.91 ,55,,,$105.91 ,$186.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.93 ,95,,,$105.91 ,$186.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.93 ,95,,,$105.91 ,$186.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.42 ,75,,,$105.91 ,$186.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.68 ,85,,,$105.91 ,$186.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.78 ,97,,,$105.91 ,$186.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.91 ,55,,,$105.91 ,$186.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.30 ,90,,,$105.91 ,$186.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.78 ,97,,,$105.91 ,$186.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.78 ,97,,,$105.91 ,$186.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.78 ,97,,,$105.91 ,$186.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.68 ,85,,,$105.91 ,$186.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.30 ,90,,,$105.91 ,$186.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.91 ,55,,,$105.91 ,$186.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.93 ,90,,,$105.91 ,$186.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.91 ,55,,,$105.91 ,$186.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.08 ,93,,,$105.91 ,$186.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 AMBU CHILD (PEDIATRIC,8783060,CDM,270,RC,,HCPCS,outpatient,,,$31.94 ,$23.96 ,,$29.38 ,92,,,$17.57 ,$30.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.57 ,$30.98 ,other,,Not applicable. No negotiated rates per contract,$27.47 ,86,,,$17.57 ,$30.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.55 ,80,,,$17.57 ,$30.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.96 ,75,,,$17.57 ,$30.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,93,,,$17.57 ,$30.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 AMBU INFANT MASK,8783023,CDM,270,RC,,HCPCS,outpatient,,,$31.94 ,$23.96 ,,$29.38 ,92,,,$17.57 ,$30.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.57 ,$30.98 ,other,,Not applicable. No negotiated rates per contract,$27.47 ,86,,,$17.57 ,$30.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.55 ,80,,,$17.57 ,$30.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.34 ,95,,,$17.57 ,$30.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.96 ,75,,,$17.57 ,$30.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.98 ,97,,,$17.57 ,$30.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.15 ,85,,,$17.57 ,$30.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.75 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.34 ,90,,,$17.57 ,$30.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.57 ,55,,,$17.57 ,$30.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.70 ,93,,,$17.57 ,$30.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 BAAM AIRWAY FLOW MONI,8783033,CDM,270,RC,,HCPCS,outpatient,,,$68.06 ,$51.05 ,,$62.62 ,92,,,$37.43 ,$66.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.43 ,55,,,$37.43 ,$66.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.43 ,$66.02 ,other,,Not applicable. No negotiated rates per contract,$58.53 ,86,,,$37.43 ,$66.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$54.45 ,80,,,$37.43 ,$66.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.43 ,55,,,$37.43 ,$66.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.66 ,95,,,$37.43 ,$66.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$64.66 ,95,,,$37.43 ,$66.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.05 ,75,,,$37.43 ,$66.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$57.85 ,85,,,$37.43 ,$66.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.02 ,97,,,$37.43 ,$66.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.43 ,55,,,$37.43 ,$66.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.25 ,90,,,$37.43 ,$66.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.02 ,97,,,$37.43 ,$66.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.02 ,97,,,$37.43 ,$66.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.02 ,97,,,$37.43 ,$66.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.85 ,85,,,$37.43 ,$66.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.25 ,90,,,$37.43 ,$66.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.43 ,55,,,$37.43 ,$66.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.66 ,90,,,$37.43 ,$66.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.43 ,55,,,$37.43 ,$66.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.30 ,93,,,$37.43 ,$66.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 CANNULA,8785735,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 FACE TENT MASK 001220,8785036,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 HUDSON DISP HUMIDIFIE,8783030,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 HUMIDIFIER 640ML/650ml,8785325,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 INFANT AMBU BAG,8783034,CDM,270,RC,,HCPCS,outpatient,,,$135.55 ,$101.66 ,,$124.71 ,92,,,$74.55 ,$131.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$74.55 ,55,,,$74.55 ,$131.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$74.55 ,$131.48 ,other,,Not applicable. No negotiated rates per contract,$116.57 ,86,,,$74.55 ,$131.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$108.44 ,80,,,$74.55 ,$131.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$74.55 ,55,,,$74.55 ,$131.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.77 ,95,,,$74.55 ,$131.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.77 ,95,,,$74.55 ,$131.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$101.66 ,75,,,$74.55 ,$131.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$115.22 ,85,,,$74.55 ,$131.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.48 ,97,,,$74.55 ,$131.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.55 ,55,,,$74.55 ,$131.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.00 ,90,,,$74.55 ,$131.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$131.48 ,97,,,$74.55 ,$131.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.48 ,97,,,$74.55 ,$131.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.48 ,97,,,$74.55 ,$131.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.22 ,85,,,$74.55 ,$131.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.00 ,90,,,$74.55 ,$131.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.55 ,55,,,$74.55 ,$131.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.77 ,90,,,$74.55 ,$131.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.55 ,55,,,$74.55 ,$131.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.06 ,93,,,$74.55 ,$131.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 INFANT NASAL CANNULA,8785131,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 INFANT PULSE OX SENSOR,8783018,CDM,270,RC,,HCPCS,outpatient,,,$169.29 ,$126.97 ,,$155.75 ,92,,,$93.11 ,$164.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$93.11 ,55,,,$93.11 ,$164.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$93.11 ,$164.21 ,other,,Not applicable. No negotiated rates per contract,$145.59 ,86,,,$93.11 ,$164.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$135.43 ,80,,,$93.11 ,$164.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$93.11 ,55,,,$93.11 ,$164.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.83 ,95,,,$93.11 ,$164.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$160.83 ,95,,,$93.11 ,$164.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.97 ,75,,,$93.11 ,$164.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$143.90 ,85,,,$93.11 ,$164.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.21 ,97,,,$93.11 ,$164.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.11 ,55,,,$93.11 ,$164.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.36 ,90,,,$93.11 ,$164.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.21 ,97,,,$93.11 ,$164.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.21 ,97,,,$93.11 ,$164.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.21 ,97,,,$93.11 ,$164.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.90 ,85,,,$93.11 ,$164.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.36 ,90,,,$93.11 ,$164.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.11 ,55,,,$93.11 ,$164.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.83 ,90,,,$93.11 ,$164.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.11 ,55,,,$93.11 ,$164.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.44 ,93,,,$93.11 ,$164.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 MINI NEBULIZER,8785737,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 PEDIATRIC  MASK,8785729,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 PEDIATRIC AEROSOL MASK,8785733,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 PEDIATRIC AMBU BAG,8783020,CDM,270,RC,,HCPCS,outpatient,,,$137.02 ,$102.77 ,,$126.06 ,92,,,$75.36 ,$132.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$75.36 ,55,,,$75.36 ,$132.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$75.36 ,$132.91 ,other,,Not applicable. No negotiated rates per contract,$117.84 ,86,,,$75.36 ,$132.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$109.62 ,80,,,$75.36 ,$132.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$75.36 ,55,,,$75.36 ,$132.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$130.17 ,95,,,$75.36 ,$132.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.17 ,95,,,$75.36 ,$132.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$102.77 ,75,,,$75.36 ,$132.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$116.47 ,85,,,$75.36 ,$132.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.91 ,97,,,$75.36 ,$132.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.36 ,55,,,$75.36 ,$132.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.32 ,90,,,$75.36 ,$132.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.91 ,97,,,$75.36 ,$132.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.91 ,97,,,$75.36 ,$132.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.91 ,97,,,$75.36 ,$132.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.47 ,85,,,$75.36 ,$132.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.32 ,90,,,$75.36 ,$132.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.36 ,55,,,$75.36 ,$132.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$130.17 ,90,,,$75.36 ,$132.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.36 ,55,,,$75.36 ,$132.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$127.43 ,93,,,$75.36 ,$132.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 PEDIATRIC NASAL CANNULA,8785734,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 POCKET FLOW METER,8785416,CDM,270,RC,,HCPCS,outpatient,,,$82.42 ,$61.82 ,,$75.83 ,92,,,$45.33 ,$79.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.33 ,$79.95 ,other,,Not applicable. No negotiated rates per contract,$70.88 ,86,,,$45.33 ,$79.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.94 ,80,,,$45.33 ,$79.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,95,,,$45.33 ,$79.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.30 ,95,,,$45.33 ,$79.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.82 ,75,,,$45.33 ,$79.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$70.06 ,85,,,$45.33 ,$79.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.18 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.95 ,97,,,$45.33 ,$79.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.06 ,85,,,$45.33 ,$79.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.18 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$45.33 ,$79.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.33 ,55,,,$45.33 ,$79.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.65 ,93,,,$45.33 ,$79.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 SIMS TUBING CONNECTOR,8781900,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 TENDER GRIP,8781919,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 TRACH MASK,8783032,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 TUBING,8785736,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
O2 VOLUMETRIC EXERCISER,8781917,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OA/ARTHRITIS KNEE BRASS(,8786140,CDM,270,RC,,HCPCS,outpatient,,,$367.81 ,$275.86 ,,$338.39 ,92,,,$202.30 ,$356.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$202.30 ,55,,,$202.30 ,$356.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$202.30 ,$356.78 ,other,,Not applicable. No negotiated rates per contract,$316.32 ,86,,,$202.30 ,$356.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$294.25 ,80,,,$202.30 ,$356.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$202.30 ,55,,,$202.30 ,$356.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$349.42 ,95,,,$202.30 ,$356.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$349.42 ,95,,,$202.30 ,$356.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.86 ,75,,,$202.30 ,$356.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$312.64 ,85,,,$202.30 ,$356.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$356.78 ,97,,,$202.30 ,$356.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$202.30 ,55,,,$202.30 ,$356.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$331.03 ,90,,,$202.30 ,$356.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$356.78 ,97,,,$202.30 ,$356.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$356.78 ,97,,,$202.30 ,$356.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$356.78 ,97,,,$202.30 ,$356.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$312.64 ,85,,,$202.30 ,$356.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$331.03 ,90,,,$202.30 ,$356.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$202.30 ,55,,,$202.30 ,$356.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$349.42 ,90,,,$202.30 ,$356.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$202.30 ,55,,,$202.30 ,$356.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.06 ,93,,,$202.30 ,$356.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB AMNIHOOK,8782474,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB CORD CLAMP,8785173,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB INTRAN PLUS 400 IUP-4,8781948,CDM,270,RC,,HCPCS,outpatient,,,$217.14 ,$162.86 ,,$199.77 ,92,,,$119.43 ,$210.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$119.43 ,55,,,$119.43 ,$210.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$119.43 ,$210.63 ,other,,Not applicable. No negotiated rates per contract,$186.74 ,86,,,$119.43 ,$210.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$173.71 ,80,,,$119.43 ,$210.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$119.43 ,55,,,$119.43 ,$210.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.28 ,95,,,$119.43 ,$210.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$206.28 ,95,,,$119.43 ,$210.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.86 ,75,,,$119.43 ,$210.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$184.57 ,85,,,$119.43 ,$210.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.63 ,97,,,$119.43 ,$210.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.43 ,55,,,$119.43 ,$210.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.43 ,90,,,$119.43 ,$210.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.63 ,97,,,$119.43 ,$210.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.63 ,97,,,$119.43 ,$210.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.63 ,97,,,$119.43 ,$210.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.57 ,85,,,$119.43 ,$210.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$195.43 ,90,,,$119.43 ,$210.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.43 ,55,,,$119.43 ,$210.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.28 ,90,,,$119.43 ,$210.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.43 ,55,,,$119.43 ,$210.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$201.94 ,93,,,$119.43 ,$210.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB MATERNITY BABY KITS,8785154,CDM,270,RC,,HCPCS,outpatient,,,$81.14 ,$60.86 ,,$74.65 ,92,,,$44.63 ,$78.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.63 ,$78.71 ,other,,Not applicable. No negotiated rates per contract,$69.78 ,86,,,$44.63 ,$78.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.91 ,80,,,$44.63 ,$78.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.08 ,95,,,$44.63 ,$78.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.08 ,95,,,$44.63 ,$78.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.86 ,75,,,$44.63 ,$78.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.97 ,85,,,$44.63 ,$78.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.03 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.71 ,97,,,$44.63 ,$78.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.97 ,85,,,$44.63 ,$78.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.03 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.08 ,90,,,$44.63 ,$78.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.63 ,55,,,$44.63 ,$78.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.46 ,93,,,$44.63 ,$78.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB SITZ BATH WITH GRADUA,8781947,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB-MITYVAC OB DELIVERY K,8785163,CDM,270,RC,,HCPCS,outpatient,,,$149.81 ,$112.36 ,,$137.83 ,92,,,$82.40 ,$145.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.40 ,55,,,$82.40 ,$145.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.40 ,$145.32 ,other,,Not applicable. No negotiated rates per contract,$128.84 ,86,,,$82.40 ,$145.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$119.85 ,80,,,$82.40 ,$145.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.40 ,55,,,$82.40 ,$145.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.32 ,95,,,$82.40 ,$145.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.32 ,95,,,$82.40 ,$145.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.36 ,75,,,$82.40 ,$145.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$127.34 ,85,,,$82.40 ,$145.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.32 ,97,,,$82.40 ,$145.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.40 ,55,,,$82.40 ,$145.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.83 ,90,,,$82.40 ,$145.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.32 ,97,,,$82.40 ,$145.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.32 ,97,,,$82.40 ,$145.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.32 ,97,,,$82.40 ,$145.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.34 ,85,,,$82.40 ,$145.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.83 ,90,,,$82.40 ,$145.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.40 ,55,,,$82.40 ,$145.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.32 ,90,,,$82.40 ,$145.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.40 ,55,,,$82.40 ,$145.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.32 ,93,,,$82.40 ,$145.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB-PERITONEAL LAVAGE TRA,8782475,CDM,270,RC,,HCPCS,outpatient,,,$412.50 ,$309.38 ,,$379.50 ,92,,,$226.88 ,$400.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$226.88 ,55,,,$226.88 ,$400.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$226.88 ,$400.13 ,other,,Not applicable. No negotiated rates per contract,$354.75 ,86,,,$226.88 ,$400.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$330.00 ,80,,,$226.88 ,$400.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$226.88 ,55,,,$226.88 ,$400.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.88 ,95,,,$226.88 ,$400.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$391.88 ,95,,,$226.88 ,$400.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$309.38 ,75,,,$226.88 ,$400.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$350.63 ,85,,,$226.88 ,$400.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$400.13 ,97,,,$226.88 ,$400.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.88 ,55,,,$226.88 ,$400.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.25 ,90,,,$226.88 ,$400.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$400.13 ,97,,,$226.88 ,$400.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$400.13 ,97,,,$226.88 ,$400.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$400.13 ,97,,,$226.88 ,$400.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$350.63 ,85,,,$226.88 ,$400.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$371.25 ,90,,,$226.88 ,$400.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.88 ,55,,,$226.88 ,$400.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.88 ,90,,,$226.88 ,$400.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.88 ,55,,,$226.88 ,$400.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.63 ,93,,,$226.88 ,$400.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB/ DELEE SUCTION,8781946,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OB/GYN APPLICATORS  (808,8785035,CDM,270,RC,,HCPCS,outpatient,,,$56.10 ,$42.08 ,,$51.61 ,92,,,$30.86 ,$54.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.86 ,55,,,$30.86 ,$54.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.86 ,$54.42 ,other,,Not applicable. No negotiated rates per contract,$48.25 ,86,,,$30.86 ,$54.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$44.88 ,80,,,$30.86 ,$54.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.86 ,55,,,$30.86 ,$54.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.30 ,95,,,$30.86 ,$54.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$53.30 ,95,,,$30.86 ,$54.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.08 ,75,,,$30.86 ,$54.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$47.69 ,85,,,$30.86 ,$54.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.42 ,97,,,$30.86 ,$54.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.86 ,55,,,$30.86 ,$54.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.49 ,90,,,$30.86 ,$54.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$54.42 ,97,,,$30.86 ,$54.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.42 ,97,,,$30.86 ,$54.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.42 ,97,,,$30.86 ,$54.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.69 ,85,,,$30.86 ,$54.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.49 ,90,,,$30.86 ,$54.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.86 ,55,,,$30.86 ,$54.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.30 ,90,,,$30.86 ,$54.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.86 ,55,,,$30.86 ,$54.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.17 ,93,,,$30.86 ,$54.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OBGYN PACK,8843981,CDM,270,RC,,HCPCS,outpatient,,,$95.64 ,$71.73 ,,$87.99 ,92,,,$52.60 ,$92.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.60 ,$92.77 ,other,,Not applicable. No negotiated rates per contract,$82.25 ,86,,,$52.60 ,$92.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.51 ,80,,,$52.60 ,$92.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.86 ,95,,,$52.60 ,$92.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.86 ,95,,,$52.60 ,$92.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.73 ,75,,,$52.60 ,$92.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.29 ,85,,,$52.60 ,$92.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.08 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.29 ,85,,,$52.60 ,$92.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.08 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.86 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.95 ,93,,,$52.60 ,$92.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OFFICE 365 MIGRATION,8782856,CDM,270,RC,,HCPCS,outpatient,,,"$4,906.00 ","$3,679.50 ",,"$4,513.52 ",92,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,698.30 ",55,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,698.30 ","$4,758.82 ",other,,Not applicable. No negotiated rates per contract,"$4,219.16 ",86,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,924.80 ",80,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,698.30 ",55,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,660.70 ",95,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,660.70 ",95,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,679.50 ",75,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,170.10 ",85,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,758.82 ",97,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,698.30 ",55,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,415.40 ",90,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,758.82 ",97,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,758.82 ",97,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,758.82 ",97,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,170.10 ",85,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,415.40 ",90,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,698.30 ",55,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,660.70 ",90,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,698.30 ",55,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,562.58 ",93,,,"$2,698.30 ","$4,758.82 ",percent of total billed charges,,93% of total billed charges for outpatient setting
OLYMPUS MOUTH PIECE (MAJ,8784777,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OPTIPLEX 3040 SFF CORE I,8786032,CDM,270,RC,,HCPCS,outpatient,,,"$1,296.00 ",$972.00 ,,"$1,192.32 ",92,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$712.80 ,55,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$712.80 ,"$1,257.12 ",other,,Not applicable. No negotiated rates per contract,"$1,114.56 ",86,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,036.80 ",80,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$712.80 ,55,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,231.20 ",95,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,231.20 ",95,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$972.00 ,75,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,101.60 ",85,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,257.12 ",97,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$712.80 ,55,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,166.40 ",90,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,257.12 ",97,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,257.12 ",97,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,257.12 ",97,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,101.60 ",85,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,166.40 ",90,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$712.80 ,55,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,231.20 ",90,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$712.80 ,55,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,205.28 ",93,,,$712.80 ,"$1,257.12 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ORTHOPEDIC BAR DRAPE,9057588,CDM,270,RC,,HCPCS,outpatient,,,$111.60 ,$83.70 ,,$102.67 ,92,,,$61.38 ,$108.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.38 ,55,,,$61.38 ,$108.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$61.38 ,$108.25 ,other,,Not applicable. No negotiated rates per contract,$95.98 ,86,,,$61.38 ,$108.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$89.28 ,80,,,$61.38 ,$108.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.38 ,55,,,$61.38 ,$108.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.02 ,95,,,$61.38 ,$108.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.02 ,95,,,$61.38 ,$108.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.70 ,75,,,$61.38 ,$108.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$94.86 ,85,,,$61.38 ,$108.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.25 ,97,,,$61.38 ,$108.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.38 ,55,,,$61.38 ,$108.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.44 ,90,,,$61.38 ,$108.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.25 ,97,,,$61.38 ,$108.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.25 ,97,,,$61.38 ,$108.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.25 ,97,,,$61.38 ,$108.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.86 ,85,,,$61.38 ,$108.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.44 ,90,,,$61.38 ,$108.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.38 ,55,,,$61.38 ,$108.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.02 ,90,,,$61.38 ,$108.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.38 ,55,,,$61.38 ,$108.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.79 ,93,,,$61.38 ,$108.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ORTHOPEDIC SUCTION SYSTEM,10194922,CDM,270,RC,,HCPCS,outpatient,,,$246.14 ,$184.61 ,,$226.45 ,92,,,$135.38 ,$238.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$135.38 ,55,,,$135.38 ,$238.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$135.38 ,$238.76 ,other,,Not applicable. No negotiated rates per contract,$211.68 ,86,,,$135.38 ,$238.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$196.91 ,80,,,$135.38 ,$238.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$135.38 ,55,,,$135.38 ,$238.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.83 ,95,,,$135.38 ,$238.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$233.83 ,95,,,$135.38 ,$238.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.61 ,75,,,$135.38 ,$238.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$209.22 ,85,,,$135.38 ,$238.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.76 ,97,,,$135.38 ,$238.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.38 ,55,,,$135.38 ,$238.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.53 ,90,,,$135.38 ,$238.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$238.76 ,97,,,$135.38 ,$238.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.76 ,97,,,$135.38 ,$238.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.76 ,97,,,$135.38 ,$238.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$209.22 ,85,,,$135.38 ,$238.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$221.53 ,90,,,$135.38 ,$238.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.38 ,55,,,$135.38 ,$238.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.83 ,90,,,$135.38 ,$238.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.38 ,55,,,$135.38 ,$238.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.91 ,93,,,$135.38 ,$238.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784803,CDM,270,RC,51745,HCPCS,outpatient,,,$771.75 ,$578.81 ,,$710.01 ,92,,,$424.46 ,$748.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$424.46 ,$748.60 ,other,,Not applicable. No negotiated rates per contract,$663.71 ,86,,,$424.46 ,$748.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$617.40 ,80,,,$424.46 ,$748.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$578.81 ,75,,,$424.46 ,$748.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$717.73 ,93,,,$424.46 ,$748.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,9834490,CDM,272,RC,55444,HCPCS,outpatient,,,$859.75 ,$644.81 ,,$790.97 ,92,,,$472.86 ,$833.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$472.86 ,55,,,$472.86 ,$833.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$472.86 ,$833.96 ,other,,Not applicable. No negotiated rates per contract,$739.39 ,86,,,$472.86 ,$833.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$687.80 ,80,,,$472.86 ,$833.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$472.86 ,55,,,$472.86 ,$833.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$816.76 ,95,,,$472.86 ,$833.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$816.76 ,95,,,$472.86 ,$833.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$644.81 ,75,,,$472.86 ,$833.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$730.79 ,85,,,$472.86 ,$833.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$833.96 ,97,,,$472.86 ,$833.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$472.86 ,55,,,$472.86 ,$833.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$773.78 ,90,,,$472.86 ,$833.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$833.96 ,97,,,$472.86 ,$833.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$833.96 ,97,,,$472.86 ,$833.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$833.96 ,97,,,$472.86 ,$833.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$730.79 ,85,,,$472.86 ,$833.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$773.78 ,90,,,$472.86 ,$833.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.86 ,55,,,$472.86 ,$833.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$816.76 ,90,,,$472.86 ,$833.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$472.86 ,55,,,$472.86 ,$833.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$799.57 ,93,,,$472.86 ,$833.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784808,CDM,270,RC,52609,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784805,CDM,270,RC,52605,HCPCS,outpatient,,,$534.75 ,$401.06 ,,$491.97 ,92,,,$294.11 ,$518.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.11 ,$518.71 ,other,,Not applicable. No negotiated rates per contract,$459.89 ,86,,,$294.11 ,$518.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$427.80 ,80,,,$294.11 ,$518.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.01 ,95,,,$294.11 ,$518.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$508.01 ,95,,,$294.11 ,$518.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$401.06 ,75,,,$294.11 ,$518.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$454.54 ,85,,,$294.11 ,$518.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.28 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$454.54 ,85,,,$294.11 ,$518.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.28 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.01 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$497.32 ,93,,,$294.11 ,$518.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784806,CDM,270,RC,52607,HCPCS,outpatient,,,$534.75 ,$401.06 ,,$491.97 ,92,,,$294.11 ,$518.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.11 ,$518.71 ,other,,Not applicable. No negotiated rates per contract,$459.89 ,86,,,$294.11 ,$518.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$427.80 ,80,,,$294.11 ,$518.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.01 ,95,,,$294.11 ,$518.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$508.01 ,95,,,$294.11 ,$518.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$401.06 ,75,,,$294.11 ,$518.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$454.54 ,85,,,$294.11 ,$518.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.28 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$518.71 ,97,,,$294.11 ,$518.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$454.54 ,85,,,$294.11 ,$518.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.28 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.01 ,90,,,$294.11 ,$518.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.11 ,55,,,$294.11 ,$518.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$497.32 ,93,,,$294.11 ,$518.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784819,CDM,270,RC,53135,HCPCS,outpatient,,,$546.00 ,$409.50 ,,$502.32 ,92,,,$300.30 ,$529.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$300.30 ,55,,,$300.30 ,$529.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$300.30 ,$529.62 ,other,,Not applicable. No negotiated rates per contract,$469.56 ,86,,,$300.30 ,$529.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$436.80 ,80,,,$300.30 ,$529.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$300.30 ,55,,,$300.30 ,$529.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$518.70 ,95,,,$300.30 ,$529.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$518.70 ,95,,,$300.30 ,$529.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$409.50 ,75,,,$300.30 ,$529.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$464.10 ,85,,,$300.30 ,$529.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$529.62 ,97,,,$300.30 ,$529.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.30 ,55,,,$300.30 ,$529.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$491.40 ,90,,,$300.30 ,$529.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$529.62 ,97,,,$300.30 ,$529.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$529.62 ,97,,,$300.30 ,$529.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$529.62 ,97,,,$300.30 ,$529.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$464.10 ,85,,,$300.30 ,$529.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$491.40 ,90,,,$300.30 ,$529.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.30 ,55,,,$300.30 ,$529.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$518.70 ,90,,,$300.30 ,$529.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.30 ,55,,,$300.30 ,$529.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$507.78 ,93,,,$300.30 ,$529.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784820,CDM,270,RC,53136,HCPCS,outpatient,,,$771.75 ,$578.81 ,,$710.01 ,92,,,$424.46 ,$748.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$424.46 ,$748.60 ,other,,Not applicable. No negotiated rates per contract,$663.71 ,86,,,$424.46 ,$748.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$617.40 ,80,,,$424.46 ,$748.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$578.81 ,75,,,$424.46 ,$748.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$717.73 ,93,,,$424.46 ,$748.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEOMED,8784810,CDM,270,RC,52611,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTEORAPTOR 2.9 W/1 UB C,8786654,CDM,270,RC,,HCPCS,outpatient,,,"$1,870.00 ","$1,402.50 ",,"$1,720.40 ",92,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,028.50 ",55,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,028.50 ","$1,813.90 ",other,,Not applicable. No negotiated rates per contract,"$1,608.20 ",86,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,496.00 ",80,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,028.50 ",55,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.50 ",95,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,776.50 ",95,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,402.50 ",75,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,589.50 ",85,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,813.90 ",97,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,028.50 ",55,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,683.00 ",90,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,813.90 ",97,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.90 ",97,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,813.90 ",97,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,589.50 ",85,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,683.00 ",90,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.50 ",55,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.50 ",90,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,028.50 ",55,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,739.10 ",93,,,"$1,028.50 ","$1,813.90 ",percent of total billed charges,,93% of total billed charges for outpatient setting
OSTOMY POUCH NEW IMAGE LOCK N ROLL 57MM(2 1/4) HH (14603),8785323,CDM,270,RC,,HCPCS,outpatient,,,$49.91 ,$37.43 ,,$45.92 ,92,,,$27.45 ,$48.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.45 ,$48.41 ,other,,Not applicable. No negotiated rates per contract,$42.92 ,86,,,$27.45 ,$48.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.93 ,80,,,$27.45 ,$48.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.41 ,95,,,$27.45 ,$48.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.41 ,95,,,$27.45 ,$48.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.43 ,75,,,$27.45 ,$48.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.42 ,85,,,$27.45 ,$48.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.92 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.41 ,97,,,$27.45 ,$48.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.42 ,85,,,$27.45 ,$48.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.92 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.41 ,90,,,$27.45 ,$48.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.45 ,55,,,$27.45 ,$48.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.42 ,93,,,$27.45 ,$48.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTOMY POUCH NEW IMAGE LOCK N ROLL W/FILTER 70MM(2 3/4) HH,8785324,CDM,270,RC,,HCPCS,outpatient,,,$33.95 ,$25.46 ,,$31.23 ,92,,,$18.67 ,$32.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.67 ,$32.93 ,other,,Not applicable. No negotiated rates per contract,$29.20 ,86,,,$18.67 ,$32.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.16 ,80,,,$18.67 ,$32.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.25 ,95,,,$18.67 ,$32.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.25 ,95,,,$18.67 ,$32.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.46 ,75,,,$18.67 ,$32.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.86 ,85,,,$18.67 ,$32.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.56 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.86 ,85,,,$18.67 ,$32.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.56 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.25 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.57 ,93,,,$18.67 ,$32.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OSTOMY WAFER FLEX 2 3/4,8785224,CDM,270,RC,,HCPCS,outpatient,,,$49.75 ,$37.31 ,,$45.77 ,92,,,$27.36 ,$48.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.36 ,$48.26 ,other,,Not applicable. No negotiated rates per contract,$42.79 ,86,,,$27.36 ,$48.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.80 ,80,,,$27.36 ,$48.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.31 ,75,,,$27.36 ,$48.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.27 ,93,,,$27.36 ,$48.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OTHROCORD #2  VIOLET W/M,8783776,CDM,270,RC,,HCPCS,outpatient,,,$235.05 ,$176.29 ,,$216.25 ,92,,,$129.28 ,$228.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.28 ,55,,,$129.28 ,$228.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$129.28 ,$228.00 ,other,,Not applicable. No negotiated rates per contract,$202.14 ,86,,,$129.28 ,$228.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$188.04 ,80,,,$129.28 ,$228.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.28 ,55,,,$129.28 ,$228.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.30 ,95,,,$129.28 ,$228.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$223.30 ,95,,,$129.28 ,$228.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.29 ,75,,,$129.28 ,$228.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$199.79 ,85,,,$129.28 ,$228.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.00 ,97,,,$129.28 ,$228.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.28 ,55,,,$129.28 ,$228.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$211.55 ,90,,,$129.28 ,$228.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.00 ,97,,,$129.28 ,$228.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.00 ,97,,,$129.28 ,$228.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.00 ,97,,,$129.28 ,$228.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.79 ,85,,,$129.28 ,$228.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$211.55 ,90,,,$129.28 ,$228.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.28 ,55,,,$129.28 ,$228.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$223.30 ,90,,,$129.28 ,$228.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.28 ,55,,,$129.28 ,$228.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.60 ,93,,,$129.28 ,$228.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PACK ORTHO-MAJOR,8785225,CDM,270,RC,,HCPCS,outpatient,,,$139.42 ,$104.57 ,,$128.27 ,92,,,$76.68 ,$135.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.68 ,55,,,$76.68 ,$135.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.68 ,$135.24 ,other,,Not applicable. No negotiated rates per contract,$119.90 ,86,,,$76.68 ,$135.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$111.54 ,80,,,$76.68 ,$135.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.68 ,55,,,$76.68 ,$135.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.45 ,95,,,$76.68 ,$135.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.45 ,95,,,$76.68 ,$135.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.57 ,75,,,$76.68 ,$135.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$118.51 ,85,,,$76.68 ,$135.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.24 ,97,,,$76.68 ,$135.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.68 ,55,,,$76.68 ,$135.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.48 ,90,,,$76.68 ,$135.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$135.24 ,97,,,$76.68 ,$135.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.24 ,97,,,$76.68 ,$135.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$135.24 ,97,,,$76.68 ,$135.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.51 ,85,,,$76.68 ,$135.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.48 ,90,,,$76.68 ,$135.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.68 ,55,,,$76.68 ,$135.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.45 ,90,,,$76.68 ,$135.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.68 ,55,,,$76.68 ,$135.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$129.66 ,93,,,$76.68 ,$135.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PAD,8786358,CDM,270,RC,,HCPCS,outpatient,,,$26.69 ,$20.02 ,,$24.55 ,92,,,$14.68 ,$25.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.68 ,$25.89 ,other,,Not applicable. No negotiated rates per contract,$22.95 ,86,,,$14.68 ,$25.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.35 ,80,,,$14.68 ,$25.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.36 ,95,,,$14.68 ,$25.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.36 ,95,,,$14.68 ,$25.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.02 ,75,,,$14.68 ,$25.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.69 ,85,,,$14.68 ,$25.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.02 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.69 ,85,,,$14.68 ,$25.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.02 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.36 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.82 ,93,,,$14.68 ,$25.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PAD,8784616,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PALACOS R+G PRO 75 US      PALA,8783597,CDM,270,RC,,HCPCS,outpatient,,,"$3,081.25 ","$2,310.94 ",,"$2,834.75 ",92,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,694.69 ",55,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,694.69 ","$2,988.81 ",other,,Not applicable. No negotiated rates per contract,"$2,649.88 ",86,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,465.00 ",80,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,694.69 ",55,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,927.19 ",95,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,927.19 ",95,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,310.94 ",75,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,619.06 ",85,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,988.81 ",97,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,694.69 ",55,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,773.13 ",90,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,988.81 ",97,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,988.81 ",97,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,988.81 ",97,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,619.06 ",85,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,773.13 ",90,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,694.69 ",55,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,927.19 ",90,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,694.69 ",55,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,865.56 ",93,,,"$1,694.69 ","$2,988.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PART,8784760,CDM,270,RC,,HCPCS,outpatient,,,$637.00 ,$477.75 ,,$586.04 ,92,,,$350.35 ,$617.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$350.35 ,55,,,$350.35 ,$617.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$350.35 ,$617.89 ,other,,Not applicable. No negotiated rates per contract,$547.82 ,86,,,$350.35 ,$617.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$509.60 ,80,,,$350.35 ,$617.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$350.35 ,55,,,$350.35 ,$617.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$605.15 ,95,,,$350.35 ,$617.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$605.15 ,95,,,$350.35 ,$617.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$477.75 ,75,,,$350.35 ,$617.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$541.45 ,85,,,$350.35 ,$617.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$617.89 ,97,,,$350.35 ,$617.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$350.35 ,55,,,$350.35 ,$617.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.30 ,90,,,$350.35 ,$617.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$617.89 ,97,,,$350.35 ,$617.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$617.89 ,97,,,$350.35 ,$617.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$617.89 ,97,,,$350.35 ,$617.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$541.45 ,85,,,$350.35 ,$617.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$573.30 ,90,,,$350.35 ,$617.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$350.35 ,55,,,$350.35 ,$617.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$605.15 ,90,,,$350.35 ,$617.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$350.35 ,55,,,$350.35 ,$617.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$592.41 ,93,,,$350.35 ,$617.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PATCH  VENTRIO HERNIA CI,8782313,CDM,270,RC,,HCPCS,outpatient,,,"$2,499.00 ","$1,874.25 ",,"$2,299.08 ",92,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,374.45 ",55,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,374.45 ","$2,424.03 ",other,,Not applicable. No negotiated rates per contract,"$2,149.14 ",86,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,999.20 ",80,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,374.45 ",55,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,374.05 ",95,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,374.05 ",95,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,874.25 ",75,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,124.15 ",85,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,424.03 ",97,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,374.45 ",55,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,249.10 ",90,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,424.03 ",97,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,424.03 ",97,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,424.03 ",97,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,124.15 ",85,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,249.10 ",90,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,374.45 ",55,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,374.05 ",90,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,374.45 ",55,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,324.07 ",93,,,"$1,374.45 ","$2,424.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PATCH MEDIUM HYBRESIS IO,8783115,CDM,270,RC,,HCPCS,outpatient,,,$283.50 ,$212.63 ,,$260.82 ,92,,,$155.93 ,$275.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.93 ,55,,,$155.93 ,$275.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$155.93 ,$275.00 ,other,,Not applicable. No negotiated rates per contract,$243.81 ,86,,,$155.93 ,$275.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$226.80 ,80,,,$155.93 ,$275.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.93 ,55,,,$155.93 ,$275.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.33 ,95,,,$155.93 ,$275.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.33 ,95,,,$155.93 ,$275.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.63 ,75,,,$155.93 ,$275.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$240.98 ,85,,,$155.93 ,$275.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.00 ,97,,,$155.93 ,$275.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.93 ,55,,,$155.93 ,$275.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.15 ,90,,,$155.93 ,$275.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.00 ,97,,,$155.93 ,$275.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.00 ,97,,,$155.93 ,$275.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.00 ,97,,,$155.93 ,$275.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.98 ,85,,,$155.93 ,$275.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.15 ,90,,,$155.93 ,$275.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.93 ,55,,,$155.93 ,$275.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.33 ,90,,,$155.93 ,$275.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.93 ,55,,,$155.93 ,$275.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.66 ,93,,,$155.93 ,$275.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PATIENT ADULT ELECTRODES,8784146,CDM,270,RC,,HCPCS,outpatient,,,"$6,900.00 ","$5,175.00 ",,"$6,348.00 ",92,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,795.00 ",55,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,795.00 ","$6,693.00 ",other,,Not applicable. No negotiated rates per contract,"$5,934.00 ",86,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,520.00 ",80,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,795.00 ",55,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,555.00 ",95,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,555.00 ",95,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,175.00 ",75,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,865.00 ",85,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,693.00 ",97,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,795.00 ",55,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,210.00 ",90,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,693.00 ",97,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,693.00 ",97,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,693.00 ",97,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,865.00 ",85,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,210.00 ",90,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,795.00 ",55,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,555.00 ",90,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,795.00 ",55,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,417.00 ",93,,,"$3,795.00 ","$6,693.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PATIENT INTERMEDIARY TUBINGPAT.,8783817,CDM,270,RC,,HCPCS,outpatient,,,$206.34 ,$154.76 ,,$189.83 ,92,,,$113.49 ,$200.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$113.49 ,55,,,$113.49 ,$200.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$113.49 ,$200.15 ,other,,Not applicable. No negotiated rates per contract,$177.45 ,86,,,$113.49 ,$200.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$165.07 ,80,,,$113.49 ,$200.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$113.49 ,55,,,$113.49 ,$200.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.02 ,95,,,$113.49 ,$200.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$196.02 ,95,,,$113.49 ,$200.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$154.76 ,75,,,$113.49 ,$200.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$175.39 ,85,,,$113.49 ,$200.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$200.15 ,97,,,$113.49 ,$200.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.49 ,55,,,$113.49 ,$200.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.71 ,90,,,$113.49 ,$200.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$200.15 ,97,,,$113.49 ,$200.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.15 ,97,,,$113.49 ,$200.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.15 ,97,,,$113.49 ,$200.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.39 ,85,,,$113.49 ,$200.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$185.71 ,90,,,$113.49 ,$200.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.49 ,55,,,$113.49 ,$200.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.02 ,90,,,$113.49 ,$200.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.49 ,55,,,$113.49 ,$200.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$191.90 ,93,,,$113.49 ,$200.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PEANUT SPONGES (1PK/5),8977417,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PENCIL ROCKERSWITCH (ELE,8785753,CDM,270,RC,,HCPCS,outpatient,,,$52.97 ,$39.73 ,,$48.73 ,92,,,$29.13 ,$51.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.13 ,$51.38 ,other,,Not applicable. No negotiated rates per contract,$45.55 ,86,,,$29.13 ,$51.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.38 ,80,,,$29.13 ,$51.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.32 ,95,,,$29.13 ,$51.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.32 ,95,,,$29.13 ,$51.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.73 ,75,,,$29.13 ,$51.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.02 ,85,,,$29.13 ,$51.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.67 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.38 ,97,,,$29.13 ,$51.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.02 ,85,,,$29.13 ,$51.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.67 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.32 ,90,,,$29.13 ,$51.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.13 ,55,,,$29.13 ,$51.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.26 ,93,,,$29.13 ,$51.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PERC INSERT KIT FOR 2.9M,8942863,CDM,270,RC,,HCPCS,outpatient,,,"$1,044.23 ",$783.17 ,,$960.69 ,92,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$574.33 ,55,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$574.33 ,"$1,012.90 ",other,,Not applicable. No negotiated rates per contract,$898.04 ,86,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$835.38 ,80,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$574.33 ,55,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$992.02 ,95,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$992.02 ,95,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$783.17 ,75,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$887.60 ,85,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,012.90 ",97,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$574.33 ,55,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$939.81 ,90,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,012.90 ",97,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,012.90 ",97,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,012.90 ",97,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$887.60 ,85,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$939.81 ,90,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$574.33 ,55,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$992.02 ,90,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$574.33 ,55,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$971.13 ,93,,,$574.33 ,"$1,012.90 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PERINEAL COLD PACK (NOVA,8781925,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PICNIC TABLE ROUND ADA GREEN WHEELCHAIR ACCESSIBLE,8786915,CDM,270,RC,,HCPCS,outpatient,,,"$1,603.00 ","$1,202.25 ",,"$1,474.76 ",92,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$881.65 ,55,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$881.65 ,"$1,554.91 ",other,,Not applicable. No negotiated rates per contract,"$1,378.58 ",86,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,282.40 ",80,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$881.65 ,55,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,522.85 ",95,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,522.85 ",95,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,202.25 ",75,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,362.55 ",85,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,554.91 ",97,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$881.65 ,55,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,442.70 ",90,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,554.91 ",97,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,554.91 ",97,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,554.91 ",97,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,362.55 ",85,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,442.70 ",90,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$881.65 ,55,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,522.85 ",90,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$881.65 ,55,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,490.79 ",93,,,$881.65 ,"$1,554.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PILOT DRILL 1MM  J-LATCH,8784822,CDM,270,RC,,HCPCS,outpatient,,,$783.75 ,$587.81 ,,$721.05 ,92,,,$431.06 ,$760.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.06 ,$760.24 ,other,,Not applicable. No negotiated rates per contract,$674.03 ,86,,,$431.06 ,$760.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$627.00 ,80,,,$431.06 ,$760.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.81 ,75,,,$431.06 ,$760.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.89 ,93,,,$431.06 ,$760.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PILOT DRILL 2.0MM J-LATC,8784801,CDM,270,RC,,HCPCS,outpatient,,,$783.75 ,$587.81 ,,$721.05 ,92,,,$431.06 ,$760.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.06 ,$760.24 ,other,,Not applicable. No negotiated rates per contract,$674.03 ,86,,,$431.06 ,$760.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$627.00 ,80,,,$431.06 ,$760.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.81 ,75,,,$431.06 ,$760.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.89 ,93,,,$431.06 ,$760.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PKG. SUCTION/ IRRIGATION ADAPTER W/ STOPCOCK,9085722,CDM,270,RC,,HCPCS,outpatient,,,$815.10 ,$611.33 ,,$749.89 ,92,,,$448.31 ,$790.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$448.31 ,55,,,$448.31 ,$790.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$448.31 ,$790.65 ,other,,Not applicable. No negotiated rates per contract,$700.99 ,86,,,$448.31 ,$790.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$652.08 ,80,,,$448.31 ,$790.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$448.31 ,55,,,$448.31 ,$790.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$774.35 ,95,,,$448.31 ,$790.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$774.35 ,95,,,$448.31 ,$790.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$611.33 ,75,,,$448.31 ,$790.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$692.84 ,85,,,$448.31 ,$790.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$790.65 ,97,,,$448.31 ,$790.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$448.31 ,55,,,$448.31 ,$790.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.59 ,90,,,$448.31 ,$790.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$790.65 ,97,,,$448.31 ,$790.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$790.65 ,97,,,$448.31 ,$790.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$790.65 ,97,,,$448.31 ,$790.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$692.84 ,85,,,$448.31 ,$790.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$733.59 ,90,,,$448.31 ,$790.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$448.31 ,55,,,$448.31 ,$790.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$774.35 ,90,,,$448.31 ,$790.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$448.31 ,55,,,$448.31 ,$790.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$758.04 ,93,,,$448.31 ,$790.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLEATMAN SAC   (OR),8784774,CDM,270,RC,,HCPCS,outpatient,,,$318.20 ,$238.65 ,,$292.74 ,92,,,$175.01 ,$308.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$175.01 ,55,,,$175.01 ,$308.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$175.01 ,$308.65 ,other,,Not applicable. No negotiated rates per contract,$273.65 ,86,,,$175.01 ,$308.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$254.56 ,80,,,$175.01 ,$308.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$175.01 ,55,,,$175.01 ,$308.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.29 ,95,,,$175.01 ,$308.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.29 ,95,,,$175.01 ,$308.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$238.65 ,75,,,$175.01 ,$308.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$270.47 ,85,,,$175.01 ,$308.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$308.65 ,97,,,$175.01 ,$308.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.01 ,55,,,$175.01 ,$308.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$286.38 ,90,,,$175.01 ,$308.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$308.65 ,97,,,$175.01 ,$308.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.65 ,97,,,$175.01 ,$308.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$308.65 ,97,,,$175.01 ,$308.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$270.47 ,85,,,$175.01 ,$308.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.38 ,90,,,$175.01 ,$308.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.01 ,55,,,$175.01 ,$308.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.29 ,90,,,$175.01 ,$308.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$175.01 ,55,,,$175.01 ,$308.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$295.93 ,93,,,$175.01 ,$308.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLEURX DRAINAGE KIT WITH 1,8782168,CDM,270,RC,,HCPCS,outpatient,,,$398.25 ,$298.69 ,,$366.39 ,92,,,$219.04 ,$386.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.04 ,$386.30 ,other,,Not applicable. No negotiated rates per contract,$342.50 ,86,,,$219.04 ,$386.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.60 ,80,,,$219.04 ,$386.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.34 ,95,,,$219.04 ,$386.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.34 ,95,,,$219.04 ,$386.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.69 ,75,,,$219.04 ,$386.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.51 ,85,,,$219.04 ,$386.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.43 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.51 ,85,,,$219.04 ,$386.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.43 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.34 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.37 ,93,,,$219.04 ,$386.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLEURX DRAINAGE KIT WITH 500 ML VACUUM BOTTLE (50-7500B),8782169,CDM,270,RC,,HCPCS,outpatient,,,$398.25 ,$298.69 ,,$366.39 ,92,,,$219.04 ,$386.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.04 ,$386.30 ,other,,Not applicable. No negotiated rates per contract,$342.50 ,86,,,$219.04 ,$386.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$318.60 ,80,,,$219.04 ,$386.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.34 ,95,,,$219.04 ,$386.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$378.34 ,95,,,$219.04 ,$386.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$298.69 ,75,,,$219.04 ,$386.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$338.51 ,85,,,$219.04 ,$386.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$358.43 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$386.30 ,97,,,$219.04 ,$386.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$338.51 ,85,,,$219.04 ,$386.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.43 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$378.34 ,90,,,$219.04 ,$386.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.04 ,55,,,$219.04 ,$386.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$370.37 ,93,,,$219.04 ,$386.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLEURX PERITONEAL CATHET,8782231,CDM,270,RC,,HCPCS,outpatient,,,"$2,443.75 ","$1,832.81 ",,"$2,248.25 ",92,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,344.06 ",55,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,344.06 ","$2,370.44 ",other,,Not applicable. No negotiated rates per contract,"$2,101.63 ",86,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,955.00 ",80,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,344.06 ",55,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.56 ",95,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,321.56 ",95,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,832.81 ",75,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,077.19 ",85,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,370.44 ",97,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,344.06 ",55,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,199.38 ",90,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,370.44 ",97,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.44 ",97,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,370.44 ",97,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,077.19 ",85,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,199.38 ",90,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.06 ",55,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,321.56 ",90,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,344.06 ",55,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,272.69 ",93,,,"$1,344.06 ","$2,370.44 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PLEURX PROCEDURE PACK,8782166,CDM,270,RC,,HCPCS,outpatient,,,$195.75 ,$146.81 ,,$180.09 ,92,,,$107.66 ,$189.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$107.66 ,55,,,$107.66 ,$189.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$107.66 ,$189.88 ,other,,Not applicable. No negotiated rates per contract,$168.35 ,86,,,$107.66 ,$189.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$156.60 ,80,,,$107.66 ,$189.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$107.66 ,55,,,$107.66 ,$189.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.96 ,95,,,$107.66 ,$189.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$185.96 ,95,,,$107.66 ,$189.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.81 ,75,,,$107.66 ,$189.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$166.39 ,85,,,$107.66 ,$189.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.88 ,97,,,$107.66 ,$189.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.66 ,55,,,$107.66 ,$189.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.18 ,90,,,$107.66 ,$189.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$189.88 ,97,,,$107.66 ,$189.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.88 ,97,,,$107.66 ,$189.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$189.88 ,97,,,$107.66 ,$189.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.39 ,85,,,$107.66 ,$189.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$176.18 ,90,,,$107.66 ,$189.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.66 ,55,,,$107.66 ,$189.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$185.96 ,90,,,$107.66 ,$189.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.66 ,55,,,$107.66 ,$189.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.05 ,93,,,$107.66 ,$189.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLUME PEN ELITE ELECTROS,8782304,CDM,270,RC,,HCPCS,outpatient,,,$205.10 ,$153.83 ,,$188.69 ,92,,,$112.81 ,$198.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$112.81 ,55,,,$112.81 ,$198.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$112.81 ,$198.95 ,other,,Not applicable. No negotiated rates per contract,$176.39 ,86,,,$112.81 ,$198.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$164.08 ,80,,,$112.81 ,$198.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$112.81 ,55,,,$112.81 ,$198.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$194.85 ,95,,,$112.81 ,$198.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.85 ,95,,,$112.81 ,$198.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.83 ,75,,,$112.81 ,$198.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$174.34 ,85,,,$112.81 ,$198.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.95 ,97,,,$112.81 ,$198.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.81 ,55,,,$112.81 ,$198.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.59 ,90,,,$112.81 ,$198.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.95 ,97,,,$112.81 ,$198.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.95 ,97,,,$112.81 ,$198.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.95 ,97,,,$112.81 ,$198.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$174.34 ,85,,,$112.81 ,$198.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$184.59 ,90,,,$112.81 ,$198.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.81 ,55,,,$112.81 ,$198.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$194.85 ,90,,,$112.81 ,$198.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.81 ,55,,,$112.81 ,$198.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$190.74 ,93,,,$112.81 ,$198.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLUME PEN ELITE PLP2020,8782311,CDM,270,RC,,HCPCS,outpatient,,,$191.18 ,$143.39 ,,$175.89 ,92,,,$105.15 ,$185.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.15 ,55,,,$105.15 ,$185.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.15 ,$185.44 ,other,,Not applicable. No negotiated rates per contract,$164.41 ,86,,,$105.15 ,$185.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$152.94 ,80,,,$105.15 ,$185.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.15 ,55,,,$105.15 ,$185.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$181.62 ,95,,,$105.15 ,$185.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$181.62 ,95,,,$105.15 ,$185.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.39 ,75,,,$105.15 ,$185.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$162.50 ,85,,,$105.15 ,$185.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$185.44 ,97,,,$105.15 ,$185.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.15 ,55,,,$105.15 ,$185.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.06 ,90,,,$105.15 ,$185.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$185.44 ,97,,,$105.15 ,$185.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.44 ,97,,,$105.15 ,$185.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.44 ,97,,,$105.15 ,$185.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.50 ,85,,,$105.15 ,$185.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.06 ,90,,,$105.15 ,$185.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.15 ,55,,,$105.15 ,$185.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$181.62 ,90,,,$105.15 ,$185.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.15 ,55,,,$105.15 ,$185.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.80 ,93,,,$105.15 ,$185.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PLUMEPORT S E O LAPAROSC,8782310,CDM,270,RC,,HCPCS,outpatient,,,$87.81 ,$65.86 ,,$80.79 ,92,,,$48.30 ,$85.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.30 ,55,,,$48.30 ,$85.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.30 ,$85.18 ,other,,Not applicable. No negotiated rates per contract,$75.52 ,86,,,$48.30 ,$85.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$70.25 ,80,,,$48.30 ,$85.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.30 ,55,,,$48.30 ,$85.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.42 ,95,,,$48.30 ,$85.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.42 ,95,,,$48.30 ,$85.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.86 ,75,,,$48.30 ,$85.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.64 ,85,,,$48.30 ,$85.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.18 ,97,,,$48.30 ,$85.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.30 ,55,,,$48.30 ,$85.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.03 ,90,,,$48.30 ,$85.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.18 ,97,,,$48.30 ,$85.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.18 ,97,,,$48.30 ,$85.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.18 ,97,,,$48.30 ,$85.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.64 ,85,,,$48.30 ,$85.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.03 ,90,,,$48.30 ,$85.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.30 ,55,,,$48.30 ,$85.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.42 ,90,,,$48.30 ,$85.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.30 ,55,,,$48.30 ,$85.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.66 ,93,,,$48.30 ,$85.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POCKET GUIDE TO PRESSURE,8783114,CDM,270,RC,,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POLY PAT VE 32MM DIA (OR),8787048,CDM,270,RC,,HCPCS,outpatient,,,"$4,239.38 ","$3,179.54 ",,"$3,900.23 ",92,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,331.66 ",55,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,331.66 ","$4,112.20 ",other,,Not applicable. No negotiated rates per contract,"$3,645.87 ",86,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,391.50 ",80,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,331.66 ",55,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,027.41 ",95,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,027.41 ",95,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,179.54 ",75,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,603.47 ",85,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,112.20 ",97,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,331.66 ",55,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,815.44 ",90,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,112.20 ",97,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,112.20 ",97,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,112.20 ",97,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,603.47 ",85,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,815.44 ",90,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,331.66 ",55,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,027.41 ",90,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,331.66 ",55,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,942.62 ",93,,,"$2,331.66 ","$4,112.20 ",percent of total billed charges,,93% of total billed charges for outpatient setting
POLYP COLLECTION KIT,10359811,CDM,272,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POLYPECTOMY SNARE  HOT FIRM OVAL LOOP WIRE 24MM LARGE 230CM,8784171,CDM,270,RC,,HCPCS,outpatient,,,$57.75 ,$43.31 ,,$53.13 ,92,,,$31.76 ,$56.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.76 ,55,,,$31.76 ,$56.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.76 ,$56.02 ,other,,Not applicable. No negotiated rates per contract,$49.67 ,86,,,$31.76 ,$56.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.20 ,80,,,$31.76 ,$56.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.76 ,55,,,$31.76 ,$56.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.86 ,95,,,$31.76 ,$56.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.86 ,95,,,$31.76 ,$56.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.31 ,75,,,$31.76 ,$56.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.09 ,85,,,$31.76 ,$56.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.02 ,97,,,$31.76 ,$56.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.76 ,55,,,$31.76 ,$56.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.98 ,90,,,$31.76 ,$56.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.02 ,97,,,$31.76 ,$56.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.02 ,97,,,$31.76 ,$56.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.02 ,97,,,$31.76 ,$56.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.09 ,85,,,$31.76 ,$56.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.98 ,90,,,$31.76 ,$56.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.76 ,55,,,$31.76 ,$56.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.86 ,90,,,$31.76 ,$56.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.76 ,55,,,$31.76 ,$56.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.71 ,93,,,$31.76 ,$56.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PONSKY PULL PEG KIT 20 F,8782326,CDM,270,RC,,HCPCS,outpatient,,,"$1,096.50 ",$822.38 ,,"$1,008.78 ",92,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$603.08 ,55,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$603.08 ,"$1,063.61 ",other,,Not applicable. No negotiated rates per contract,$942.99 ,86,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$877.20 ,80,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$603.08 ,55,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,041.68 ",95,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,041.68 ",95,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$822.38 ,75,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$932.03 ,85,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,063.61 ",97,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$603.08 ,55,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$986.85 ,90,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.61 ",97,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.61 ",97,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.61 ",97,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$932.03 ,85,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$986.85 ,90,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$603.08 ,55,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,041.68 ",90,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$603.08 ,55,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,019.75 ",93,,,$603.08 ,"$1,063.61 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PONSKY PULL PEG KIT 28,8782329,CDM,270,RC,,HCPCS,outpatient,,,"$1,270.75 ",$953.06 ,,"$1,169.09 ",92,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$698.91 ,55,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$698.91 ,"$1,232.63 ",other,,Not applicable. No negotiated rates per contract,"$1,092.85 ",86,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,016.60 ",80,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$698.91 ,55,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,207.21 ",95,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,207.21 ",95,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$953.06 ,75,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,080.14 ",85,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,232.63 ",97,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$698.91 ,55,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,143.68 ",90,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,232.63 ",97,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,232.63 ",97,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,232.63 ",97,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,080.14 ",85,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,143.68 ",90,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$698.91 ,55,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,207.21 ",90,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$698.91 ,55,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,181.80 ",93,,,$698.91 ,"$1,232.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PORTEX ET TUBE INTRODUCER SINGLE USE BOUGIE,8783077,CDM,270,RC,,HCPCS,outpatient,,,$126.25 ,$94.69 ,,$116.15 ,92,,,$69.44 ,$122.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.44 ,55,,,$69.44 ,$122.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.44 ,$122.46 ,other,,Not applicable. No negotiated rates per contract,$108.58 ,86,,,$69.44 ,$122.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.00 ,80,,,$69.44 ,$122.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.44 ,55,,,$69.44 ,$122.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.94 ,95,,,$69.44 ,$122.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$119.94 ,95,,,$69.44 ,$122.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$94.69 ,75,,,$69.44 ,$122.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.31 ,85,,,$69.44 ,$122.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$122.46 ,97,,,$69.44 ,$122.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.44 ,55,,,$69.44 ,$122.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.63 ,90,,,$69.44 ,$122.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$122.46 ,97,,,$69.44 ,$122.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.46 ,97,,,$69.44 ,$122.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.46 ,97,,,$69.44 ,$122.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.31 ,85,,,$69.44 ,$122.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$113.63 ,90,,,$69.44 ,$122.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.44 ,55,,,$69.44 ,$122.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.94 ,90,,,$69.44 ,$122.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.44 ,55,,,$69.44 ,$122.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.41 ,93,,,$69.44 ,$122.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POST FOR WIRE SHELVING U,8783576,CDM,270,RC,,HCPCS,outpatient,,,$96.00 ,$72.00 ,,$88.32 ,92,,,$52.80 ,$93.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.80 ,$93.12 ,other,,Not applicable. No negotiated rates per contract,$82.56 ,86,,,$52.80 ,$93.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.80 ,80,,,$52.80 ,$93.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$91.20 ,95,,,$52.80 ,$93.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.00 ,75,,,$52.80 ,$93.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.12 ,97,,,$52.80 ,$93.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.60 ,85,,,$52.80 ,$93.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.40 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.20 ,90,,,$52.80 ,$93.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.80 ,55,,,$52.80 ,$93.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$89.28 ,93,,,$52.80 ,$93.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POUCH HIGH OUTPUT WITH T,8782516,CDM,270,RC,,HCPCS,outpatient,,,$76.73 ,$57.55 ,,$70.59 ,92,,,$42.20 ,$74.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.20 ,$74.43 ,other,,Not applicable. No negotiated rates per contract,$65.99 ,86,,,$42.20 ,$74.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.38 ,80,,,$42.20 ,$74.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.89 ,95,,,$42.20 ,$74.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.89 ,95,,,$42.20 ,$74.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.55 ,75,,,$42.20 ,$74.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.22 ,85,,,$42.20 ,$74.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.06 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.22 ,85,,,$42.20 ,$74.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.06 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.89 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.36 ,93,,,$42.20 ,$74.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POUCH,8782518,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POWER LOC  20G X.75IN SAFETY INFUSION (BARD ACCESS),8782336,CDM,270,RC,,HCPCS,outpatient,,,$51.15 ,$38.36 ,,$47.06 ,92,,,$28.13 ,$49.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.13 ,55,,,$28.13 ,$49.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.13 ,$49.62 ,other,,Not applicable. No negotiated rates per contract,$43.99 ,86,,,$28.13 ,$49.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.92 ,80,,,$28.13 ,$49.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.13 ,55,,,$28.13 ,$49.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.59 ,95,,,$28.13 ,$49.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.59 ,95,,,$28.13 ,$49.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.36 ,75,,,$28.13 ,$49.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.48 ,85,,,$28.13 ,$49.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.62 ,97,,,$28.13 ,$49.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.13 ,55,,,$28.13 ,$49.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.04 ,90,,,$28.13 ,$49.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.62 ,97,,,$28.13 ,$49.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.62 ,97,,,$28.13 ,$49.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.62 ,97,,,$28.13 ,$49.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.48 ,85,,,$28.13 ,$49.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.04 ,90,,,$28.13 ,$49.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.13 ,55,,,$28.13 ,$49.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.59 ,90,,,$28.13 ,$49.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.13 ,55,,,$28.13 ,$49.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.57 ,93,,,$28.13 ,$49.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
POWER PORT (MRI DEVICE) (BARD PERIPHERAL VASCULAR),8782314,CDM,270,RC,,HCPCS,outpatient,,,"$1,232.50 ",$924.38 ,,"$1,133.90 ",92,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$677.88 ,55,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$677.88 ,"$1,195.53 ",other,,Not applicable. No negotiated rates per contract,"$1,059.95 ",86,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$986.00 ,80,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$677.88 ,55,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,170.88 ",95,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,170.88 ",95,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$924.38 ,75,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,047.63 ",85,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,195.53 ",97,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$677.88 ,55,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,109.25 ",90,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,195.53 ",97,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,195.53 ",97,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,195.53 ",97,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,047.63 ",85,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,109.25 ",90,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$677.88 ,55,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,170.88 ",90,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$677.88 ,55,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,146.23 ",93,,,$677.88 ,"$1,195.53 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PRIME ZOOM ELECTRIC STRE,8786813,CDM,270,RC,,HCPCS,outpatient,,,"$29,216.00 ","$21,912.00 ",,"$26,878.72 ",92,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$16,068.80 ",55,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$16,068.80 ","$28,339.52 ",other,,Not applicable. No negotiated rates per contract,"$25,125.76 ",86,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$23,372.80 ",80,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$16,068.80 ",55,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$27,755.20 ",95,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$27,755.20 ",95,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$21,912.00 ",75,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$24,833.60 ",85,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$28,339.52 ",97,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$16,068.80 ",55,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$26,294.40 ",90,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$28,339.52 ",97,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$28,339.52 ",97,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$28,339.52 ",97,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$24,833.60 ",85,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$26,294.40 ",90,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$16,068.80 ",55,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$27,755.20 ",90,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$16,068.80 ",55,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$27,170.88 ",93,,,"$16,068.80 ","$28,339.52 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PRINT MEDIA,8786756,CDM,270,RC,,HCPCS,outpatient,,,$557.00 ,$417.75 ,,$512.44 ,92,,,$306.35 ,$540.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$306.35 ,55,,,$306.35 ,$540.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$306.35 ,$540.29 ,other,,Not applicable. No negotiated rates per contract,$479.02 ,86,,,$306.35 ,$540.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$445.60 ,80,,,$306.35 ,$540.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$306.35 ,55,,,$306.35 ,$540.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$529.15 ,95,,,$306.35 ,$540.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$529.15 ,95,,,$306.35 ,$540.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$417.75 ,75,,,$306.35 ,$540.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$473.45 ,85,,,$306.35 ,$540.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$540.29 ,97,,,$306.35 ,$540.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.35 ,55,,,$306.35 ,$540.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$501.30 ,90,,,$306.35 ,$540.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$540.29 ,97,,,$306.35 ,$540.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$540.29 ,97,,,$306.35 ,$540.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$540.29 ,97,,,$306.35 ,$540.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$473.45 ,85,,,$306.35 ,$540.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$501.30 ,90,,,$306.35 ,$540.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.35 ,55,,,$306.35 ,$540.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$529.15 ,90,,,$306.35 ,$540.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.35 ,55,,,$306.35 ,$540.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$518.01 ,93,,,$306.35 ,$540.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PROBES,8786754,CDM,270,RC,,HCPCS,outpatient,,,$904.88 ,$678.66 ,,$832.49 ,92,,,$497.68 ,$877.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$497.68 ,55,,,$497.68 ,$877.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$497.68 ,$877.73 ,other,,Not applicable. No negotiated rates per contract,$778.20 ,86,,,$497.68 ,$877.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$723.90 ,80,,,$497.68 ,$877.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$497.68 ,55,,,$497.68 ,$877.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$859.64 ,95,,,$497.68 ,$877.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$859.64 ,95,,,$497.68 ,$877.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$678.66 ,75,,,$497.68 ,$877.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$769.15 ,85,,,$497.68 ,$877.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$877.73 ,97,,,$497.68 ,$877.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$497.68 ,55,,,$497.68 ,$877.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$814.39 ,90,,,$497.68 ,$877.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$877.73 ,97,,,$497.68 ,$877.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$877.73 ,97,,,$497.68 ,$877.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$877.73 ,97,,,$497.68 ,$877.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$769.15 ,85,,,$497.68 ,$877.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$814.39 ,90,,,$497.68 ,$877.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$497.68 ,55,,,$497.68 ,$877.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$859.64 ,90,,,$497.68 ,$877.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$497.68 ,55,,,$497.68 ,$877.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$841.54 ,93,,,$497.68 ,$877.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PROCEDURE PACK,8782496,CDM,270,RC,,HCPCS,outpatient,,,$218.52 ,$163.89 ,,$201.04 ,92,,,$120.19 ,$211.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$120.19 ,55,,,$120.19 ,$211.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$120.19 ,$211.96 ,other,,Not applicable. No negotiated rates per contract,$187.93 ,86,,,$120.19 ,$211.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$174.82 ,80,,,$120.19 ,$211.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$120.19 ,55,,,$120.19 ,$211.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.59 ,95,,,$120.19 ,$211.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$207.59 ,95,,,$120.19 ,$211.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.89 ,75,,,$120.19 ,$211.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$185.74 ,85,,,$120.19 ,$211.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$211.96 ,97,,,$120.19 ,$211.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.19 ,55,,,$120.19 ,$211.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.67 ,90,,,$120.19 ,$211.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$211.96 ,97,,,$120.19 ,$211.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.96 ,97,,,$120.19 ,$211.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$211.96 ,97,,,$120.19 ,$211.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$185.74 ,85,,,$120.19 ,$211.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$196.67 ,90,,,$120.19 ,$211.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.19 ,55,,,$120.19 ,$211.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$207.59 ,90,,,$120.19 ,$211.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.19 ,55,,,$120.19 ,$211.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.22 ,93,,,$120.19 ,$211.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PROFICIENCY TESTING 2017,8782079,CDM,270,RC,,HCPCS,outpatient,,,"$18,371.75 ","$13,778.81 ",,"$16,902.01 ",92,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$10,104.46 ",55,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$10,104.46 ","$17,820.60 ",other,,Not applicable. No negotiated rates per contract,"$15,799.71 ",86,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$14,697.40 ",80,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$10,104.46 ",55,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$17,453.16 ",95,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$17,453.16 ",95,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$13,778.81 ",75,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$15,615.99 ",85,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$17,820.60 ",97,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$10,104.46 ",55,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$16,534.58 ",90,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$17,820.60 ",97,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$17,820.60 ",97,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$17,820.60 ",97,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$15,615.99 ",85,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$16,534.58 ",90,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$10,104.46 ",55,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$17,453.16 ",90,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$10,104.46 ",55,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$17,085.73 ",93,,,"$10,104.46 ","$17,820.60 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PROLYSTICA RESTORE DESCA,8786712,CDM,270,RC,,HCPCS,outpatient,,,$224.97 ,$168.73 ,,$206.97 ,92,,,$123.73 ,$218.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$123.73 ,55,,,$123.73 ,$218.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$123.73 ,$218.22 ,other,,Not applicable. No negotiated rates per contract,$193.47 ,86,,,$123.73 ,$218.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$179.98 ,80,,,$123.73 ,$218.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$123.73 ,55,,,$123.73 ,$218.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.72 ,95,,,$123.73 ,$218.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.72 ,95,,,$123.73 ,$218.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.73 ,75,,,$123.73 ,$218.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$191.22 ,85,,,$123.73 ,$218.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.22 ,97,,,$123.73 ,$218.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.73 ,55,,,$123.73 ,$218.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.47 ,90,,,$123.73 ,$218.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.22 ,97,,,$123.73 ,$218.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.22 ,97,,,$123.73 ,$218.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.22 ,97,,,$123.73 ,$218.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.22 ,85,,,$123.73 ,$218.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$202.47 ,90,,,$123.73 ,$218.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.73 ,55,,,$123.73 ,$218.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$213.72 ,90,,,$123.73 ,$218.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.73 ,55,,,$123.73 ,$218.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.22 ,93,,,$123.73 ,$218.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PROTECTIVE EYEWEAR,8957758,CDM,270,RC,54579,HCPCS,outpatient,,,$30.45 ,$22.84 ,,$28.01 ,92,,,$16.75 ,$29.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.75 ,$29.54 ,other,,Not applicable. No negotiated rates per contract,$26.19 ,86,,,$16.75 ,$29.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.36 ,80,,,$16.75 ,$29.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.93 ,95,,,$16.75 ,$29.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.93 ,95,,,$16.75 ,$29.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.84 ,75,,,$16.75 ,$29.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.88 ,85,,,$16.75 ,$29.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.41 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.54 ,97,,,$16.75 ,$29.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.88 ,85,,,$16.75 ,$29.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.41 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.93 ,90,,,$16.75 ,$29.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.75 ,55,,,$16.75 ,$29.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.32 ,93,,,$16.75 ,$29.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSN  FEM PS CMT CCR NRW SZ9 R (,8787049,CDM,270,RC,,HCPCS,outpatient,,,"$10,188.75 ","$7,641.56 ",,"$9,373.65 ",92,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$5,603.81 ","$9,883.09 ",other,,Not applicable. No negotiated rates per contract,"$8,762.33 ",86,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$8,151.00 ",80,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,679.31 ",95,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$9,679.31 ",95,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,641.56 ",75,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$8,660.44 ",85,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,169.88 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,660.44 ",85,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,169.88 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,679.31 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,475.54 ",93,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PSN  SCREW 25MM QTY 2 PE,8787038,CDM,270,RC,,HCPCS,outpatient,,,$748.13 ,$561.10 ,,$688.28 ,92,,,$411.47 ,$725.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$411.47 ,55,,,$411.47 ,$725.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$411.47 ,$725.69 ,other,,Not applicable. No negotiated rates per contract,$643.39 ,86,,,$411.47 ,$725.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$598.50 ,80,,,$411.47 ,$725.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$411.47 ,55,,,$411.47 ,$725.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$710.72 ,95,,,$411.47 ,$725.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$710.72 ,95,,,$411.47 ,$725.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$561.10 ,75,,,$411.47 ,$725.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$635.91 ,85,,,$411.47 ,$725.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$725.69 ,97,,,$411.47 ,$725.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.47 ,55,,,$411.47 ,$725.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$673.32 ,90,,,$411.47 ,$725.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$725.69 ,97,,,$411.47 ,$725.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$725.69 ,97,,,$411.47 ,$725.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$725.69 ,97,,,$411.47 ,$725.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$635.91 ,85,,,$411.47 ,$725.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$673.32 ,90,,,$411.47 ,$725.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$411.47 ,55,,,$411.47 ,$725.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$710.72 ,90,,,$411.47 ,$725.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$411.47 ,55,,,$411.47 ,$725.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.76 ,93,,,$411.47 ,$725.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PSN ASF PS 12MM (OR),8787043,CDM,270,RC,,HCPCS,outpatient,,,"$5,403.13 ","$4,052.35 ",,"$4,970.88 ",92,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,971.72 ","$5,241.04 ",other,,Not applicable. No negotiated rates per contract,"$4,646.69 ",86,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,322.50 ",80,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,132.97 ",95,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,132.97 ",95,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,052.35 ",75,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,592.66 ",85,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,862.82 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,592.66 ",85,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,862.82 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,132.97 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,024.91 ",93,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PSN ASF PS 12MM VE R 6-9CD  (OR,8787051,CDM,270,RC,,HCPCS,outpatient,,,"$5,403.13 ","$4,052.35 ",,"$4,970.88 ",92,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,971.72 ","$5,241.04 ",other,,Not applicable. No negotiated rates per contract,"$4,646.69 ",86,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,322.50 ",80,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,132.97 ",95,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,132.97 ",95,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,052.35 ",75,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,592.66 ",85,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,862.82 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,241.04 ",97,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,592.66 ",85,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,862.82 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,132.97 ",90,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,971.72 ",55,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,024.91 ",93,,,"$2,971.72 ","$5,241.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PSN FEM PS (OR),8787041,CDM,270,RC,,HCPCS,outpatient,,,"$10,188.75 ","$7,641.56 ",,"$9,373.65 ",92,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$5,603.81 ","$9,883.09 ",other,,Not applicable. No negotiated rates per contract,"$8,762.33 ",86,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$8,151.00 ",80,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,679.31 ",95,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$9,679.31 ",95,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$7,641.56 ",75,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$8,660.44 ",85,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,169.88 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$9,883.09 ",97,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$8,660.44 ",85,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$9,169.88 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,679.31 ",90,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,603.81 ",55,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$9,475.54 ",93,,,"$5,603.81 ","$9,883.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PSN TIB STM 5  (OR),8787044,CDM,270,RC,,HCPCS,outpatient,,,"$5,248.75 ","$3,936.56 ",,"$4,828.85 ",92,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,886.81 ","$5,091.29 ",other,,Not applicable. No negotiated rates per contract,"$4,513.93 ",86,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,199.00 ",80,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,986.31 ",95,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,986.31 ",95,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,936.56 ",75,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,461.44 ",85,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,723.88 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,461.44 ",85,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,723.88 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,986.31 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,881.34 ",93,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PSN TIB STM 5 DEG SZ D R  (OR),8787050,CDM,270,RC,,HCPCS,outpatient,,,"$5,248.75 ","$3,936.56 ",,"$4,828.85 ",92,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,886.81 ","$5,091.29 ",other,,Not applicable. No negotiated rates per contract,"$4,513.93 ",86,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,199.00 ",80,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,986.31 ",95,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,986.31 ",95,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,936.56 ",75,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,461.44 ",85,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,723.88 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,091.29 ",97,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,461.44 ",85,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,723.88 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,986.31 ",90,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,886.81 ",55,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,881.34 ",93,,,"$2,886.81 ","$5,091.29 ",percent of total billed charges,,93% of total billed charges for outpatient setting
PULLEY BLUERANGER (PT),8786160,CDM,270,RC,,HCPCS,outpatient,,,$57.59 ,$43.19 ,,$52.98 ,92,,,$31.67 ,$55.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.67 ,55,,,$31.67 ,$55.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.67 ,$55.86 ,other,,Not applicable. No negotiated rates per contract,$49.53 ,86,,,$31.67 ,$55.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.07 ,80,,,$31.67 ,$55.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.67 ,55,,,$31.67 ,$55.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.71 ,95,,,$31.67 ,$55.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.71 ,95,,,$31.67 ,$55.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.19 ,75,,,$31.67 ,$55.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.95 ,85,,,$31.67 ,$55.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.86 ,97,,,$31.67 ,$55.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.67 ,55,,,$31.67 ,$55.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.83 ,90,,,$31.67 ,$55.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.86 ,97,,,$31.67 ,$55.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.86 ,97,,,$31.67 ,$55.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.86 ,97,,,$31.67 ,$55.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.95 ,85,,,$31.67 ,$55.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.83 ,90,,,$31.67 ,$55.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.67 ,55,,,$31.67 ,$55.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.71 ,90,,,$31.67 ,$55.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.67 ,55,,,$31.67 ,$55.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.56 ,93,,,$31.67 ,$55.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PULSE OX FINGER TIP,8785193,CDM,270,RC,,HCPCS,outpatient,,,$289.64 ,$217.23 ,,$266.47 ,92,,,$159.30 ,$280.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.30 ,55,,,$159.30 ,$280.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.30 ,$280.95 ,other,,Not applicable. No negotiated rates per contract,$249.09 ,86,,,$159.30 ,$280.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$231.71 ,80,,,$159.30 ,$280.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.30 ,55,,,$159.30 ,$280.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.16 ,95,,,$159.30 ,$280.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.16 ,95,,,$159.30 ,$280.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.23 ,75,,,$159.30 ,$280.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.19 ,85,,,$159.30 ,$280.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.95 ,97,,,$159.30 ,$280.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.30 ,55,,,$159.30 ,$280.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.68 ,90,,,$159.30 ,$280.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$280.95 ,97,,,$159.30 ,$280.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.95 ,97,,,$159.30 ,$280.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.95 ,97,,,$159.30 ,$280.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.19 ,85,,,$159.30 ,$280.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.68 ,90,,,$159.30 ,$280.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.30 ,55,,,$159.30 ,$280.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.16 ,90,,,$159.30 ,$280.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.30 ,55,,,$159.30 ,$280.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.37 ,93,,,$159.30 ,$280.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PUNCTURE CLOSURE DEVICE,8782106,CDM,270,RC,,HCPCS,outpatient,,,$264.63 ,$198.47 ,,$243.46 ,92,,,$145.55 ,$256.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$145.55 ,$256.69 ,other,,Not applicable. No negotiated rates per contract,$227.58 ,86,,,$145.55 ,$256.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$211.70 ,80,,,$145.55 ,$256.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.40 ,95,,,$145.55 ,$256.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.40 ,95,,,$145.55 ,$256.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.47 ,75,,,$145.55 ,$256.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$224.94 ,85,,,$145.55 ,$256.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.17 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.94 ,85,,,$145.55 ,$256.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.17 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.40 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.11 ,93,,,$145.55 ,$256.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PUTTI BONE STRAIGHT & CV,8783639,CDM,270,RC,,HCPCS,outpatient,,,$404.75 ,$303.56 ,,$372.37 ,92,,,$222.61 ,$392.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.61 ,55,,,$222.61 ,$392.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.61 ,$392.61 ,other,,Not applicable. No negotiated rates per contract,$348.09 ,86,,,$222.61 ,$392.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$323.80 ,80,,,$222.61 ,$392.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.61 ,55,,,$222.61 ,$392.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.51 ,95,,,$222.61 ,$392.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.51 ,95,,,$222.61 ,$392.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.56 ,75,,,$222.61 ,$392.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.04 ,85,,,$222.61 ,$392.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.61 ,97,,,$222.61 ,$392.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.61 ,55,,,$222.61 ,$392.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.28 ,90,,,$222.61 ,$392.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.61 ,97,,,$222.61 ,$392.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.61 ,97,,,$222.61 ,$392.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.61 ,97,,,$222.61 ,$392.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.04 ,85,,,$222.61 ,$392.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.28 ,90,,,$222.61 ,$392.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.61 ,55,,,$222.61 ,$392.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.51 ,90,,,$222.61 ,$392.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.61 ,55,,,$222.61 ,$392.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.42 ,93,,,$222.61 ,$392.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
PYLORTEK TEST KIT (OR),8786505,CDM,270,RC,,HCPCS,outpatient,,,$70.13 ,$52.60 ,,$64.52 ,92,,,$38.57 ,$68.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.57 ,55,,,$38.57 ,$68.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.57 ,$68.03 ,other,,Not applicable. No negotiated rates per contract,$60.31 ,86,,,$38.57 ,$68.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.10 ,80,,,$38.57 ,$68.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.57 ,55,,,$38.57 ,$68.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.62 ,95,,,$38.57 ,$68.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.62 ,95,,,$38.57 ,$68.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.60 ,75,,,$38.57 ,$68.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.61 ,85,,,$38.57 ,$68.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.03 ,97,,,$38.57 ,$68.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.57 ,55,,,$38.57 ,$68.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.12 ,90,,,$38.57 ,$68.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.03 ,97,,,$38.57 ,$68.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.03 ,97,,,$38.57 ,$68.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.03 ,97,,,$38.57 ,$68.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.61 ,85,,,$38.57 ,$68.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.12 ,90,,,$38.57 ,$68.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.57 ,55,,,$38.57 ,$68.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.62 ,90,,,$38.57 ,$68.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.57 ,55,,,$38.57 ,$68.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.22 ,93,,,$38.57 ,$68.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Post Op Shoe L3260,8971141,CDM,270,RC,L3260,HCPCS,outpatient,,,$85.00 ,$63.75 ,,$78.20 ,92,,,$46.75 ,$82.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.75 ,$82.45 ,other,,Not applicable. No negotiated rates per contract,$73.10 ,86,,,$46.75 ,$82.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.00 ,80,,,$46.75 ,$82.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.75 ,75,,,$46.75 ,$82.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.05 ,93,,,$46.75 ,$82.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
QC KIT,8942864,CDM,270,RC,,HCPCS,outpatient,,,"$1,593.75 ","$1,195.31 ",,"$1,466.25 ",92,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$876.56 ,"$1,545.94 ",other,,Not applicable. No negotiated rates per contract,"$1,370.63 ",86,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,275.00 ",80,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.06 ",95,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,514.06 ",95,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,195.31 ",75,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,354.69 ",85,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,434.38 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,354.69 ",85,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,434.38 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.06 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,482.19 ",93,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
QUARTER SIZ LID & PERF B,8782048,CDM,270,RC,,HCPCS,outpatient,,,"$1,123.06 ",$842.30 ,,"$1,033.22 ",92,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$617.68 ,55,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$617.68 ,"$1,089.37 ",other,,Not applicable. No negotiated rates per contract,$965.83 ,86,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$898.45 ,80,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$617.68 ,55,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,066.91 ",95,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,066.91 ",95,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$842.30 ,75,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$954.60 ,85,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,089.37 ",97,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$617.68 ,55,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,010.75 ",90,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,089.37 ",97,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,089.37 ",97,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,089.37 ",97,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$954.60 ,85,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,010.75 ",90,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$617.68 ,55,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,066.91 ",90,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$617.68 ,55,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,044.45 ",93,,,$617.68 ,"$1,089.37 ",percent of total billed charges,,93% of total billed charges for outpatient setting
QUICK CLIP 2  LONG SINGLE 135 LONG,8784768,CDM,270,RC,,HCPCS,outpatient,,,$477.75 ,$358.31 ,,$439.53 ,92,,,$262.76 ,$463.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$262.76 ,55,,,$262.76 ,$463.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$262.76 ,$463.42 ,other,,Not applicable. No negotiated rates per contract,$410.87 ,86,,,$262.76 ,$463.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$382.20 ,80,,,$262.76 ,$463.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$262.76 ,55,,,$262.76 ,$463.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.86 ,95,,,$262.76 ,$463.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$453.86 ,95,,,$262.76 ,$463.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$358.31 ,75,,,$262.76 ,$463.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$406.09 ,85,,,$262.76 ,$463.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$463.42 ,97,,,$262.76 ,$463.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.76 ,55,,,$262.76 ,$463.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.98 ,90,,,$262.76 ,$463.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$463.42 ,97,,,$262.76 ,$463.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.42 ,97,,,$262.76 ,$463.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$463.42 ,97,,,$262.76 ,$463.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.09 ,85,,,$262.76 ,$463.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$429.98 ,90,,,$262.76 ,$463.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.76 ,55,,,$262.76 ,$463.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.86 ,90,,,$262.76 ,$463.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.76 ,55,,,$262.76 ,$463.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.31 ,93,,,$262.76 ,$463.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
QUICK PRESSURE MONITOR S,8786822,CDM,270,RC,,HCPCS,outpatient,,,$695.63 ,$521.72 ,,$639.98 ,92,,,$382.60 ,$674.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$382.60 ,55,,,$382.60 ,$674.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$382.60 ,$674.76 ,other,,Not applicable. No negotiated rates per contract,$598.24 ,86,,,$382.60 ,$674.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$556.50 ,80,,,$382.60 ,$674.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$382.60 ,55,,,$382.60 ,$674.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$660.85 ,95,,,$382.60 ,$674.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$660.85 ,95,,,$382.60 ,$674.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$521.72 ,75,,,$382.60 ,$674.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$591.29 ,85,,,$382.60 ,$674.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$674.76 ,97,,,$382.60 ,$674.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$382.60 ,55,,,$382.60 ,$674.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$626.07 ,90,,,$382.60 ,$674.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$674.76 ,97,,,$382.60 ,$674.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$674.76 ,97,,,$382.60 ,$674.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$674.76 ,97,,,$382.60 ,$674.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$591.29 ,85,,,$382.60 ,$674.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$626.07 ,90,,,$382.60 ,$674.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.60 ,55,,,$382.60 ,$674.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$660.85 ,90,,,$382.60 ,$674.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$382.60 ,55,,,$382.60 ,$674.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$646.94 ,93,,,$382.60 ,$674.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
QUICKTRACH,8783073,CDM,270,RC,,HCPCS,outpatient,,,$947.58 ,$710.69 ,,$871.77 ,92,,,$521.17 ,$919.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$521.17 ,55,,,$521.17 ,$919.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$521.17 ,$919.15 ,other,,Not applicable. No negotiated rates per contract,$814.92 ,86,,,$521.17 ,$919.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$758.06 ,80,,,$521.17 ,$919.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$521.17 ,55,,,$521.17 ,$919.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$900.20 ,95,,,$521.17 ,$919.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$900.20 ,95,,,$521.17 ,$919.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$710.69 ,75,,,$521.17 ,$919.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$805.44 ,85,,,$521.17 ,$919.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$919.15 ,97,,,$521.17 ,$919.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$521.17 ,55,,,$521.17 ,$919.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$852.82 ,90,,,$521.17 ,$919.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$919.15 ,97,,,$521.17 ,$919.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$919.15 ,97,,,$521.17 ,$919.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$919.15 ,97,,,$521.17 ,$919.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$805.44 ,85,,,$521.17 ,$919.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$852.82 ,90,,,$521.17 ,$919.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$521.17 ,55,,,$521.17 ,$919.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$900.20 ,90,,,$521.17 ,$919.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$521.17 ,55,,,$521.17 ,$919.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$881.25 ,93,,,$521.17 ,$919.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
R/R SYS6 SYNTHES LARGEAT,8786810,CDM,270,RC,,HCPCS,outpatient,,,"$2,847.50 ","$2,135.63 ",,"$2,619.70 ",92,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,566.13 ",55,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,566.13 ","$2,762.08 ",other,,Not applicable. No negotiated rates per contract,"$2,448.85 ",86,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,278.00 ",80,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,566.13 ",55,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,705.13 ",95,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,705.13 ",95,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,135.63 ",75,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,420.38 ",85,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,762.08 ",97,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,566.13 ",55,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,562.75 ",90,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,762.08 ",97,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,762.08 ",97,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,762.08 ",97,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,420.38 ",85,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,562.75 ",90,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,566.13 ",55,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,705.13 ",90,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,566.13 ",55,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,648.18 ",93,,,"$1,566.13 ","$2,762.08 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RACK FOR HIBBS & BRUNS C,8783633,CDM,270,RC,,HCPCS,outpatient,,,"$1,281.00 ",$960.75 ,,"$1,178.52 ",92,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$704.55 ,55,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$704.55 ,"$1,242.57 ",other,,Not applicable. No negotiated rates per contract,"$1,101.66 ",86,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,024.80 ",80,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$704.55 ,55,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,216.95 ",95,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,216.95 ",95,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$960.75 ,75,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,088.85 ",85,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,242.57 ",97,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$704.55 ,55,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,152.90 ",90,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,242.57 ",97,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,242.57 ",97,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,242.57 ",97,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,088.85 ",85,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,152.90 ",90,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$704.55 ,55,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,216.95 ",90,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$704.55 ,55,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,191.33 ",93,,,$704.55 ,"$1,242.57 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RADIAL HINGED ULNAR DEVI,8786176,CDM,270,RC,,HCPCS,outpatient,,,$360.45 ,$270.34 ,,$331.61 ,92,,,$198.25 ,$349.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$198.25 ,55,,,$198.25 ,$349.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$198.25 ,$349.64 ,other,,Not applicable. No negotiated rates per contract,$309.99 ,86,,,$198.25 ,$349.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$288.36 ,80,,,$198.25 ,$349.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$198.25 ,55,,,$198.25 ,$349.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.43 ,95,,,$198.25 ,$349.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$342.43 ,95,,,$198.25 ,$349.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.34 ,75,,,$198.25 ,$349.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$306.38 ,85,,,$198.25 ,$349.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$349.64 ,97,,,$198.25 ,$349.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.25 ,55,,,$198.25 ,$349.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$324.41 ,90,,,$198.25 ,$349.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$349.64 ,97,,,$198.25 ,$349.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.64 ,97,,,$198.25 ,$349.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$349.64 ,97,,,$198.25 ,$349.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.38 ,85,,,$198.25 ,$349.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$324.41 ,90,,,$198.25 ,$349.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.25 ,55,,,$198.25 ,$349.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$342.43 ,90,,,$198.25 ,$349.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$198.25 ,55,,,$198.25 ,$349.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$335.22 ,93,,,$198.25 ,$349.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RANFAC CATHETER (XL-11),8786406,CDM,270,RC,,HCPCS,outpatient,,,$217.50 ,$163.13 ,,$200.10 ,92,,,$119.63 ,$210.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$119.63 ,55,,,$119.63 ,$210.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$119.63 ,$210.98 ,other,,Not applicable. No negotiated rates per contract,$187.05 ,86,,,$119.63 ,$210.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$174.00 ,80,,,$119.63 ,$210.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$119.63 ,55,,,$119.63 ,$210.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.63 ,95,,,$119.63 ,$210.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$206.63 ,95,,,$119.63 ,$210.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.13 ,75,,,$119.63 ,$210.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$184.88 ,85,,,$119.63 ,$210.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.98 ,97,,,$119.63 ,$210.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$119.63 ,55,,,$119.63 ,$210.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.75 ,90,,,$119.63 ,$210.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$210.98 ,97,,,$119.63 ,$210.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.98 ,97,,,$119.63 ,$210.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$210.98 ,97,,,$119.63 ,$210.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.88 ,85,,,$119.63 ,$210.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$195.75 ,90,,,$119.63 ,$210.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.63 ,55,,,$119.63 ,$210.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$206.63 ,90,,,$119.63 ,$210.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$119.63 ,55,,,$119.63 ,$210.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$202.28 ,93,,,$119.63 ,$210.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RANFAC INTRODUCER NEEDLE,8786474,CDM,270,RC,,HCPCS,outpatient,,,$152.25 ,$114.19 ,,$140.07 ,92,,,$83.74 ,$147.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.74 ,55,,,$83.74 ,$147.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.74 ,$147.68 ,other,,Not applicable. No negotiated rates per contract,$130.94 ,86,,,$83.74 ,$147.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.80 ,80,,,$83.74 ,$147.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.74 ,55,,,$83.74 ,$147.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.64 ,95,,,$83.74 ,$147.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.64 ,95,,,$83.74 ,$147.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.19 ,75,,,$83.74 ,$147.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.41 ,85,,,$83.74 ,$147.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.68 ,97,,,$83.74 ,$147.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.74 ,55,,,$83.74 ,$147.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.03 ,90,,,$83.74 ,$147.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.68 ,97,,,$83.74 ,$147.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.68 ,97,,,$83.74 ,$147.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.68 ,97,,,$83.74 ,$147.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.41 ,85,,,$83.74 ,$147.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.03 ,90,,,$83.74 ,$147.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.74 ,55,,,$83.74 ,$147.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.64 ,90,,,$83.74 ,$147.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.74 ,55,,,$83.74 ,$147.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.59 ,93,,,$83.74 ,$147.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RAPTORMITE 3.0 PK,8786656,CDM,270,RC,,HCPCS,outpatient,,,"$1,683.00 ","$1,262.25 ",,"$1,548.36 ",92,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$925.65 ,55,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$925.65 ,"$1,632.51 ",other,,Not applicable. No negotiated rates per contract,"$1,447.38 ",86,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,346.40 ",80,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$925.65 ,55,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,598.85 ",95,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,598.85 ",95,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,262.25 ",75,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,430.55 ",85,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,632.51 ",97,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$925.65 ,55,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.70 ",90,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,632.51 ",97,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,632.51 ",97,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,632.51 ",97,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,430.55 ",85,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,514.70 ",90,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$925.65 ,55,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,598.85 ",90,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$925.65 ,55,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,565.19 ",93,,,$925.65 ,"$1,632.51 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RED Z SAFETEC,8783090,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REPAIR MICRODRILL STRAIG,8786811,CDM,270,RC,,HCPCS,outpatient,,,"$1,259.00 ",$944.25 ,,"$1,158.28 ",92,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$692.45 ,55,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$692.45 ,"$1,221.23 ",other,,Not applicable. No negotiated rates per contract,"$1,082.74 ",86,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,007.20 ",80,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$692.45 ,55,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,196.05 ",95,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,196.05 ",95,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$944.25 ,75,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,070.15 ",85,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,221.23 ",97,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$692.45 ,55,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,133.10 ",90,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,221.23 ",97,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,221.23 ",97,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,221.23 ",97,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,070.15 ",85,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,133.10 ",90,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$692.45 ,55,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,196.05 ",90,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$692.45 ,55,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,170.87 ",93,,,$692.45 ,"$1,221.23 ",percent of total billed charges,,93% of total billed charges for outpatient setting
REPLACEMENT PROJECTOR LA,8782803,CDM,270,RC,,HCPCS,outpatient,,,$285.00 ,$213.75 ,,$262.20 ,92,,,$156.75 ,$276.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.75 ,55,,,$156.75 ,$276.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.75 ,$276.45 ,other,,Not applicable. No negotiated rates per contract,$245.10 ,86,,,$156.75 ,$276.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$228.00 ,80,,,$156.75 ,$276.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.75 ,55,,,$156.75 ,$276.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.75 ,95,,,$156.75 ,$276.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$270.75 ,95,,,$156.75 ,$276.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$213.75 ,75,,,$156.75 ,$276.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$242.25 ,85,,,$156.75 ,$276.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$276.45 ,97,,,$156.75 ,$276.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.75 ,55,,,$156.75 ,$276.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.50 ,90,,,$156.75 ,$276.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$276.45 ,97,,,$156.75 ,$276.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.45 ,97,,,$156.75 ,$276.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.45 ,97,,,$156.75 ,$276.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.25 ,85,,,$156.75 ,$276.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.50 ,90,,,$156.75 ,$276.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.75 ,55,,,$156.75 ,$276.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$270.75 ,90,,,$156.75 ,$276.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.75 ,55,,,$156.75 ,$276.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.05 ,93,,,$156.75 ,$276.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RESOLUTION CLIP (NEW ITE,8782234,CDM,270,RC,,HCPCS,outpatient,,,$990.25 ,$742.69 ,,$911.03 ,92,,,$544.64 ,$960.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$544.64 ,55,,,$544.64 ,$960.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$544.64 ,$960.54 ,other,,Not applicable. No negotiated rates per contract,$851.62 ,86,,,$544.64 ,$960.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$792.20 ,80,,,$544.64 ,$960.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$544.64 ,55,,,$544.64 ,$960.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$940.74 ,95,,,$544.64 ,$960.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$940.74 ,95,,,$544.64 ,$960.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$742.69 ,75,,,$544.64 ,$960.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$841.71 ,85,,,$544.64 ,$960.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$960.54 ,97,,,$544.64 ,$960.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$544.64 ,55,,,$544.64 ,$960.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$891.23 ,90,,,$544.64 ,$960.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$960.54 ,97,,,$544.64 ,$960.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$960.54 ,97,,,$544.64 ,$960.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$960.54 ,97,,,$544.64 ,$960.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$841.71 ,85,,,$544.64 ,$960.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$891.23 ,90,,,$544.64 ,$960.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$544.64 ,55,,,$544.64 ,$960.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$940.74 ,90,,,$544.64 ,$960.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$544.64 ,55,,,$544.64 ,$960.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$920.93 ,93,,,$544.64 ,$960.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETRACTOR CANNULA ADJ. 8.0MM X 85MM W/OUTFLOW,8782886,CDM,270,RC,,HCPCS,outpatient,,,$405.00 ,$303.75 ,,$372.60 ,92,,,$222.75 ,$392.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.75 ,$392.85 ,other,,Not applicable. No negotiated rates per contract,$348.30 ,86,,,$222.75 ,$392.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$324.00 ,80,,,$222.75 ,$392.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.75 ,95,,,$222.75 ,$392.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.75 ,75,,,$222.75 ,$392.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.85 ,97,,,$222.75 ,$392.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$344.25 ,85,,,$222.75 ,$392.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.50 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.75 ,90,,,$222.75 ,$392.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.75 ,55,,,$222.75 ,$392.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.65 ,93,,,$222.75 ,$392.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETRACTOR HIBBS #1   (9),8783616,CDM,270,RC,,HCPCS,outpatient,,,$210.25 ,$157.69 ,,$193.43 ,92,,,$115.64 ,$203.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.64 ,55,,,$115.64 ,$203.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$115.64 ,$203.94 ,other,,Not applicable. No negotiated rates per contract,$180.82 ,86,,,$115.64 ,$203.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$168.20 ,80,,,$115.64 ,$203.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.64 ,55,,,$115.64 ,$203.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.74 ,95,,,$115.64 ,$203.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.74 ,95,,,$115.64 ,$203.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.69 ,75,,,$115.64 ,$203.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.71 ,85,,,$115.64 ,$203.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.94 ,97,,,$115.64 ,$203.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.64 ,55,,,$115.64 ,$203.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.23 ,90,,,$115.64 ,$203.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.94 ,97,,,$115.64 ,$203.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.94 ,97,,,$115.64 ,$203.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.94 ,97,,,$115.64 ,$203.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.71 ,85,,,$115.64 ,$203.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.23 ,90,,,$115.64 ,$203.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.64 ,55,,,$115.64 ,$203.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.74 ,90,,,$115.64 ,$203.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.64 ,55,,,$115.64 ,$203.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$195.53 ,93,,,$115.64 ,$203.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETRACTOR HOHMANN,8783615,CDM,270,RC,,HCPCS,outpatient,,,$188.50 ,$141.38 ,,$173.42 ,92,,,$103.68 ,$182.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$103.68 ,55,,,$103.68 ,$182.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$103.68 ,$182.85 ,other,,Not applicable. No negotiated rates per contract,$162.11 ,86,,,$103.68 ,$182.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$150.80 ,80,,,$103.68 ,$182.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$103.68 ,55,,,$103.68 ,$182.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.08 ,95,,,$103.68 ,$182.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.08 ,95,,,$103.68 ,$182.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.38 ,75,,,$103.68 ,$182.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.23 ,85,,,$103.68 ,$182.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$182.85 ,97,,,$103.68 ,$182.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.68 ,55,,,$103.68 ,$182.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.65 ,90,,,$103.68 ,$182.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.85 ,97,,,$103.68 ,$182.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.85 ,97,,,$103.68 ,$182.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.85 ,97,,,$103.68 ,$182.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.23 ,85,,,$103.68 ,$182.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.65 ,90,,,$103.68 ,$182.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.68 ,55,,,$103.68 ,$182.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.08 ,90,,,$103.68 ,$182.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.68 ,55,,,$103.68 ,$182.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.31 ,93,,,$103.68 ,$182.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETRACTOR,8782744,CDM,270,RC,53886,HCPCS,outpatient,,,$141.83 ,$106.37 ,,$130.48 ,92,,,$78.01 ,$137.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$78.01 ,55,,,$78.01 ,$137.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$78.01 ,$137.58 ,other,,Not applicable. No negotiated rates per contract,$121.97 ,86,,,$78.01 ,$137.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$113.46 ,80,,,$78.01 ,$137.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$78.01 ,55,,,$78.01 ,$137.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.74 ,95,,,$78.01 ,$137.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$134.74 ,95,,,$78.01 ,$137.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$106.37 ,75,,,$78.01 ,$137.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$120.56 ,85,,,$78.01 ,$137.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.58 ,97,,,$78.01 ,$137.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.01 ,55,,,$78.01 ,$137.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$127.65 ,90,,,$78.01 ,$137.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.58 ,97,,,$78.01 ,$137.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.58 ,97,,,$78.01 ,$137.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.58 ,97,,,$78.01 ,$137.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.56 ,85,,,$78.01 ,$137.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$127.65 ,90,,,$78.01 ,$137.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.01 ,55,,,$78.01 ,$137.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.74 ,90,,,$78.01 ,$137.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.01 ,55,,,$78.01 ,$137.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.90 ,93,,,$78.01 ,$137.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETRO DRILL GUIDE ASSY (,8782089,CDM,270,RC,,HCPCS,outpatient,,,$884.00 ,$663.00 ,,$813.28 ,92,,,$486.20 ,$857.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$486.20 ,55,,,$486.20 ,$857.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$486.20 ,$857.48 ,other,,Not applicable. No negotiated rates per contract,$760.24 ,86,,,$486.20 ,$857.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$707.20 ,80,,,$486.20 ,$857.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$486.20 ,55,,,$486.20 ,$857.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$839.80 ,95,,,$486.20 ,$857.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$839.80 ,95,,,$486.20 ,$857.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$663.00 ,75,,,$486.20 ,$857.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$751.40 ,85,,,$486.20 ,$857.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$857.48 ,97,,,$486.20 ,$857.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$486.20 ,55,,,$486.20 ,$857.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$795.60 ,90,,,$486.20 ,$857.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$857.48 ,97,,,$486.20 ,$857.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$857.48 ,97,,,$486.20 ,$857.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$857.48 ,97,,,$486.20 ,$857.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$751.40 ,85,,,$486.20 ,$857.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$795.60 ,90,,,$486.20 ,$857.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$486.20 ,55,,,$486.20 ,$857.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$839.80 ,90,,,$486.20 ,$857.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$486.20 ,55,,,$486.20 ,$857.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$822.12 ,93,,,$486.20 ,$857.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RETROCUTTER 9MM (OR),8782091,CDM,270,RC,,HCPCS,outpatient,,,"$1,185.75 ",$889.31 ,,"$1,090.89 ",92,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$652.16 ,55,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$652.16 ,"$1,150.18 ",other,,Not applicable. No negotiated rates per contract,"$1,019.75 ",86,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$948.60 ,80,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$652.16 ,55,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,126.46 ",95,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,126.46 ",95,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$889.31 ,75,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,007.89 ",85,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,150.18 ",97,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$652.16 ,55,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,067.18 ",90,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,150.18 ",97,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,150.18 ",97,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,150.18 ",97,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,007.89 ",85,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,067.18 ",90,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$652.16 ,55,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,126.46 ",90,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$652.16 ,55,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,102.75 ",93,,,$652.16 ,"$1,150.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
REVERSE KNUCKLE BENDER SPLINT (,8786181,CDM,270,RC,,HCPCS,outpatient,,,$106.25 ,$79.69 ,,$97.75 ,92,,,$58.44 ,$103.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.44 ,55,,,$58.44 ,$103.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$58.44 ,$103.06 ,other,,Not applicable. No negotiated rates per contract,$91.38 ,86,,,$58.44 ,$103.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$85.00 ,80,,,$58.44 ,$103.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.44 ,55,,,$58.44 ,$103.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.94 ,95,,,$58.44 ,$103.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.94 ,95,,,$58.44 ,$103.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.69 ,75,,,$58.44 ,$103.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$90.31 ,85,,,$58.44 ,$103.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.06 ,97,,,$58.44 ,$103.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.44 ,55,,,$58.44 ,$103.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.63 ,90,,,$58.44 ,$103.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$103.06 ,97,,,$58.44 ,$103.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.06 ,97,,,$58.44 ,$103.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.06 ,97,,,$58.44 ,$103.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.31 ,85,,,$58.44 ,$103.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.63 ,90,,,$58.44 ,$103.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.44 ,55,,,$58.44 ,$103.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.94 ,90,,,$58.44 ,$103.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.44 ,55,,,$58.44 ,$103.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.81 ,93,,,$58.44 ,$103.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
REVOLUTION CEMENT MIXING  SYSTEM W/ BREAKA,8786820,CDM,270,RC,,HCPCS,outpatient,,,$625.33 ,$469.00 ,,$575.30 ,92,,,$343.93 ,$606.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$343.93 ,55,,,$343.93 ,$606.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$343.93 ,$606.57 ,other,,Not applicable. No negotiated rates per contract,$537.78 ,86,,,$343.93 ,$606.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$500.26 ,80,,,$343.93 ,$606.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$343.93 ,55,,,$343.93 ,$606.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$594.06 ,95,,,$343.93 ,$606.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$594.06 ,95,,,$343.93 ,$606.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$469.00 ,75,,,$343.93 ,$606.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$531.53 ,85,,,$343.93 ,$606.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$606.57 ,97,,,$343.93 ,$606.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$343.93 ,55,,,$343.93 ,$606.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$562.80 ,90,,,$343.93 ,$606.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$606.57 ,97,,,$343.93 ,$606.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$606.57 ,97,,,$343.93 ,$606.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$606.57 ,97,,,$343.93 ,$606.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$531.53 ,85,,,$343.93 ,$606.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$562.80 ,90,,,$343.93 ,$606.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$343.93 ,55,,,$343.93 ,$606.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$594.06 ,90,,,$343.93 ,$606.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$343.93 ,55,,,$343.93 ,$606.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$581.56 ,93,,,$343.93 ,$606.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RIB BELT L0220,8971133,CDM,270,RC,L0220,HCPCS,outpatient,,,$78.00 ,$58.50 ,,$71.76 ,92,,,$42.90 ,$75.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.90 ,55,,,$42.90 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.90 ,$75.66 ,other,,Not applicable. No negotiated rates per contract,$67.08 ,86,,,$42.90 ,$75.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$62.40 ,80,,,$42.90 ,$75.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.90 ,55,,,$42.90 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.10 ,95,,,$42.90 ,$75.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$74.10 ,95,,,$42.90 ,$75.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$58.50 ,75,,,$42.90 ,$75.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$66.30 ,85,,,$42.90 ,$75.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$75.66 ,97,,,$42.90 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.90 ,55,,,$42.90 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.20 ,90,,,$42.90 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$75.66 ,97,,,$42.90 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.66 ,97,,,$42.90 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.66 ,97,,,$42.90 ,$75.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.30 ,85,,,$42.90 ,$75.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$70.20 ,90,,,$42.90 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.90 ,55,,,$42.90 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.10 ,90,,,$42.90 ,$75.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.90 ,55,,,$42.90 ,$75.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.54 ,93,,,$42.90 ,$75.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"RIB BELT SIZE 8"" MALE",8957634,CDM,270,RC,,HCPCS,outpatient,,,$57.26 ,$42.95 ,,$52.68 ,92,,,$31.49 ,$55.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.49 ,55,,,$31.49 ,$55.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.49 ,$55.54 ,other,,Not applicable. No negotiated rates per contract,$49.24 ,86,,,$31.49 ,$55.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.81 ,80,,,$31.49 ,$55.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.49 ,55,,,$31.49 ,$55.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.40 ,95,,,$31.49 ,$55.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.40 ,95,,,$31.49 ,$55.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.95 ,75,,,$31.49 ,$55.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.67 ,85,,,$31.49 ,$55.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.54 ,97,,,$31.49 ,$55.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.49 ,55,,,$31.49 ,$55.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.53 ,90,,,$31.49 ,$55.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.54 ,97,,,$31.49 ,$55.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.54 ,97,,,$31.49 ,$55.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.54 ,97,,,$31.49 ,$55.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.67 ,85,,,$31.49 ,$55.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.53 ,90,,,$31.49 ,$55.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.49 ,55,,,$31.49 ,$55.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.40 ,90,,,$31.49 ,$55.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.49 ,55,,,$31.49 ,$55.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.25 ,93,,,$31.49 ,$55.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RICHARDSON-EASTMAN RETRA,8783640,CDM,270,RC,,HCPCS,outpatient,,,$151.89 ,$113.92 ,,$139.74 ,92,,,$83.54 ,$147.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.54 ,55,,,$83.54 ,$147.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.54 ,$147.33 ,other,,Not applicable. No negotiated rates per contract,$130.63 ,86,,,$83.54 ,$147.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.51 ,80,,,$83.54 ,$147.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.54 ,55,,,$83.54 ,$147.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.30 ,95,,,$83.54 ,$147.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.30 ,95,,,$83.54 ,$147.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.92 ,75,,,$83.54 ,$147.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.11 ,85,,,$83.54 ,$147.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.33 ,97,,,$83.54 ,$147.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.54 ,55,,,$83.54 ,$147.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.70 ,90,,,$83.54 ,$147.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.33 ,97,,,$83.54 ,$147.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.33 ,97,,,$83.54 ,$147.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.33 ,97,,,$83.54 ,$147.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.11 ,85,,,$83.54 ,$147.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.70 ,90,,,$83.54 ,$147.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.54 ,55,,,$83.54 ,$147.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.30 ,90,,,$83.54 ,$147.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.54 ,55,,,$83.54 ,$147.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.26 ,93,,,$83.54 ,$147.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RIDIGLOOP ADJUSTABLE         RI,8783771,CDM,270,RC,,HCPCS,outpatient,,,"$1,910.42 ","$1,432.82 ",,"$1,757.59 ",92,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,050.73 ",55,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,050.73 ","$1,853.11 ",other,,Not applicable. No negotiated rates per contract,"$1,642.96 ",86,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,528.34 ",80,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,050.73 ",55,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,814.90 ",95,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,814.90 ",95,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,432.82 ",75,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,623.86 ",85,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,853.11 ",97,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,050.73 ",55,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,719.38 ",90,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,853.11 ",97,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,853.11 ",97,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,853.11 ",97,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,623.86 ",85,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,719.38 ",90,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,050.73 ",55,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,814.90 ",90,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,050.73 ",55,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,776.69 ",93,,,"$1,050.73 ","$1,853.11 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RIGIDFIX BIOCRYL BTB CRO,8783764,CDM,270,RC,,HCPCS,outpatient,,,"$2,116.50 ","$1,587.38 ",,"$1,947.18 ",92,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,164.08 ",55,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,164.08 ","$2,053.01 ",other,,Not applicable. No negotiated rates per contract,"$1,820.19 ",86,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,693.20 ",80,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,164.08 ",55,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,010.68 ",95,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,010.68 ",95,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,587.38 ",75,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,799.03 ",85,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,053.01 ",97,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,164.08 ",55,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,904.85 ",90,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,053.01 ",97,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,053.01 ",97,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,053.01 ",97,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,799.03 ",85,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,904.85 ",90,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,164.08 ",55,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,010.68 ",90,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,164.08 ",55,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,968.35 ",93,,,"$1,164.08 ","$2,053.01 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RIGIDLOOP DISPOSOLVE KIT      D,8783768,CDM,270,RC,,HCPCS,outpatient,,,"$2,508.05 ","$1,881.04 ",,"$2,307.41 ",92,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,379.43 ",55,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,379.43 ","$2,432.81 ",other,,Not applicable. No negotiated rates per contract,"$2,156.92 ",86,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,006.44 ",80,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,379.43 ",55,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,382.65 ",95,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,382.65 ",95,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,881.04 ",75,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,131.84 ",85,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,432.81 ",97,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,379.43 ",55,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,257.25 ",90,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,432.81 ",97,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,432.81 ",97,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,432.81 ",97,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,131.84 ",85,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,257.25 ",90,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,379.43 ",55,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,382.65 ",90,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,379.43 ",55,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,332.49 ",93,,,"$1,379.43 ","$2,432.81 ",percent of total billed charges,,93% of total billed charges for outpatient setting
RINGS SOFTFLEX SKIN BARR,8785321,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ROUND BUR 2.4MM ( HAND C,8786815,CDM,270,RC,,HCPCS,outpatient,,,$393.53 ,$295.15 ,,$362.05 ,92,,,$216.44 ,$381.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$216.44 ,$381.72 ,other,,Not applicable. No negotiated rates per contract,$338.44 ,86,,,$216.44 ,$381.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$314.82 ,80,,,$216.44 ,$381.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.85 ,95,,,$216.44 ,$381.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.85 ,95,,,$216.44 ,$381.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$295.15 ,75,,,$216.44 ,$381.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$334.50 ,85,,,$216.44 ,$381.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$354.18 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$381.72 ,97,,,$216.44 ,$381.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$334.50 ,85,,,$216.44 ,$381.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$354.18 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$373.85 ,90,,,$216.44 ,$381.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$216.44 ,55,,,$216.44 ,$381.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$365.98 ,93,,,$216.44 ,$381.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ROYLAN FITED COMPRESSION GLOVGL,8786180,CDM,270,RC,,HCPCS,outpatient,,,$63.11 ,$47.33 ,,$58.06 ,92,,,$34.71 ,$61.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$34.71 ,55,,,$34.71 ,$61.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$34.71 ,$61.22 ,other,,Not applicable. No negotiated rates per contract,$54.27 ,86,,,$34.71 ,$61.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$50.49 ,80,,,$34.71 ,$61.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$34.71 ,55,,,$34.71 ,$61.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.95 ,95,,,$34.71 ,$61.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.95 ,95,,,$34.71 ,$61.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.33 ,75,,,$34.71 ,$61.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$53.64 ,85,,,$34.71 ,$61.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.22 ,97,,,$34.71 ,$61.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.71 ,55,,,$34.71 ,$61.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.80 ,90,,,$34.71 ,$61.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.22 ,97,,,$34.71 ,$61.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.22 ,97,,,$34.71 ,$61.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.22 ,97,,,$34.71 ,$61.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.64 ,85,,,$34.71 ,$61.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.80 ,90,,,$34.71 ,$61.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.71 ,55,,,$34.71 ,$61.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.95 ,90,,,$34.71 ,$61.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.71 ,55,,,$34.71 ,$61.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.69 ,93,,,$34.71 ,$61.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RUSSELL PNEUMOFIX,8782235,CDM,270,RC,,HCPCS,outpatient,,,$231.93 ,$173.95 ,,$213.38 ,92,,,$127.56 ,$224.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.56 ,55,,,$127.56 ,$224.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.56 ,$224.97 ,other,,Not applicable. No negotiated rates per contract,$199.46 ,86,,,$127.56 ,$224.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$185.54 ,80,,,$127.56 ,$224.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.56 ,55,,,$127.56 ,$224.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.33 ,95,,,$127.56 ,$224.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.33 ,95,,,$127.56 ,$224.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$173.95 ,75,,,$127.56 ,$224.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.14 ,85,,,$127.56 ,$224.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$224.97 ,97,,,$127.56 ,$224.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.56 ,55,,,$127.56 ,$224.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.74 ,90,,,$127.56 ,$224.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$224.97 ,97,,,$127.56 ,$224.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.97 ,97,,,$127.56 ,$224.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.97 ,97,,,$127.56 ,$224.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.14 ,85,,,$127.56 ,$224.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.74 ,90,,,$127.56 ,$224.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.56 ,55,,,$127.56 ,$224.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.33 ,90,,,$127.56 ,$224.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.56 ,55,,,$127.56 ,$224.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.69 ,93,,,$127.56 ,$224.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAGITAL SAW BLADE,9804854,CDM,272,RC,55424,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SALEM SUMP 10FR,8783045,CDM,270,RC,,HCPCS,outpatient,,,$25.81 ,$19.36 ,,$23.75 ,92,,,$14.20 ,$25.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.20 ,$25.04 ,other,,Not applicable. No negotiated rates per contract,$22.20 ,86,,,$14.20 ,$25.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.65 ,80,,,$14.20 ,$25.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.36 ,75,,,$14.20 ,$25.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.00 ,93,,,$14.20 ,$25.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SALEM SUMP 12FR,8783046,CDM,270,RC,,HCPCS,outpatient,,,$25.81 ,$19.36 ,,$23.75 ,92,,,$14.20 ,$25.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.20 ,$25.04 ,other,,Not applicable. No negotiated rates per contract,$22.20 ,86,,,$14.20 ,$25.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.65 ,80,,,$14.20 ,$25.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.52 ,95,,,$14.20 ,$25.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.36 ,75,,,$14.20 ,$25.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.04 ,97,,,$14.20 ,$25.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.94 ,85,,,$14.20 ,$25.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.23 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.52 ,90,,,$14.20 ,$25.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.20 ,55,,,$14.20 ,$25.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.00 ,93,,,$14.20 ,$25.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SALEM SUMP 14FR,8781942,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SALEM SUMP 16FR,8781943,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SALEM SUMP 18FR,8781944,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SALEM SUMP ANTI-REFLEX VALVE,8785345,CDM,270,RC,,HCPCS,outpatient,,,$47.19 ,$35.39 ,,$43.41 ,92,,,$25.95 ,$45.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.95 ,$45.77 ,other,,Not applicable. No negotiated rates per contract,$40.58 ,86,,,$25.95 ,$45.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.75 ,80,,,$25.95 ,$45.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.39 ,75,,,$25.95 ,$45.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,93,,,$25.95 ,$45.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAM  STANDARD PELVIC SLING II -,8783061,CDM,270,RC,,HCPCS,outpatient,,,$473.74 ,$355.31 ,,$435.84 ,92,,,$260.56 ,$459.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$260.56 ,55,,,$260.56 ,$459.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$260.56 ,$459.53 ,other,,Not applicable. No negotiated rates per contract,$407.42 ,86,,,$260.56 ,$459.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$378.99 ,80,,,$260.56 ,$459.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$260.56 ,55,,,$260.56 ,$459.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.05 ,95,,,$260.56 ,$459.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$450.05 ,95,,,$260.56 ,$459.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$355.31 ,75,,,$260.56 ,$459.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$402.68 ,85,,,$260.56 ,$459.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$459.53 ,97,,,$260.56 ,$459.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.56 ,55,,,$260.56 ,$459.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$426.37 ,90,,,$260.56 ,$459.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$459.53 ,97,,,$260.56 ,$459.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$459.53 ,97,,,$260.56 ,$459.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$459.53 ,97,,,$260.56 ,$459.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$402.68 ,85,,,$260.56 ,$459.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$426.37 ,90,,,$260.56 ,$459.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$260.56 ,55,,,$260.56 ,$459.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$450.05 ,90,,,$260.56 ,$459.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$260.56 ,55,,,$260.56 ,$459.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.58 ,93,,,$260.56 ,$459.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAM JUNIOR SPLINT,8783063,CDM,270,RC,,HCPCS,outpatient,,,$76.73 ,$57.55 ,,$70.59 ,92,,,$42.20 ,$74.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.20 ,$74.43 ,other,,Not applicable. No negotiated rates per contract,$65.99 ,86,,,$42.20 ,$74.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.38 ,80,,,$42.20 ,$74.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.89 ,95,,,$42.20 ,$74.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.89 ,95,,,$42.20 ,$74.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.55 ,75,,,$42.20 ,$74.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.22 ,85,,,$42.20 ,$74.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.06 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.43 ,97,,,$42.20 ,$74.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.22 ,85,,,$42.20 ,$74.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.06 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.89 ,90,,,$42.20 ,$74.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.20 ,55,,,$42.20 ,$74.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.36 ,93,,,$42.20 ,$74.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAM LARGE PELVIC SLING II,8783062,CDM,270,RC,,HCPCS,outpatient,,,$475.47 ,$356.60 ,,$437.43 ,92,,,$261.51 ,$461.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.51 ,55,,,$261.51 ,$461.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.51 ,$461.21 ,other,,Not applicable. No negotiated rates per contract,$408.90 ,86,,,$261.51 ,$461.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$380.38 ,80,,,$261.51 ,$461.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.51 ,55,,,$261.51 ,$461.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.70 ,95,,,$261.51 ,$461.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$451.70 ,95,,,$261.51 ,$461.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.60 ,75,,,$261.51 ,$461.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$404.15 ,85,,,$261.51 ,$461.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$461.21 ,97,,,$261.51 ,$461.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.51 ,55,,,$261.51 ,$461.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$427.92 ,90,,,$261.51 ,$461.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$461.21 ,97,,,$261.51 ,$461.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.21 ,97,,,$261.51 ,$461.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$461.21 ,97,,,$261.51 ,$461.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$404.15 ,85,,,$261.51 ,$461.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$427.92 ,90,,,$261.51 ,$461.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.51 ,55,,,$261.51 ,$461.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.70 ,90,,,$261.51 ,$461.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.51 ,55,,,$261.51 ,$461.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$442.19 ,93,,,$261.51 ,$461.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAM SPLINT,8783057,CDM,270,RC,,HCPCS,outpatient,,,$79.75 ,$59.81 ,,$73.37 ,92,,,$43.86 ,$77.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$43.86 ,55,,,$43.86 ,$77.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$43.86 ,$77.36 ,other,,Not applicable. No negotiated rates per contract,$68.59 ,86,,,$43.86 ,$77.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$63.80 ,80,,,$43.86 ,$77.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$43.86 ,55,,,$43.86 ,$77.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.76 ,95,,,$43.86 ,$77.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.76 ,95,,,$43.86 ,$77.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$59.81 ,75,,,$43.86 ,$77.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$67.79 ,85,,,$43.86 ,$77.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.36 ,97,,,$43.86 ,$77.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.86 ,55,,,$43.86 ,$77.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.78 ,90,,,$43.86 ,$77.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.36 ,97,,,$43.86 ,$77.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.36 ,97,,,$43.86 ,$77.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.36 ,97,,,$43.86 ,$77.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.79 ,85,,,$43.86 ,$77.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.78 ,90,,,$43.86 ,$77.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.86 ,55,,,$43.86 ,$77.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.76 ,90,,,$43.86 ,$77.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.86 ,55,,,$43.86 ,$77.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.17 ,93,,,$43.86 ,$77.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SAM SPLINT,8783058,CDM,270,RC,,HCPCS,outpatient,,,$76.64 ,$57.48 ,,$70.51 ,92,,,$42.15 ,$74.34 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.15 ,55,,,$42.15 ,$74.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.15 ,$74.34 ,other,,Not applicable. No negotiated rates per contract,$65.91 ,86,,,$42.15 ,$74.34 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.31 ,80,,,$42.15 ,$74.34 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.15 ,55,,,$42.15 ,$74.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.81 ,95,,,$42.15 ,$74.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.81 ,95,,,$42.15 ,$74.34 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.48 ,75,,,$42.15 ,$74.34 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.14 ,85,,,$42.15 ,$74.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.34 ,97,,,$42.15 ,$74.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.15 ,55,,,$42.15 ,$74.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.98 ,90,,,$42.15 ,$74.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.34 ,97,,,$42.15 ,$74.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.34 ,97,,,$42.15 ,$74.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.34 ,97,,,$42.15 ,$74.34 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.14 ,85,,,$42.15 ,$74.34 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.98 ,90,,,$42.15 ,$74.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.15 ,55,,,$42.15 ,$74.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.81 ,90,,,$42.15 ,$74.34 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.15 ,55,,,$42.15 ,$74.34 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.28 ,93,,,$42.15 ,$74.34 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SANI-CLOTH PLUS WIPES LA,8785176,CDM,270,RC,,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARA 3000 LARGE DELUXE C,8782082,CDM,270,RC,,HCPCS,outpatient,,,$991.74 ,$743.81 ,,$912.40 ,92,,,$545.46 ,$961.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$545.46 ,$961.99 ,other,,Not applicable. No negotiated rates per contract,$852.90 ,86,,,$545.46 ,$961.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$793.39 ,80,,,$545.46 ,$961.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$743.81 ,75,,,$545.46 ,$961.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$922.32 ,93,,,$545.46 ,$961.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARA 3000 SMALL DELUXE C,8782081,CDM,270,RC,,HCPCS,outpatient,,,$991.74 ,$743.81 ,,$912.40 ,92,,,$545.46 ,$961.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$545.46 ,$961.99 ,other,,Not applicable. No negotiated rates per contract,$852.90 ,86,,,$545.46 ,$961.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$793.39 ,80,,,$545.46 ,$961.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$743.81 ,75,,,$545.46 ,$961.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$922.32 ,93,,,$545.46 ,$961.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SARA 3000 XTRA LARGE DEL,8782083,CDM,270,RC,,HCPCS,outpatient,,,$991.74 ,$743.81 ,,$912.40 ,92,,,$545.46 ,$961.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$545.46 ,$961.99 ,other,,Not applicable. No negotiated rates per contract,$852.90 ,86,,,$545.46 ,$961.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$793.39 ,80,,,$545.46 ,$961.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$942.15 ,95,,,$545.46 ,$961.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$743.81 ,75,,,$545.46 ,$961.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$961.99 ,97,,,$545.46 ,$961.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$842.98 ,85,,,$545.46 ,$961.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$892.57 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$942.15 ,90,,,$545.46 ,$961.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$545.46 ,55,,,$545.46 ,$961.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$922.32 ,93,,,$545.46 ,$961.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCALPEL #10 SAFETY,8785758,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCALPEL #11 SAFETY,8785759,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCALPEL #15 SAFETY (D4515),8785760,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCALPEL SURGICAL RETRACT,8785308,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCD COMPRESSION FOOT CUFF,8781930,CDM,270,RC,,HCPCS,outpatient,,,$232.80 ,$174.60 ,,$214.18 ,92,,,$128.04 ,$225.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.04 ,55,,,$128.04 ,$225.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.04 ,$225.82 ,other,,Not applicable. No negotiated rates per contract,$200.21 ,86,,,$128.04 ,$225.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.24 ,80,,,$128.04 ,$225.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.04 ,55,,,$128.04 ,$225.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.16 ,95,,,$128.04 ,$225.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.16 ,95,,,$128.04 ,$225.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.60 ,75,,,$128.04 ,$225.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.88 ,85,,,$128.04 ,$225.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.82 ,97,,,$128.04 ,$225.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.04 ,55,,,$128.04 ,$225.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.52 ,90,,,$128.04 ,$225.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.82 ,97,,,$128.04 ,$225.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.82 ,97,,,$128.04 ,$225.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.82 ,97,,,$128.04 ,$225.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.88 ,85,,,$128.04 ,$225.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.52 ,90,,,$128.04 ,$225.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,55,,,$128.04 ,$225.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.16 ,90,,,$128.04 ,$225.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.04 ,55,,,$128.04 ,$225.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.50 ,93,,,$128.04 ,$225.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCD COMPRESSION KNEE LEN,8782917,CDM,270,RC,,HCPCS,outpatient,,,$132.60 ,$99.45 ,,$121.99 ,92,,,$72.93 ,$128.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$72.93 ,55,,,$72.93 ,$128.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$72.93 ,$128.62 ,other,,Not applicable. No negotiated rates per contract,$114.04 ,86,,,$72.93 ,$128.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$106.08 ,80,,,$72.93 ,$128.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$72.93 ,55,,,$72.93 ,$128.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.97 ,95,,,$72.93 ,$128.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$125.97 ,95,,,$72.93 ,$128.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.45 ,75,,,$72.93 ,$128.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$112.71 ,85,,,$72.93 ,$128.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$128.62 ,97,,,$72.93 ,$128.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.93 ,55,,,$72.93 ,$128.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.34 ,90,,,$72.93 ,$128.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.62 ,97,,,$72.93 ,$128.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.62 ,97,,,$72.93 ,$128.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.62 ,97,,,$72.93 ,$128.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.71 ,85,,,$72.93 ,$128.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.34 ,90,,,$72.93 ,$128.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.93 ,55,,,$72.93 ,$128.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$125.97 ,90,,,$72.93 ,$128.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.93 ,55,,,$72.93 ,$128.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.32 ,93,,,$72.93 ,$128.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCD COMPRESSION TUBING S,8782913,CDM,270,RC,,HCPCS,outpatient,,,$371.93 ,$278.95 ,,$342.18 ,92,,,$204.56 ,$360.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.56 ,55,,,$204.56 ,$360.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.56 ,$360.77 ,other,,Not applicable. No negotiated rates per contract,$319.86 ,86,,,$204.56 ,$360.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$297.54 ,80,,,$204.56 ,$360.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.56 ,55,,,$204.56 ,$360.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.33 ,95,,,$204.56 ,$360.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$353.33 ,95,,,$204.56 ,$360.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.95 ,75,,,$204.56 ,$360.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$316.14 ,85,,,$204.56 ,$360.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$360.77 ,97,,,$204.56 ,$360.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.56 ,55,,,$204.56 ,$360.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$334.74 ,90,,,$204.56 ,$360.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.77 ,97,,,$204.56 ,$360.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.77 ,97,,,$204.56 ,$360.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.77 ,97,,,$204.56 ,$360.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.14 ,85,,,$204.56 ,$360.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$334.74 ,90,,,$204.56 ,$360.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.56 ,55,,,$204.56 ,$360.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$353.33 ,90,,,$204.56 ,$360.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.56 ,55,,,$204.56 ,$360.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.89 ,93,,,$204.56 ,$360.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCENTED ANESTHESIA MASK,8786515,CDM,270,RC,,HCPCS,outpatient,,,$151.13 ,$113.35 ,,$139.04 ,92,,,$83.12 ,$146.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.12 ,$146.60 ,other,,Not applicable. No negotiated rates per contract,$129.97 ,86,,,$83.12 ,$146.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.90 ,80,,,$83.12 ,$146.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.57 ,95,,,$83.12 ,$146.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.57 ,95,,,$83.12 ,$146.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.35 ,75,,,$83.12 ,$146.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.46 ,85,,,$83.12 ,$146.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.02 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.46 ,85,,,$83.12 ,$146.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.02 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.57 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.55 ,93,,,$83.12 ,$146.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCENTED ANESTHIA MASK SP,8786514,CDM,270,RC,,HCPCS,outpatient,,,$151.13 ,$113.35 ,,$139.04 ,92,,,$83.12 ,$146.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.12 ,$146.60 ,other,,Not applicable. No negotiated rates per contract,$129.97 ,86,,,$83.12 ,$146.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.90 ,80,,,$83.12 ,$146.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.57 ,95,,,$83.12 ,$146.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.57 ,95,,,$83.12 ,$146.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.35 ,75,,,$83.12 ,$146.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.46 ,85,,,$83.12 ,$146.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.02 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.60 ,97,,,$83.12 ,$146.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.46 ,85,,,$83.12 ,$146.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.02 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.57 ,90,,,$83.12 ,$146.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.12 ,55,,,$83.12 ,$146.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.55 ,93,,,$83.12 ,$146.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCHNIDT ARTERY FORCEPS C,8783644,CDM,270,RC,,HCPCS,outpatient,,,$114.39 ,$85.79 ,,$105.24 ,92,,,$62.91 ,$110.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$62.91 ,55,,,$62.91 ,$110.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$62.91 ,$110.96 ,other,,Not applicable. No negotiated rates per contract,$98.38 ,86,,,$62.91 ,$110.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$91.51 ,80,,,$62.91 ,$110.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$62.91 ,55,,,$62.91 ,$110.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.67 ,95,,,$62.91 ,$110.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.67 ,95,,,$62.91 ,$110.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$85.79 ,75,,,$62.91 ,$110.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.23 ,85,,,$62.91 ,$110.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$110.96 ,97,,,$62.91 ,$110.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.91 ,55,,,$62.91 ,$110.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.95 ,90,,,$62.91 ,$110.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$110.96 ,97,,,$62.91 ,$110.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.96 ,97,,,$62.91 ,$110.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$110.96 ,97,,,$62.91 ,$110.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.23 ,85,,,$62.91 ,$110.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.95 ,90,,,$62.91 ,$110.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.91 ,55,,,$62.91 ,$110.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.67 ,90,,,$62.91 ,$110.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.91 ,55,,,$62.91 ,$110.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.38 ,93,,,$62.91 ,$110.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 2.4 MM HEADLSS COMPRESSION -SHORT THREAD 23MM,8786860,CDM,270,RC,,HCPCS,outpatient,,,"$1,398.25 ","$1,048.69 ",,"$1,286.39 ",92,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$769.04 ,"$1,356.30 ",other,,Not applicable. No negotiated rates per contract,"$1,202.50 ",86,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,118.60 ",80,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,328.34 ",95,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,328.34 ",95,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,048.69 ",75,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,188.51 ",85,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,258.43 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,188.51 ",85,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,258.43 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,328.34 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,300.37 ",93,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 2.4 MM HEADLSS COMPRESSION -SHORT THREAD 28MM,8786861,CDM,270,RC,,HCPCS,outpatient,,,"$1,398.25 ","$1,048.69 ",,"$1,286.39 ",92,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$769.04 ,"$1,356.30 ",other,,Not applicable. No negotiated rates per contract,"$1,202.50 ",86,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,118.60 ",80,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,328.34 ",95,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,328.34 ",95,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,048.69 ",75,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,188.51 ",85,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,258.43 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,356.30 ",97,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,188.51 ",85,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,258.43 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,328.34 ",90,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$769.04 ,55,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,300.37 ",93,,,$769.04 ,"$1,356.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 2.7MM  CORTEX SLF-TPNG T8 STARDRIVE RECESS 12MM,8786867,CDM,270,RC,,HCPCS,outpatient,,,$268.98 ,$201.74 ,,$247.46 ,92,,,$147.94 ,$260.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$147.94 ,$260.91 ,other,,Not applicable. No negotiated rates per contract,$231.32 ,86,,,$147.94 ,$260.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$215.18 ,80,,,$147.94 ,$260.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.53 ,95,,,$147.94 ,$260.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.53 ,95,,,$147.94 ,$260.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.74 ,75,,,$147.94 ,$260.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$228.63 ,85,,,$147.94 ,$260.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.08 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.63 ,85,,,$147.94 ,$260.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$242.08 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.53 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.15 ,93,,,$147.94 ,$260.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 2.7MM  CORTEX SLF-TPNG T8 STARDRIVE RECESS 14MM,8786868,CDM,270,RC,,HCPCS,outpatient,,,$268.98 ,$201.74 ,,$247.46 ,92,,,$147.94 ,$260.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$147.94 ,$260.91 ,other,,Not applicable. No negotiated rates per contract,$231.32 ,86,,,$147.94 ,$260.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$215.18 ,80,,,$147.94 ,$260.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.53 ,95,,,$147.94 ,$260.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$255.53 ,95,,,$147.94 ,$260.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$201.74 ,75,,,$147.94 ,$260.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$228.63 ,85,,,$147.94 ,$260.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.08 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$260.91 ,97,,,$147.94 ,$260.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.63 ,85,,,$147.94 ,$260.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$242.08 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.53 ,90,,,$147.94 ,$260.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.94 ,55,,,$147.94 ,$260.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$250.15 ,93,,,$147.94 ,$260.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 4.5MM CORTEX SELF,8786859,CDM,270,RC,,HCPCS,outpatient,,,$232.00 ,$174.00 ,,$213.44 ,92,,,$127.60 ,$225.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.60 ,$225.04 ,other,,Not applicable. No negotiated rates per contract,$199.52 ,86,,,$127.60 ,$225.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$185.60 ,80,,,$127.60 ,$225.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.00 ,75,,,$127.60 ,$225.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.76 ,93,,,$127.60 ,$225.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW 4.5MM CORTEX SELF-,8786858,CDM,270,RC,,HCPCS,outpatient,,,$232.00 ,$174.00 ,,$213.44 ,92,,,$127.60 ,$225.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.60 ,$225.04 ,other,,Not applicable. No negotiated rates per contract,$199.52 ,86,,,$127.60 ,$225.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$185.60 ,80,,,$127.60 ,$225.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.40 ,95,,,$127.60 ,$225.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.00 ,75,,,$127.60 ,$225.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.04 ,97,,,$127.60 ,$225.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.20 ,85,,,$127.60 ,$225.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.80 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.40 ,90,,,$127.60 ,$225.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.60 ,55,,,$127.60 ,$225.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.76 ,93,,,$127.60 ,$225.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW VA LOCKING STARDRIVE 18MM (2.4MM),8786869,CDM,270,RC,,HCPCS,outpatient,,,$687.23 ,$515.42 ,,$632.25 ,92,,,$377.98 ,$666.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$377.98 ,$666.61 ,other,,Not applicable. No negotiated rates per contract,$591.02 ,86,,,$377.98 ,$666.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$549.78 ,80,,,$377.98 ,$666.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.87 ,95,,,$377.98 ,$666.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$652.87 ,95,,,$377.98 ,$666.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.42 ,75,,,$377.98 ,$666.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$584.15 ,85,,,$377.98 ,$666.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.51 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$584.15 ,85,,,$377.98 ,$666.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$618.51 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.87 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$639.12 ,93,,,$377.98 ,$666.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW VA LOCKING STARDRIVE 22MM (2.4MM),8786870,CDM,270,RC,,HCPCS,outpatient,,,$687.23 ,$515.42 ,,$632.25 ,92,,,$377.98 ,$666.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$377.98 ,$666.61 ,other,,Not applicable. No negotiated rates per contract,$591.02 ,86,,,$377.98 ,$666.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$549.78 ,80,,,$377.98 ,$666.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.87 ,95,,,$377.98 ,$666.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$652.87 ,95,,,$377.98 ,$666.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$515.42 ,75,,,$377.98 ,$666.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$584.15 ,85,,,$377.98 ,$666.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$618.51 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.61 ,97,,,$377.98 ,$666.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$584.15 ,85,,,$377.98 ,$666.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$618.51 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$652.87 ,90,,,$377.98 ,$666.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$377.98 ,55,,,$377.98 ,$666.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$639.12 ,93,,,$377.98 ,$666.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW WITH SELF-TAPPING 9MM (1.5MM CORTEX),8786872,CDM,270,RC,,HCPCS,outpatient,,,$232.15 ,$174.11 ,,$213.58 ,92,,,$127.68 ,$225.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$127.68 ,55,,,$127.68 ,$225.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$127.68 ,$225.19 ,other,,Not applicable. No negotiated rates per contract,$199.65 ,86,,,$127.68 ,$225.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$185.72 ,80,,,$127.68 ,$225.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$127.68 ,55,,,$127.68 ,$225.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.54 ,95,,,$127.68 ,$225.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$220.54 ,95,,,$127.68 ,$225.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.11 ,75,,,$127.68 ,$225.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$197.33 ,85,,,$127.68 ,$225.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.19 ,97,,,$127.68 ,$225.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.68 ,55,,,$127.68 ,$225.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.94 ,90,,,$127.68 ,$225.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$225.19 ,97,,,$127.68 ,$225.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.19 ,97,,,$127.68 ,$225.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$225.19 ,97,,,$127.68 ,$225.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.33 ,85,,,$127.68 ,$225.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.94 ,90,,,$127.68 ,$225.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.68 ,55,,,$127.68 ,$225.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$220.54 ,90,,,$127.68 ,$225.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$127.68 ,55,,,$127.68 ,$225.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$215.90 ,93,,,$127.68 ,$225.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784807,CDM,270,RC,,HCPCS,outpatient,,,$563.50 ,$422.63 ,,$518.42 ,92,,,$309.93 ,$546.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$309.93 ,$546.60 ,other,,Not applicable. No negotiated rates per contract,$484.61 ,86,,,$309.93 ,$546.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$450.80 ,80,,,$309.93 ,$546.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.33 ,95,,,$309.93 ,$546.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$535.33 ,95,,,$309.93 ,$546.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$422.63 ,75,,,$309.93 ,$546.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$478.98 ,85,,,$309.93 ,$546.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$507.15 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$546.60 ,97,,,$309.93 ,$546.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$478.98 ,85,,,$309.93 ,$546.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$507.15 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$535.33 ,90,,,$309.93 ,$546.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$309.93 ,55,,,$309.93 ,$546.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$524.06 ,93,,,$309.93 ,$546.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784809,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784817,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784816,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784815,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784812,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784813,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784814,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784821,CDM,270,RC,,HCPCS,outpatient,,,$575.00 ,$431.25 ,,$529.00 ,92,,,$316.25 ,$557.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$316.25 ,55,,,$316.25 ,$557.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$316.25 ,$557.75 ,other,,Not applicable. No negotiated rates per contract,$494.50 ,86,,,$316.25 ,$557.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$460.00 ,80,,,$316.25 ,$557.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$316.25 ,55,,,$316.25 ,$557.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$546.25 ,95,,,$316.25 ,$557.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$546.25 ,95,,,$316.25 ,$557.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$431.25 ,75,,,$316.25 ,$557.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$488.75 ,85,,,$316.25 ,$557.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$557.75 ,97,,,$316.25 ,$557.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$316.25 ,55,,,$316.25 ,$557.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$517.50 ,90,,,$316.25 ,$557.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$557.75 ,97,,,$316.25 ,$557.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.75 ,97,,,$316.25 ,$557.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.75 ,97,,,$316.25 ,$557.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$488.75 ,85,,,$316.25 ,$557.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$517.50 ,90,,,$316.25 ,$557.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.25 ,55,,,$316.25 ,$557.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$546.25 ,90,,,$316.25 ,$557.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$316.25 ,55,,,$316.25 ,$557.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.75 ,93,,,$316.25 ,$557.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784804,CDM,270,RC,,HCPCS,outpatient,,,$656.25 ,$492.19 ,,$603.75 ,92,,,$360.94 ,$636.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$360.94 ,$636.56 ,other,,Not applicable. No negotiated rates per contract,$564.38 ,86,,,$360.94 ,$636.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$525.00 ,80,,,$360.94 ,$636.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$623.44 ,95,,,$360.94 ,$636.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$492.19 ,75,,,$360.94 ,$636.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$636.56 ,97,,,$360.94 ,$636.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$557.81 ,85,,,$360.94 ,$636.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$590.63 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$623.44 ,90,,,$360.94 ,$636.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$360.94 ,55,,,$360.94 ,$636.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$610.31 ,93,,,$360.94 ,$636.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784824,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,8784825,CDM,278,RC,,HCPCS,both,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCREW,9524389,CDM,270,RC,,HCPCS,outpatient,,,$603.75 ,$452.81 ,,$555.45 ,92,,,$332.06 ,$585.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$332.06 ,$585.64 ,other,,Not applicable. No negotiated rates per contract,$519.23 ,86,,,$332.06 ,$585.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$483.00 ,80,,,$332.06 ,$585.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$573.56 ,95,,,$332.06 ,$585.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$452.81 ,75,,,$332.06 ,$585.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$585.64 ,97,,,$332.06 ,$585.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.19 ,85,,,$332.06 ,$585.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$543.38 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$573.56 ,90,,,$332.06 ,$585.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$332.06 ,55,,,$332.06 ,$585.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$561.49 ,93,,,$332.06 ,$585.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SCRUB PANT DICKIES GEN FLEX YOUTILITY MEN'S XLARGE NAVY,8786951,CDM,270,RC,,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SEAL,8783454,CDM,270,RC,,HCPCS,outpatient,,,$68.97 ,$51.73 ,,$63.45 ,92,,,$37.93 ,$66.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.93 ,55,,,$37.93 ,$66.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.93 ,$66.90 ,other,,Not applicable. No negotiated rates per contract,$59.31 ,86,,,$37.93 ,$66.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.18 ,80,,,$37.93 ,$66.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.93 ,55,,,$37.93 ,$66.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.52 ,95,,,$37.93 ,$66.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.52 ,95,,,$37.93 ,$66.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.73 ,75,,,$37.93 ,$66.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.62 ,85,,,$37.93 ,$66.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.90 ,97,,,$37.93 ,$66.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.93 ,55,,,$37.93 ,$66.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.07 ,90,,,$37.93 ,$66.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.90 ,97,,,$37.93 ,$66.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.90 ,97,,,$37.93 ,$66.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.90 ,97,,,$37.93 ,$66.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.62 ,85,,,$37.93 ,$66.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.07 ,90,,,$37.93 ,$66.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.93 ,55,,,$37.93 ,$66.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.52 ,90,,,$37.93 ,$66.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.93 ,55,,,$37.93 ,$66.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.14 ,93,,,$37.93 ,$66.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SECONDARY FIXATION KIT,8942866,CDM,270,RC,,HCPCS,outpatient,,,"$2,844.27 ","$2,133.20 ",,"$2,616.73 ",92,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,564.35 ",55,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,564.35 ","$2,758.94 ",other,,Not applicable. No negotiated rates per contract,"$2,446.07 ",86,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,275.42 ",80,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,564.35 ",55,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,702.06 ",95,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,702.06 ",95,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,133.20 ",75,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,417.63 ",85,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,758.94 ",97,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,564.35 ",55,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,559.84 ",90,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,758.94 ",97,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,758.94 ",97,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,758.94 ",97,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,417.63 ",85,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,559.84 ",90,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,564.35 ",55,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,702.06 ",90,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,564.35 ",55,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,645.17 ",93,,,"$1,564.35 ","$2,758.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SENSOR BIS XP (1860106),8782919,CDM,270,RC,,HCPCS,outpatient,,,$152.99 ,$114.74 ,,$140.75 ,92,,,$84.14 ,$148.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.14 ,55,,,$84.14 ,$148.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.14 ,$148.40 ,other,,Not applicable. No negotiated rates per contract,$131.57 ,86,,,$84.14 ,$148.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$122.39 ,80,,,$84.14 ,$148.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.14 ,55,,,$84.14 ,$148.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.34 ,95,,,$84.14 ,$148.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.34 ,95,,,$84.14 ,$148.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.74 ,75,,,$84.14 ,$148.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.04 ,85,,,$84.14 ,$148.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.40 ,97,,,$84.14 ,$148.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.14 ,55,,,$84.14 ,$148.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.69 ,90,,,$84.14 ,$148.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.40 ,97,,,$84.14 ,$148.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.40 ,97,,,$84.14 ,$148.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.40 ,97,,,$84.14 ,$148.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.04 ,85,,,$84.14 ,$148.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.69 ,90,,,$84.14 ,$148.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.14 ,55,,,$84.14 ,$148.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.34 ,90,,,$84.14 ,$148.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.14 ,55,,,$84.14 ,$148.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.28 ,93,,,$84.14 ,$148.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SENSOR DISPOSIBLE SPO2 ADUL/PEDIATRIC,8786259,CDM,270,RC,,HCPCS,outpatient,,,$97.81 ,$73.36 ,,$89.99 ,92,,,$53.80 ,$94.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.80 ,55,,,$53.80 ,$94.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$53.80 ,$94.88 ,other,,Not applicable. No negotiated rates per contract,$84.12 ,86,,,$53.80 ,$94.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$78.25 ,80,,,$53.80 ,$94.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.80 ,55,,,$53.80 ,$94.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.92 ,95,,,$53.80 ,$94.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$92.92 ,95,,,$53.80 ,$94.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.36 ,75,,,$53.80 ,$94.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$83.14 ,85,,,$53.80 ,$94.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.88 ,97,,,$53.80 ,$94.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.80 ,55,,,$53.80 ,$94.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.03 ,90,,,$53.80 ,$94.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.88 ,97,,,$53.80 ,$94.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.88 ,97,,,$53.80 ,$94.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.88 ,97,,,$53.80 ,$94.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.14 ,85,,,$53.80 ,$94.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.03 ,90,,,$53.80 ,$94.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.80 ,55,,,$53.80 ,$94.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.92 ,90,,,$53.80 ,$94.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.80 ,55,,,$53.80 ,$94.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.96 ,93,,,$53.80 ,$94.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SENSOR REUSABLE CLIP ADULT SPO2 (M1196A),8786252,CDM,270,RC,,HCPCS,outpatient,,,$494.38 ,$370.79 ,,$454.83 ,92,,,$271.91 ,$479.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$271.91 ,55,,,$271.91 ,$479.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$271.91 ,$479.55 ,other,,Not applicable. No negotiated rates per contract,$425.17 ,86,,,$271.91 ,$479.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$395.50 ,80,,,$271.91 ,$479.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$271.91 ,55,,,$271.91 ,$479.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.66 ,95,,,$271.91 ,$479.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$469.66 ,95,,,$271.91 ,$479.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$370.79 ,75,,,$271.91 ,$479.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$420.22 ,85,,,$271.91 ,$479.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$479.55 ,97,,,$271.91 ,$479.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$271.91 ,55,,,$271.91 ,$479.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$444.94 ,90,,,$271.91 ,$479.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.55 ,97,,,$271.91 ,$479.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.55 ,97,,,$271.91 ,$479.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.55 ,97,,,$271.91 ,$479.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$420.22 ,85,,,$271.91 ,$479.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$444.94 ,90,,,$271.91 ,$479.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.91 ,55,,,$271.91 ,$479.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$469.66 ,90,,,$271.91 ,$479.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$271.91 ,55,,,$271.91 ,$479.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$459.77 ,93,,,$271.91 ,$479.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SENSOR,8783074,CDM,270,RC,,HCPCS,outpatient,,,$496.51 ,$372.38 ,,$456.79 ,92,,,$273.08 ,$481.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.08 ,55,,,$273.08 ,$481.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.08 ,$481.61 ,other,,Not applicable. No negotiated rates per contract,$427.00 ,86,,,$273.08 ,$481.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$397.21 ,80,,,$273.08 ,$481.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.08 ,55,,,$273.08 ,$481.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.68 ,95,,,$273.08 ,$481.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$471.68 ,95,,,$273.08 ,$481.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$372.38 ,75,,,$273.08 ,$481.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$422.03 ,85,,,$273.08 ,$481.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.61 ,97,,,$273.08 ,$481.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.08 ,55,,,$273.08 ,$481.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$446.86 ,90,,,$273.08 ,$481.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$481.61 ,97,,,$273.08 ,$481.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.61 ,97,,,$273.08 ,$481.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.61 ,97,,,$273.08 ,$481.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$422.03 ,85,,,$273.08 ,$481.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$446.86 ,90,,,$273.08 ,$481.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.08 ,55,,,$273.08 ,$481.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$471.68 ,90,,,$273.08 ,$481.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.08 ,55,,,$273.08 ,$481.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$461.75 ,93,,,$273.08 ,$481.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SEQUENT DISPOSABLE KIT (,8782888,CDM,270,RC,,HCPCS,outpatient,,,$535.38 ,$401.54 ,,$492.55 ,92,,,$294.46 ,$519.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.46 ,55,,,$294.46 ,$519.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.46 ,$519.32 ,other,,Not applicable. No negotiated rates per contract,$460.43 ,86,,,$294.46 ,$519.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.30 ,80,,,$294.46 ,$519.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.46 ,55,,,$294.46 ,$519.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.61 ,95,,,$294.46 ,$519.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$508.61 ,95,,,$294.46 ,$519.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$401.54 ,75,,,$294.46 ,$519.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.07 ,85,,,$294.46 ,$519.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.32 ,97,,,$294.46 ,$519.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.46 ,55,,,$294.46 ,$519.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.84 ,90,,,$294.46 ,$519.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.32 ,97,,,$294.46 ,$519.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.32 ,97,,,$294.46 ,$519.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.32 ,97,,,$294.46 ,$519.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.07 ,85,,,$294.46 ,$519.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.84 ,90,,,$294.46 ,$519.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.46 ,55,,,$294.46 ,$519.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.61 ,90,,,$294.46 ,$519.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.46 ,55,,,$294.46 ,$519.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$497.90 ,93,,,$294.46 ,$519.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SEQUENT MENISCAL REPAIR,8782887,CDM,270,RC,,HCPCS,outpatient,,,"$3,063.27 ","$2,297.45 ",,"$2,818.21 ",92,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,684.80 ",55,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,684.80 ","$2,971.37 ",other,,Not applicable. No negotiated rates per contract,"$2,634.41 ",86,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,450.62 ",80,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,684.80 ",55,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,910.11 ",95,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,910.11 ",95,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,297.45 ",75,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,603.78 ",85,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,971.37 ",97,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,684.80 ",55,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,756.94 ",90,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,971.37 ",97,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,971.37 ",97,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,971.37 ",97,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,603.78 ",85,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,756.94 ",90,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,684.80 ",55,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,910.11 ",90,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,684.80 ",55,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,848.84 ",93,,,"$1,684.80 ","$2,971.37 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SERVICE HOURS FOR THE CT,8786248,CDM,270,RC,,HCPCS,outpatient,,,"$1,135.00 ",$851.25 ,,"$1,044.20 ",92,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$624.25 ,55,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$624.25 ,"$1,100.95 ",other,,Not applicable. No negotiated rates per contract,$976.10 ,86,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$908.00 ,80,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$624.25 ,55,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,078.25 ",95,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,078.25 ",95,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$851.25 ,75,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$964.75 ,85,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,100.95 ",97,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$624.25 ,55,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,021.50 ",90,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,100.95 ",97,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,100.95 ",97,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,100.95 ",97,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$964.75 ,85,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,021.50 ",90,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$624.25 ,55,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,078.25 ",90,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$624.25 ,55,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,055.55 ",93,,,$624.25 ,"$1,100.95 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SET BLOOD/FLUID WARMING SET 3M,8785341,CDM,270,RC,,HCPCS,outpatient,,,$105.63 ,$79.22 ,,$97.18 ,92,,,$58.10 ,$102.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$58.10 ,55,,,$58.10 ,$102.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$58.10 ,$102.46 ,other,,Not applicable. No negotiated rates per contract,$90.84 ,86,,,$58.10 ,$102.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$84.50 ,80,,,$58.10 ,$102.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$58.10 ,55,,,$58.10 ,$102.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.35 ,95,,,$58.10 ,$102.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$100.35 ,95,,,$58.10 ,$102.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$79.22 ,75,,,$58.10 ,$102.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.79 ,85,,,$58.10 ,$102.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$102.46 ,97,,,$58.10 ,$102.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.10 ,55,,,$58.10 ,$102.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.07 ,90,,,$58.10 ,$102.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.46 ,97,,,$58.10 ,$102.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.46 ,97,,,$58.10 ,$102.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.46 ,97,,,$58.10 ,$102.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.79 ,85,,,$58.10 ,$102.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.07 ,90,,,$58.10 ,$102.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.10 ,55,,,$58.10 ,$102.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.35 ,90,,,$58.10 ,$102.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.10 ,55,,,$58.10 ,$102.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.24 ,93,,,$58.10 ,$102.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SET TUBING TRUMPET VALVE NEZHAT DORSET  SMOKEVAC SERIES 4,10194830,CDM,270,RC,,HCPCS,outpatient,,,$280.58 ,$210.44 ,,$258.13 ,92,,,$154.32 ,$272.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$154.32 ,55,,,$154.32 ,$272.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$154.32 ,$272.16 ,other,,Not applicable. No negotiated rates per contract,$241.30 ,86,,,$154.32 ,$272.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$224.46 ,80,,,$154.32 ,$272.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$154.32 ,55,,,$154.32 ,$272.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.55 ,95,,,$154.32 ,$272.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$266.55 ,95,,,$154.32 ,$272.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$210.44 ,75,,,$154.32 ,$272.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$238.49 ,85,,,$154.32 ,$272.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$272.16 ,97,,,$154.32 ,$272.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$154.32 ,55,,,$154.32 ,$272.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.52 ,90,,,$154.32 ,$272.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$272.16 ,97,,,$154.32 ,$272.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.16 ,97,,,$154.32 ,$272.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$272.16 ,97,,,$154.32 ,$272.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$238.49 ,85,,,$154.32 ,$272.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.52 ,90,,,$154.32 ,$272.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.32 ,55,,,$154.32 ,$272.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$266.55 ,90,,,$154.32 ,$272.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$154.32 ,55,,,$154.32 ,$272.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.94 ,93,,,$154.32 ,$272.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHELF BIN,8783539,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHILEY,8782914,CDM,270,RC,,HCPCS,outpatient,,,$288.19 ,$216.14 ,,$265.13 ,92,,,$158.50 ,$279.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$158.50 ,55,,,$158.50 ,$279.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$158.50 ,$279.54 ,other,,Not applicable. No negotiated rates per contract,$247.84 ,86,,,$158.50 ,$279.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$230.55 ,80,,,$158.50 ,$279.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$158.50 ,55,,,$158.50 ,$279.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$273.78 ,95,,,$158.50 ,$279.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$273.78 ,95,,,$158.50 ,$279.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$216.14 ,75,,,$158.50 ,$279.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$244.96 ,85,,,$158.50 ,$279.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$279.54 ,97,,,$158.50 ,$279.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.50 ,55,,,$158.50 ,$279.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$259.37 ,90,,,$158.50 ,$279.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$279.54 ,97,,,$158.50 ,$279.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.54 ,97,,,$158.50 ,$279.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$279.54 ,97,,,$158.50 ,$279.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.96 ,85,,,$158.50 ,$279.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$259.37 ,90,,,$158.50 ,$279.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.50 ,55,,,$158.50 ,$279.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$273.78 ,90,,,$158.50 ,$279.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$158.50 ,55,,,$158.50 ,$279.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.02 ,93,,,$158.50 ,$279.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHOULDER CANNULA SET(UNI,8782878,CDM,270,RC,,HCPCS,outpatient,,,$119.74 ,$89.81 ,,$110.16 ,92,,,$65.86 ,$116.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.86 ,55,,,$65.86 ,$116.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.86 ,$116.15 ,other,,Not applicable. No negotiated rates per contract,$102.98 ,86,,,$65.86 ,$116.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.79 ,80,,,$65.86 ,$116.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.86 ,55,,,$65.86 ,$116.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.75 ,95,,,$65.86 ,$116.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.75 ,95,,,$65.86 ,$116.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.81 ,75,,,$65.86 ,$116.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.78 ,85,,,$65.86 ,$116.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.15 ,97,,,$65.86 ,$116.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.86 ,55,,,$65.86 ,$116.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.77 ,90,,,$65.86 ,$116.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.15 ,97,,,$65.86 ,$116.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.15 ,97,,,$65.86 ,$116.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.15 ,97,,,$65.86 ,$116.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.78 ,85,,,$65.86 ,$116.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.77 ,90,,,$65.86 ,$116.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.86 ,55,,,$65.86 ,$116.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.75 ,90,,,$65.86 ,$116.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.86 ,55,,,$65.86 ,$116.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.36 ,93,,,$65.86 ,$116.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHOULDER IMMOBILIZER ELASTIC XLG (9008-04),8785064,CDM,270,RC,,HCPCS,outpatient,,,$87.50 ,$65.63 ,,$80.50 ,92,,,$48.13 ,$84.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.13 ,55,,,$48.13 ,$84.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.13 ,$84.88 ,other,,Not applicable. No negotiated rates per contract,$75.25 ,86,,,$48.13 ,$84.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$70.00 ,80,,,$48.13 ,$84.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.13 ,55,,,$48.13 ,$84.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.13 ,95,,,$48.13 ,$84.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.13 ,95,,,$48.13 ,$84.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.63 ,75,,,$48.13 ,$84.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$74.38 ,85,,,$48.13 ,$84.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.88 ,97,,,$48.13 ,$84.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.13 ,55,,,$48.13 ,$84.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.75 ,90,,,$48.13 ,$84.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.88 ,97,,,$48.13 ,$84.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.88 ,97,,,$48.13 ,$84.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.88 ,97,,,$48.13 ,$84.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.38 ,85,,,$48.13 ,$84.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.75 ,90,,,$48.13 ,$84.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.13 ,55,,,$48.13 ,$84.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.13 ,90,,,$48.13 ,$84.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.13 ,55,,,$48.13 ,$84.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.38 ,93,,,$48.13 ,$84.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHOULDER IMMOBILIZER,8971145,CDM,270,RC,L3670,HCPCS,outpatient,,,$85.00 ,$63.75 ,,$78.20 ,92,,,$46.75 ,$82.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$46.75 ,$82.45 ,other,,Not applicable. No negotiated rates per contract,$73.10 ,86,,,$46.75 ,$82.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$68.00 ,80,,,$46.75 ,$82.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$80.75 ,95,,,$46.75 ,$82.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.75 ,75,,,$46.75 ,$82.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.45 ,97,,,$46.75 ,$82.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.25 ,85,,,$46.75 ,$82.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$76.50 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.75 ,90,,,$46.75 ,$82.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.75 ,55,,,$46.75 ,$82.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.05 ,93,,,$46.75 ,$82.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SIEMENS,8786573,CDM,270,RC,,HCPCS,outpatient,,,$312.00 ,$234.00 ,,$287.04 ,92,,,$171.60 ,$302.64 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$171.60 ,$302.64 ,other,,Not applicable. No negotiated rates per contract,$268.32 ,86,,,$171.60 ,$302.64 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$249.60 ,80,,,$171.60 ,$302.64 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$296.40 ,95,,,$171.60 ,$302.64 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$234.00 ,75,,,$171.60 ,$302.64 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$302.64 ,97,,,$171.60 ,$302.64 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.20 ,85,,,$171.60 ,$302.64 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$280.80 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$296.40 ,90,,,$171.60 ,$302.64 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.60 ,55,,,$171.60 ,$302.64 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$290.16 ,93,,,$171.60 ,$302.64 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SIEMENS/ HM WASH PROBE (,8786574,CDM,270,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SIGNATURE STAMP R J FILL,8786386,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SIMPLEX HV US  BONE CEMENT ( 10 PACK),9683337,CDM,272,RC,,HCPCS,outpatient,,,$418.75 ,$314.06 ,,$385.25 ,92,,,$230.31 ,$406.19 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$230.31 ,55,,,$230.31 ,$406.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$230.31 ,$406.19 ,other,,Not applicable. No negotiated rates per contract,$360.13 ,86,,,$230.31 ,$406.19 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$335.00 ,80,,,$230.31 ,$406.19 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$230.31 ,55,,,$230.31 ,$406.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$397.81 ,95,,,$230.31 ,$406.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$397.81 ,95,,,$230.31 ,$406.19 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.06 ,75,,,$230.31 ,$406.19 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$355.94 ,85,,,$230.31 ,$406.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$406.19 ,97,,,$230.31 ,$406.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.31 ,55,,,$230.31 ,$406.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.88 ,90,,,$230.31 ,$406.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.19 ,97,,,$230.31 ,$406.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.19 ,97,,,$230.31 ,$406.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.19 ,97,,,$230.31 ,$406.19 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$355.94 ,85,,,$230.31 ,$406.19 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$376.88 ,90,,,$230.31 ,$406.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.31 ,55,,,$230.31 ,$406.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$397.81 ,90,,,$230.31 ,$406.19 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.31 ,55,,,$230.31 ,$406.19 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.44 ,93,,,$230.31 ,$406.19 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SIMPLEX P FULL DOSE CEMENT,9132869,CDM,270,RC,,HCPCS,outpatient,,,$419.19 ,$314.39 ,,$385.65 ,92,,,$230.55 ,$406.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$230.55 ,55,,,$230.55 ,$406.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$230.55 ,$406.61 ,other,,Not applicable. No negotiated rates per contract,$360.50 ,86,,,$230.55 ,$406.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$335.35 ,80,,,$230.55 ,$406.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$230.55 ,55,,,$230.55 ,$406.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.23 ,95,,,$230.55 ,$406.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$398.23 ,95,,,$230.55 ,$406.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.39 ,75,,,$230.55 ,$406.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$356.31 ,85,,,$230.55 ,$406.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$406.61 ,97,,,$230.55 ,$406.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.55 ,55,,,$230.55 ,$406.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.27 ,90,,,$230.55 ,$406.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.61 ,97,,,$230.55 ,$406.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.61 ,97,,,$230.55 ,$406.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.61 ,97,,,$230.55 ,$406.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$356.31 ,85,,,$230.55 ,$406.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$377.27 ,90,,,$230.55 ,$406.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.55 ,55,,,$230.55 ,$406.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.23 ,90,,,$230.55 ,$406.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.55 ,55,,,$230.55 ,$406.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.85 ,93,,,$230.55 ,$406.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SKIN BARRIER SEAL EAKIN,8785502,CDM,270,RC,,HCPCS,outpatient,,,$40.08 ,$30.06 ,,$36.87 ,92,,,$22.04 ,$38.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.04 ,55,,,$22.04 ,$38.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.04 ,$38.88 ,other,,Not applicable. No negotiated rates per contract,$34.47 ,86,,,$22.04 ,$38.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.06 ,80,,,$22.04 ,$38.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.04 ,55,,,$22.04 ,$38.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.08 ,95,,,$22.04 ,$38.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.08 ,95,,,$22.04 ,$38.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.06 ,75,,,$22.04 ,$38.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.07 ,85,,,$22.04 ,$38.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.88 ,97,,,$22.04 ,$38.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.04 ,55,,,$22.04 ,$38.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.07 ,90,,,$22.04 ,$38.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.88 ,97,,,$22.04 ,$38.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.88 ,97,,,$22.04 ,$38.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.88 ,97,,,$22.04 ,$38.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.07 ,85,,,$22.04 ,$38.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.07 ,90,,,$22.04 ,$38.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.04 ,55,,,$22.04 ,$38.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.08 ,90,,,$22.04 ,$38.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.04 ,55,,,$22.04 ,$38.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.27 ,93,,,$22.04 ,$38.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SKIN GRAFT 4 X5,8783725,CDM,278,RC,,HCPCS,both,,,"$20,342.50 ","$15,256.88 ",,"$18,715.10 ",92,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$11,188.38 ",55,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$11,188.38 ","$19,732.23 ",other,,Not applicable. No negotiated rates per contract,"$17,494.55 ",86,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$16,274.00 ",80,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$11,188.38 ",55,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$19,325.38 ",95,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$19,325.38 ",95,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$15,256.88 ",75,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$17,291.13 ",85,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$19,732.23 ",97,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,188.38 ",55,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$18,308.25 ",90,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$19,732.23 ",97,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$19,732.23 ",97,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$19,732.23 ",97,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$17,291.13 ",85,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$18,308.25 ",90,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$11,188.38 ",55,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$19,325.38 ",90,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$11,188.38 ",55,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$18,918.53 ",93,,,"$11,188.38 ","$19,732.23 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SKIN STAPLE REMOVER KITS,8785362,CDM,270,RC,,HCPCS,outpatient,,,$25.73 ,$19.30 ,,$23.67 ,92,,,$14.15 ,$24.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.15 ,55,,,$14.15 ,$24.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.15 ,$24.96 ,other,,Not applicable. No negotiated rates per contract,$22.13 ,86,,,$14.15 ,$24.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.58 ,80,,,$14.15 ,$24.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.15 ,55,,,$14.15 ,$24.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.44 ,95,,,$14.15 ,$24.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.44 ,95,,,$14.15 ,$24.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.30 ,75,,,$14.15 ,$24.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.87 ,85,,,$14.15 ,$24.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.96 ,97,,,$14.15 ,$24.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.15 ,55,,,$14.15 ,$24.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.16 ,90,,,$14.15 ,$24.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.96 ,97,,,$14.15 ,$24.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.96 ,97,,,$14.15 ,$24.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.96 ,97,,,$14.15 ,$24.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.87 ,85,,,$14.15 ,$24.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.16 ,90,,,$14.15 ,$24.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.15 ,55,,,$14.15 ,$24.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.44 ,90,,,$14.15 ,$24.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.15 ,55,,,$14.15 ,$24.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.93 ,93,,,$14.15 ,$24.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLICONE CLAMP D:5MM,8782049,CDM,270,RC,,HCPCS,outpatient,,,$92.30 ,$69.23 ,,$84.92 ,92,,,$50.77 ,$89.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.77 ,55,,,$50.77 ,$89.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.77 ,$89.53 ,other,,Not applicable. No negotiated rates per contract,$79.38 ,86,,,$50.77 ,$89.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$73.84 ,80,,,$50.77 ,$89.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.77 ,55,,,$50.77 ,$89.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.69 ,95,,,$50.77 ,$89.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.69 ,95,,,$50.77 ,$89.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.23 ,75,,,$50.77 ,$89.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$78.46 ,85,,,$50.77 ,$89.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.53 ,97,,,$50.77 ,$89.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.77 ,55,,,$50.77 ,$89.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.07 ,90,,,$50.77 ,$89.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.53 ,97,,,$50.77 ,$89.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.53 ,97,,,$50.77 ,$89.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.53 ,97,,,$50.77 ,$89.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.46 ,85,,,$50.77 ,$89.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.07 ,90,,,$50.77 ,$89.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.77 ,55,,,$50.77 ,$89.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.69 ,90,,,$50.77 ,$89.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.77 ,55,,,$50.77 ,$89.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.84 ,93,,,$50.77 ,$89.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLING ARM DELUXE XLARGE,8785102,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLING LG ARMSLING (79-84027),8785247,CDM,270,RC,,HCPCS,outpatient,,,$26.69 ,$20.02 ,,$24.55 ,92,,,$14.68 ,$25.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.68 ,$25.89 ,other,,Not applicable. No negotiated rates per contract,$22.95 ,86,,,$14.68 ,$25.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.35 ,80,,,$14.68 ,$25.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.36 ,95,,,$14.68 ,$25.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.36 ,95,,,$14.68 ,$25.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.02 ,75,,,$14.68 ,$25.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.69 ,85,,,$14.68 ,$25.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.02 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.89 ,97,,,$14.68 ,$25.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.69 ,85,,,$14.68 ,$25.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.02 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.36 ,90,,,$14.68 ,$25.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.68 ,55,,,$14.68 ,$25.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.82 ,93,,,$14.68 ,$25.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLING LIMB RESTRAINT,8785123,CDM,270,RC,,HCPCS,outpatient,,,$42.35 ,$31.76 ,,$38.96 ,92,,,$23.29 ,$41.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.29 ,$41.08 ,other,,Not applicable. No negotiated rates per contract,$36.42 ,86,,,$23.29 ,$41.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.88 ,80,,,$23.29 ,$41.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.23 ,95,,,$23.29 ,$41.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.23 ,95,,,$23.29 ,$41.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.76 ,75,,,$23.29 ,$41.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.00 ,85,,,$23.29 ,$41.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.12 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.00 ,85,,,$23.29 ,$41.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.12 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.23 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.39 ,93,,,$23.29 ,$41.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLING MED ARMSLING (79-84025),8785246,CDM,270,RC,,HCPCS,outpatient,,,$25.11 ,$18.83 ,,$23.10 ,92,,,$13.81 ,$24.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.81 ,55,,,$13.81 ,$24.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.81 ,$24.36 ,other,,Not applicable. No negotiated rates per contract,$21.59 ,86,,,$13.81 ,$24.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.09 ,80,,,$13.81 ,$24.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.81 ,55,,,$13.81 ,$24.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,95,,,$13.81 ,$24.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.85 ,95,,,$13.81 ,$24.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.83 ,75,,,$13.81 ,$24.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.34 ,85,,,$13.81 ,$24.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.36 ,97,,,$13.81 ,$24.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.81 ,55,,,$13.81 ,$24.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.60 ,90,,,$13.81 ,$24.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.36 ,97,,,$13.81 ,$24.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.36 ,97,,,$13.81 ,$24.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.36 ,97,,,$13.81 ,$24.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.34 ,85,,,$13.81 ,$24.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.60 ,90,,,$13.81 ,$24.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.81 ,55,,,$13.81 ,$24.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.85 ,90,,,$13.81 ,$24.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.81 ,55,,,$13.81 ,$24.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.35 ,93,,,$13.81 ,$24.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLING SM ARMSLING,8785245,CDM,270,RC,,HCPCS,outpatient,,,$28.44 ,$21.33 ,,$26.16 ,92,,,$15.64 ,$27.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.64 ,55,,,$15.64 ,$27.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.64 ,$27.59 ,other,,Not applicable. No negotiated rates per contract,$24.46 ,86,,,$15.64 ,$27.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.75 ,80,,,$15.64 ,$27.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.64 ,55,,,$15.64 ,$27.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.02 ,95,,,$15.64 ,$27.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.02 ,95,,,$15.64 ,$27.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.33 ,75,,,$15.64 ,$27.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.17 ,85,,,$15.64 ,$27.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.59 ,97,,,$15.64 ,$27.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.64 ,55,,,$15.64 ,$27.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.60 ,90,,,$15.64 ,$27.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.59 ,97,,,$15.64 ,$27.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.59 ,97,,,$15.64 ,$27.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.59 ,97,,,$15.64 ,$27.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.17 ,85,,,$15.64 ,$27.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.60 ,90,,,$15.64 ,$27.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.64 ,55,,,$15.64 ,$27.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.02 ,90,,,$15.64 ,$27.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.64 ,55,,,$15.64 ,$27.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.45 ,93,,,$15.64 ,$27.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SMALL FEMALE POST OP SHOE (79-90193),8785127,CDM,270,RC,,HCPCS,outpatient,,,$43.64 ,$32.73 ,,$40.15 ,92,,,$24.00 ,$42.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.00 ,55,,,$24.00 ,$42.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.00 ,$42.33 ,other,,Not applicable. No negotiated rates per contract,$37.53 ,86,,,$24.00 ,$42.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.91 ,80,,,$24.00 ,$42.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.00 ,55,,,$24.00 ,$42.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.46 ,95,,,$24.00 ,$42.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.46 ,95,,,$24.00 ,$42.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.73 ,75,,,$24.00 ,$42.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.09 ,85,,,$24.00 ,$42.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.33 ,97,,,$24.00 ,$42.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.00 ,55,,,$24.00 ,$42.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.28 ,90,,,$24.00 ,$42.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.33 ,97,,,$24.00 ,$42.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.33 ,97,,,$24.00 ,$42.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.33 ,97,,,$24.00 ,$42.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.09 ,85,,,$24.00 ,$42.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.28 ,90,,,$24.00 ,$42.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.00 ,55,,,$24.00 ,$42.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.46 ,90,,,$24.00 ,$42.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.00 ,55,,,$24.00 ,$42.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.59 ,93,,,$24.00 ,$42.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SMALL MALE POST OP SHOE (SIZE 7-9),8785124,CDM,270,RC,,HCPCS,outpatient,,,$44.39 ,$33.29 ,,$40.84 ,92,,,$24.41 ,$43.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.41 ,55,,,$24.41 ,$43.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.41 ,$43.06 ,other,,Not applicable. No negotiated rates per contract,$38.18 ,86,,,$24.41 ,$43.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.51 ,80,,,$24.41 ,$43.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.41 ,55,,,$24.41 ,$43.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.17 ,95,,,$24.41 ,$43.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.17 ,95,,,$24.41 ,$43.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.29 ,75,,,$24.41 ,$43.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.73 ,85,,,$24.41 ,$43.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.06 ,97,,,$24.41 ,$43.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.41 ,55,,,$24.41 ,$43.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.95 ,90,,,$24.41 ,$43.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.06 ,97,,,$24.41 ,$43.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.06 ,97,,,$24.41 ,$43.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.06 ,97,,,$24.41 ,$43.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.73 ,85,,,$24.41 ,$43.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.95 ,90,,,$24.41 ,$43.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.41 ,55,,,$24.41 ,$43.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.17 ,90,,,$24.41 ,$43.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.41 ,55,,,$24.41 ,$43.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.28 ,93,,,$24.41 ,$43.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SMART CAPNOLINE PLUS 02 (STRYKER MEDICAL),8786292,CDM,270,RC,,HCPCS,outpatient,,,$100.83 ,$75.62 ,,$92.76 ,92,,,$55.46 ,$97.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$55.46 ,$97.81 ,other,,Not applicable. No negotiated rates per contract,$86.71 ,86,,,$55.46 ,$97.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$80.66 ,80,,,$55.46 ,$97.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.79 ,95,,,$55.46 ,$97.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.79 ,95,,,$55.46 ,$97.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$75.62 ,75,,,$55.46 ,$97.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$85.71 ,85,,,$55.46 ,$97.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.75 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.81 ,97,,,$55.46 ,$97.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.71 ,85,,,$55.46 ,$97.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$90.75 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$95.79 ,90,,,$55.46 ,$97.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.46 ,55,,,$55.46 ,$97.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.77 ,93,,,$55.46 ,$97.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SN FREE TEXT ITEM,8704812,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SOFT TISSUE RECTANGLE KO,8782760,CDM,270,RC,,HCPCS,outpatient,,,"$1,794.99 ","$1,346.24 ",,"$1,651.39 ",92,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$987.24 ,55,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$987.24 ,"$1,741.14 ",other,,Not applicable. No negotiated rates per contract,"$1,543.69 ",86,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,435.99 ",80,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$987.24 ,55,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.24 ",95,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,705.24 ",95,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,346.24 ",75,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,525.74 ",85,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,741.14 ",97,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$987.24 ,55,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,615.49 ",90,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,741.14 ",97,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,741.14 ",97,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,741.14 ",97,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,525.74 ",85,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,615.49 ",90,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$987.24 ,55,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.24 ",90,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$987.24 ,55,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,669.34 ",93,,,$987.24 ,"$1,741.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SOLUTION ANTI-FOG,8781932,CDM,270,RC,,HCPCS,outpatient,,,$67.00 ,$50.25 ,,$61.64 ,92,,,$36.85 ,$64.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$36.85 ,$64.99 ,other,,Not applicable. No negotiated rates per contract,$57.62 ,86,,,$36.85 ,$64.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$53.60 ,80,,,$36.85 ,$64.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$63.65 ,95,,,$36.85 ,$64.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.25 ,75,,,$36.85 ,$64.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.99 ,97,,,$36.85 ,$64.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.95 ,85,,,$36.85 ,$64.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$60.30 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.65 ,90,,,$36.85 ,$64.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.85 ,55,,,$36.85 ,$64.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.31 ,93,,,$36.85 ,$64.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPEAR SURGICAL WECK CELL,8784130,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPECTRUM I I SUTURE HOOK,8782879,CDM,270,RC,,HCPCS,outpatient,,,$452.56 ,$339.42 ,,$416.36 ,92,,,$248.91 ,$438.98 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$248.91 ,55,,,$248.91 ,$438.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$248.91 ,$438.98 ,other,,Not applicable. No negotiated rates per contract,$389.20 ,86,,,$248.91 ,$438.98 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$362.05 ,80,,,$248.91 ,$438.98 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$248.91 ,55,,,$248.91 ,$438.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.93 ,95,,,$248.91 ,$438.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$429.93 ,95,,,$248.91 ,$438.98 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$339.42 ,75,,,$248.91 ,$438.98 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$384.68 ,85,,,$248.91 ,$438.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$438.98 ,97,,,$248.91 ,$438.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.91 ,55,,,$248.91 ,$438.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$407.30 ,90,,,$248.91 ,$438.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$438.98 ,97,,,$248.91 ,$438.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$438.98 ,97,,,$248.91 ,$438.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$438.98 ,97,,,$248.91 ,$438.98 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$384.68 ,85,,,$248.91 ,$438.98 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$407.30 ,90,,,$248.91 ,$438.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.91 ,55,,,$248.91 ,$438.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.93 ,90,,,$248.91 ,$438.98 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.91 ,55,,,$248.91 ,$438.98 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$420.88 ,93,,,$248.91 ,$438.98 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPEEDTRAP GREEN             SPD,8783770,CDM,270,RC,,HCPCS,outpatient,,,$476.96 ,$357.72 ,,$438.80 ,92,,,$262.33 ,$462.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$262.33 ,$462.65 ,other,,Not applicable. No negotiated rates per contract,$410.19 ,86,,,$262.33 ,$462.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$381.57 ,80,,,$262.33 ,$462.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.11 ,95,,,$262.33 ,$462.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$453.11 ,95,,,$262.33 ,$462.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.72 ,75,,,$262.33 ,$462.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$405.42 ,85,,,$262.33 ,$462.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.26 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$405.42 ,85,,,$262.33 ,$462.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$429.26 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.11 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$443.57 ,93,,,$262.33 ,$462.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPEEDTRAP WHITE           SPDTR,8783769,CDM,270,RC,,HCPCS,outpatient,,,$476.96 ,$357.72 ,,$438.80 ,92,,,$262.33 ,$462.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$262.33 ,$462.65 ,other,,Not applicable. No negotiated rates per contract,$410.19 ,86,,,$262.33 ,$462.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$381.57 ,80,,,$262.33 ,$462.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.11 ,95,,,$262.33 ,$462.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$453.11 ,95,,,$262.33 ,$462.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$357.72 ,75,,,$262.33 ,$462.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$405.42 ,85,,,$262.33 ,$462.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.26 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$462.65 ,97,,,$262.33 ,$462.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$405.42 ,85,,,$262.33 ,$462.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$429.26 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$453.11 ,90,,,$262.33 ,$462.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$262.33 ,55,,,$262.33 ,$462.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$443.57 ,93,,,$262.33 ,$462.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA LG RIGHT THUMB SPICA,8785058,CDM,270,RC,,HCPCS,outpatient,,,$192.92 ,$144.69 ,,$177.49 ,92,,,$106.11 ,$187.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.11 ,55,,,$106.11 ,$187.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$106.11 ,$187.13 ,other,,Not applicable. No negotiated rates per contract,$165.91 ,86,,,$106.11 ,$187.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.34 ,80,,,$106.11 ,$187.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.11 ,55,,,$106.11 ,$187.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.27 ,95,,,$106.11 ,$187.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.27 ,95,,,$106.11 ,$187.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.69 ,75,,,$106.11 ,$187.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.98 ,85,,,$106.11 ,$187.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.13 ,97,,,$106.11 ,$187.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.11 ,55,,,$106.11 ,$187.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.63 ,90,,,$106.11 ,$187.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$187.13 ,97,,,$106.11 ,$187.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.13 ,97,,,$106.11 ,$187.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.13 ,97,,,$106.11 ,$187.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.98 ,85,,,$106.11 ,$187.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.63 ,90,,,$106.11 ,$187.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.11 ,55,,,$106.11 ,$187.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.27 ,90,,,$106.11 ,$187.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.11 ,55,,,$106.11 ,$187.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.42 ,93,,,$106.11 ,$187.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA MED LEFT THUMB SPICA (3050),8785052,CDM,270,RC,,HCPCS,outpatient,,,$175.02 ,$131.27 ,,$161.02 ,92,,,$96.26 ,$169.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.26 ,$169.77 ,other,,Not applicable. No negotiated rates per contract,$150.52 ,86,,,$96.26 ,$169.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.02 ,80,,,$96.26 ,$169.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.27 ,95,,,$96.26 ,$169.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.27 ,75,,,$96.26 ,$169.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.77 ,97,,,$96.26 ,$169.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.77 ,85,,,$96.26 ,$169.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.52 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.27 ,90,,,$96.26 ,$169.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.26 ,55,,,$96.26 ,$169.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.77 ,93,,,$96.26 ,$169.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA MED RIGHT THUMB SPICA,8785057,CDM,270,RC,,HCPCS,outpatient,,,$177.70 ,$133.28 ,,$163.48 ,92,,,$97.74 ,$172.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.74 ,55,,,$97.74 ,$172.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.74 ,$172.37 ,other,,Not applicable. No negotiated rates per contract,$152.82 ,86,,,$97.74 ,$172.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.16 ,80,,,$97.74 ,$172.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.74 ,55,,,$97.74 ,$172.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.82 ,95,,,$97.74 ,$172.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.82 ,95,,,$97.74 ,$172.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.28 ,75,,,$97.74 ,$172.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.05 ,85,,,$97.74 ,$172.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.37 ,97,,,$97.74 ,$172.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.74 ,55,,,$97.74 ,$172.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.93 ,90,,,$97.74 ,$172.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.37 ,97,,,$97.74 ,$172.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.37 ,97,,,$97.74 ,$172.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.37 ,97,,,$97.74 ,$172.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.05 ,85,,,$97.74 ,$172.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.93 ,90,,,$97.74 ,$172.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.74 ,55,,,$97.74 ,$172.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.82 ,90,,,$97.74 ,$172.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.74 ,55,,,$97.74 ,$172.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.26 ,93,,,$97.74 ,$172.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA SM LEFT THUMB SPICA,8785051,CDM,270,RC,,HCPCS,outpatient,,,$189.73 ,$142.30 ,,$174.55 ,92,,,$104.35 ,$184.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.35 ,55,,,$104.35 ,$184.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.35 ,$184.04 ,other,,Not applicable. No negotiated rates per contract,$163.17 ,86,,,$104.35 ,$184.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.78 ,80,,,$104.35 ,$184.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.35 ,55,,,$104.35 ,$184.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.24 ,95,,,$104.35 ,$184.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.24 ,95,,,$104.35 ,$184.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.30 ,75,,,$104.35 ,$184.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$161.27 ,85,,,$104.35 ,$184.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$184.04 ,97,,,$104.35 ,$184.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.35 ,55,,,$104.35 ,$184.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.76 ,90,,,$104.35 ,$184.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$184.04 ,97,,,$104.35 ,$184.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.04 ,97,,,$104.35 ,$184.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$184.04 ,97,,,$104.35 ,$184.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$161.27 ,85,,,$104.35 ,$184.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.76 ,90,,,$104.35 ,$184.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.35 ,55,,,$104.35 ,$184.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.24 ,90,,,$104.35 ,$184.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.35 ,55,,,$104.35 ,$184.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.45 ,93,,,$104.35 ,$184.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA SM RIGHT THUMB SPICA (3130),8785056,CDM,270,RC,,HCPCS,outpatient,,,$173.57 ,$130.18 ,,$159.68 ,92,,,$95.46 ,$168.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$95.46 ,55,,,$95.46 ,$168.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$95.46 ,$168.36 ,other,,Not applicable. No negotiated rates per contract,$149.27 ,86,,,$95.46 ,$168.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$138.86 ,80,,,$95.46 ,$168.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$95.46 ,55,,,$95.46 ,$168.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.89 ,95,,,$95.46 ,$168.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$164.89 ,95,,,$95.46 ,$168.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$130.18 ,75,,,$95.46 ,$168.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$147.53 ,85,,,$95.46 ,$168.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$168.36 ,97,,,$95.46 ,$168.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.46 ,55,,,$95.46 ,$168.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.21 ,90,,,$95.46 ,$168.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$168.36 ,97,,,$95.46 ,$168.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.36 ,97,,,$95.46 ,$168.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.36 ,97,,,$95.46 ,$168.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.53 ,85,,,$95.46 ,$168.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.21 ,90,,,$95.46 ,$168.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.46 ,55,,,$95.46 ,$168.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.89 ,90,,,$95.46 ,$168.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.46 ,55,,,$95.46 ,$168.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.42 ,93,,,$95.46 ,$168.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA SPLINT,8971147,CDM,270,RC,L3808,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SPICA XLG LEFT THUMB SPI,8785054,CDM,270,RC,,HCPCS,outpatient,,,$154.57 ,$115.93 ,,$142.20 ,92,,,$85.01 ,$149.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.01 ,55,,,$85.01 ,$149.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.01 ,$149.93 ,other,,Not applicable. No negotiated rates per contract,$132.93 ,86,,,$85.01 ,$149.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$123.66 ,80,,,$85.01 ,$149.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.01 ,55,,,$85.01 ,$149.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.84 ,95,,,$85.01 ,$149.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$146.84 ,95,,,$85.01 ,$149.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.93 ,75,,,$85.01 ,$149.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.38 ,85,,,$85.01 ,$149.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$149.93 ,97,,,$85.01 ,$149.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.01 ,55,,,$85.01 ,$149.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.11 ,90,,,$85.01 ,$149.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.93 ,97,,,$85.01 ,$149.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.93 ,97,,,$85.01 ,$149.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.93 ,97,,,$85.01 ,$149.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.38 ,85,,,$85.01 ,$149.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.11 ,90,,,$85.01 ,$149.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.01 ,55,,,$85.01 ,$149.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$146.84 ,90,,,$85.01 ,$149.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.01 ,55,,,$85.01 ,$149.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.75 ,93,,,$85.01 ,$149.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA XLG RIGHT THUMB SP,8785059,CDM,270,RC,,HCPCS,outpatient,,,$215.11 ,$161.33 ,,$197.90 ,92,,,$118.31 ,$208.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.31 ,55,,,$118.31 ,$208.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$118.31 ,$208.66 ,other,,Not applicable. No negotiated rates per contract,$184.99 ,86,,,$118.31 ,$208.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$172.09 ,80,,,$118.31 ,$208.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.31 ,55,,,$118.31 ,$208.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.35 ,95,,,$118.31 ,$208.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.35 ,95,,,$118.31 ,$208.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.33 ,75,,,$118.31 ,$208.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.84 ,85,,,$118.31 ,$208.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.66 ,97,,,$118.31 ,$208.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.31 ,55,,,$118.31 ,$208.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.60 ,90,,,$118.31 ,$208.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.66 ,97,,,$118.31 ,$208.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.66 ,97,,,$118.31 ,$208.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.66 ,97,,,$118.31 ,$208.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.84 ,85,,,$118.31 ,$208.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.60 ,90,,,$118.31 ,$208.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.31 ,55,,,$118.31 ,$208.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.35 ,90,,,$118.31 ,$208.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.31 ,55,,,$118.31 ,$208.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.05 ,93,,,$118.31 ,$208.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA XSM LEFT THUMB SPICA (3020),8785050,CDM,270,RC,,HCPCS,outpatient,,,$138.65 ,$103.99 ,,$127.56 ,92,,,$76.26 ,$134.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$76.26 ,55,,,$76.26 ,$134.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$76.26 ,$134.49 ,other,,Not applicable. No negotiated rates per contract,$119.24 ,86,,,$76.26 ,$134.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$110.92 ,80,,,$76.26 ,$134.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$76.26 ,55,,,$76.26 ,$134.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.72 ,95,,,$76.26 ,$134.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.72 ,95,,,$76.26 ,$134.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$103.99 ,75,,,$76.26 ,$134.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$117.85 ,85,,,$76.26 ,$134.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.49 ,97,,,$76.26 ,$134.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$76.26 ,55,,,$76.26 ,$134.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.79 ,90,,,$76.26 ,$134.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$134.49 ,97,,,$76.26 ,$134.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.49 ,97,,,$76.26 ,$134.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$134.49 ,97,,,$76.26 ,$134.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.85 ,85,,,$76.26 ,$134.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.79 ,90,,,$76.26 ,$134.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.26 ,55,,,$76.26 ,$134.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.72 ,90,,,$76.26 ,$134.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$76.26 ,55,,,$76.26 ,$134.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$128.94 ,93,,,$76.26 ,$134.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA XSM RT THUMB SPICA (3120),8785055,CDM,270,RC,,HCPCS,outpatient,,,$209.67 ,$157.25 ,,$192.90 ,92,,,$115.32 ,$203.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.32 ,55,,,$115.32 ,$203.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$115.32 ,$203.38 ,other,,Not applicable. No negotiated rates per contract,$180.32 ,86,,,$115.32 ,$203.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$167.74 ,80,,,$115.32 ,$203.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.32 ,55,,,$115.32 ,$203.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.19 ,95,,,$115.32 ,$203.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$199.19 ,95,,,$115.32 ,$203.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.25 ,75,,,$115.32 ,$203.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$178.22 ,85,,,$115.32 ,$203.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.38 ,97,,,$115.32 ,$203.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.32 ,55,,,$115.32 ,$203.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$188.70 ,90,,,$115.32 ,$203.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.38 ,97,,,$115.32 ,$203.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.38 ,97,,,$115.32 ,$203.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.38 ,97,,,$115.32 ,$203.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.22 ,85,,,$115.32 ,$203.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$188.70 ,90,,,$115.32 ,$203.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.32 ,55,,,$115.32 ,$203.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.19 ,90,,,$115.32 ,$203.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.32 ,55,,,$115.32 ,$203.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$194.99 ,93,,,$115.32 ,$203.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA,8785053,CDM,270,RC,,HCPCS,outpatient,,,$192.71 ,$144.53 ,,$177.29 ,92,,,$105.99 ,$186.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.99 ,55,,,$105.99 ,$186.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.99 ,$186.93 ,other,,Not applicable. No negotiated rates per contract,$165.73 ,86,,,$105.99 ,$186.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$154.17 ,80,,,$105.99 ,$186.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.99 ,55,,,$105.99 ,$186.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.07 ,95,,,$105.99 ,$186.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$183.07 ,95,,,$105.99 ,$186.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.53 ,75,,,$105.99 ,$186.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.80 ,85,,,$105.99 ,$186.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.93 ,97,,,$105.99 ,$186.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.99 ,55,,,$105.99 ,$186.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$173.44 ,90,,,$105.99 ,$186.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.93 ,97,,,$105.99 ,$186.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.93 ,97,,,$105.99 ,$186.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.93 ,97,,,$105.99 ,$186.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.80 ,85,,,$105.99 ,$186.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$173.44 ,90,,,$105.99 ,$186.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.99 ,55,,,$105.99 ,$186.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.07 ,90,,,$105.99 ,$186.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.99 ,55,,,$105.99 ,$186.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.22 ,93,,,$105.99 ,$186.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPINAL NEEDLE (20G X 5) BD QUINCKE LONG LENGTH,8961860,CDM,270,RC,,HCPCS,outpatient,,,$57.42 ,$43.07 ,,$52.83 ,92,,,$31.58 ,$55.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.58 ,$55.70 ,other,,Not applicable. No negotiated rates per contract,$49.38 ,86,,,$31.58 ,$55.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$45.94 ,80,,,$31.58 ,$55.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.55 ,95,,,$31.58 ,$55.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.55 ,95,,,$31.58 ,$55.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.07 ,75,,,$31.58 ,$55.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.81 ,85,,,$31.58 ,$55.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.68 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.70 ,97,,,$31.58 ,$55.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.81 ,85,,,$31.58 ,$55.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.68 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.55 ,90,,,$31.58 ,$55.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.58 ,55,,,$31.58 ,$55.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.40 ,93,,,$31.58 ,$55.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPINAL NEEDLE 18G 3 1/2 (MCKESSON),8984333,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPINAL NEEDLE WHITACRE 22G x 3.5IN,8942868,CDM,270,RC,,HCPCS,outpatient,,,$90.60 ,$67.95 ,,$83.35 ,92,,,$49.83 ,$87.88 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.83 ,$87.88 ,other,,Not applicable. No negotiated rates per contract,$77.92 ,86,,,$49.83 ,$87.88 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$72.48 ,80,,,$49.83 ,$87.88 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.07 ,95,,,$49.83 ,$87.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.07 ,95,,,$49.83 ,$87.88 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$67.95 ,75,,,$49.83 ,$87.88 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.01 ,85,,,$49.83 ,$87.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$81.54 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.88 ,97,,,$49.83 ,$87.88 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.01 ,85,,,$49.83 ,$87.88 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$81.54 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.07 ,90,,,$49.83 ,$87.88 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.83 ,55,,,$49.83 ,$87.88 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.26 ,93,,,$49.83 ,$87.88 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPINAL NEEDLE,8942869,CDM,270,RC,,HCPCS,outpatient,,,$57.50 ,$43.13 ,,$52.90 ,92,,,$31.63 ,$55.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.63 ,$55.78 ,other,,Not applicable. No negotiated rates per contract,$49.45 ,86,,,$31.63 ,$55.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.00 ,80,,,$31.63 ,$55.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.63 ,95,,,$31.63 ,$55.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.63 ,95,,,$31.63 ,$55.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.13 ,75,,,$31.63 ,$55.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.88 ,85,,,$31.63 ,$55.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.75 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.88 ,85,,,$31.63 ,$55.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.75 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.63 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.48 ,93,,,$31.63 ,$55.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT  FINGER STAX STARTER KIT,8784896,CDM,270,RC,,HCPCS,outpatient,,,$489.06 ,$366.80 ,,$449.94 ,92,,,$268.98 ,$474.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$268.98 ,55,,,$268.98 ,$474.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$268.98 ,$474.39 ,other,,Not applicable. No negotiated rates per contract,$420.59 ,86,,,$268.98 ,$474.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$391.25 ,80,,,$268.98 ,$474.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$268.98 ,55,,,$268.98 ,$474.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$464.61 ,95,,,$268.98 ,$474.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$464.61 ,95,,,$268.98 ,$474.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$366.80 ,75,,,$268.98 ,$474.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$415.70 ,85,,,$268.98 ,$474.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$474.39 ,97,,,$268.98 ,$474.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.98 ,55,,,$268.98 ,$474.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$440.15 ,90,,,$268.98 ,$474.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$474.39 ,97,,,$268.98 ,$474.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$474.39 ,97,,,$268.98 ,$474.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$474.39 ,97,,,$268.98 ,$474.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$415.70 ,85,,,$268.98 ,$474.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$440.15 ,90,,,$268.98 ,$474.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$268.98 ,55,,,$268.98 ,$474.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$464.61 ,90,,,$268.98 ,$474.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$268.98 ,55,,,$268.98 ,$474.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$454.83 ,93,,,$268.98 ,$474.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT  LARGE BASEBALL SPLINT,8785427,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT 10 UNIVERSAL WRIS,8785111,CDM,270,RC,,HCPCS,outpatient,,,$46.53 ,$34.90 ,,$42.81 ,92,,,$25.59 ,$45.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.59 ,$45.13 ,other,,Not applicable. No negotiated rates per contract,$40.02 ,86,,,$25.59 ,$45.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.22 ,80,,,$25.59 ,$45.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.90 ,75,,,$25.59 ,$45.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.27 ,93,,,$25.59 ,$45.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT 7 UNIVERSAL WRIST,8785110,CDM,270,RC,,HCPCS,outpatient,,,$54.12 ,$40.59 ,,$49.79 ,92,,,$29.77 ,$52.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.77 ,55,,,$29.77 ,$52.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.77 ,$52.50 ,other,,Not applicable. No negotiated rates per contract,$46.54 ,86,,,$29.77 ,$52.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$43.30 ,80,,,$29.77 ,$52.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.77 ,55,,,$29.77 ,$52.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.41 ,95,,,$29.77 ,$52.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.41 ,95,,,$29.77 ,$52.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.59 ,75,,,$29.77 ,$52.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$46.00 ,85,,,$29.77 ,$52.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.50 ,97,,,$29.77 ,$52.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.77 ,55,,,$29.77 ,$52.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.71 ,90,,,$29.77 ,$52.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.50 ,97,,,$29.77 ,$52.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.50 ,97,,,$29.77 ,$52.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.50 ,97,,,$29.77 ,$52.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.00 ,85,,,$29.77 ,$52.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.71 ,90,,,$29.77 ,$52.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.77 ,55,,,$29.77 ,$52.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.41 ,90,,,$29.77 ,$52.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.77 ,55,,,$29.77 ,$52.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.33 ,93,,,$29.77 ,$52.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT EXTRA-FAST SETTIN,8785740,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT LG CLAVICLE SPLIN,8785109,CDM,270,RC,,HCPCS,outpatient,,,$44.72 ,$33.54 ,,$41.14 ,92,,,$24.60 ,$43.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.60 ,$43.38 ,other,,Not applicable. No negotiated rates per contract,$38.46 ,86,,,$24.60 ,$43.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.78 ,80,,,$24.60 ,$43.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.54 ,75,,,$24.60 ,$43.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.59 ,93,,,$24.60 ,$43.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT LG LEFT COLLES SP,8785082,CDM,270,RC,,HCPCS,outpatient,,,$35.09 ,$26.32 ,,$32.28 ,92,,,$19.30 ,$34.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.30 ,$34.04 ,other,,Not applicable. No negotiated rates per contract,$30.18 ,86,,,$19.30 ,$34.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.07 ,80,,,$19.30 ,$34.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.34 ,95,,,$19.30 ,$34.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.34 ,95,,,$19.30 ,$34.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.32 ,75,,,$19.30 ,$34.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.83 ,85,,,$19.30 ,$34.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.58 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.04 ,97,,,$19.30 ,$34.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.83 ,85,,,$19.30 ,$34.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.58 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.34 ,90,,,$19.30 ,$34.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.30 ,55,,,$19.30 ,$34.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.63 ,93,,,$19.30 ,$34.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT LG RIGHT COLLES S,8785085,CDM,270,RC,,HCPCS,outpatient,,,$35.79 ,$26.84 ,,$32.93 ,92,,,$19.68 ,$34.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.68 ,$34.72 ,other,,Not applicable. No negotiated rates per contract,$30.78 ,86,,,$19.68 ,$34.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.63 ,80,,,$19.68 ,$34.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.84 ,75,,,$19.68 ,$34.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.28 ,93,,,$19.68 ,$34.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT MED CLAVICLE SPLI,8843978,CDM,270,RC,,HCPCS,outpatient,,,$36.49 ,$27.37 ,,$33.57 ,92,,,$20.07 ,$35.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.07 ,55,,,$20.07 ,$35.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.07 ,$35.40 ,other,,Not applicable. No negotiated rates per contract,$31.38 ,86,,,$20.07 ,$35.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.19 ,80,,,$20.07 ,$35.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.07 ,55,,,$20.07 ,$35.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.67 ,95,,,$20.07 ,$35.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.67 ,95,,,$20.07 ,$35.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.37 ,75,,,$20.07 ,$35.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.02 ,85,,,$20.07 ,$35.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.40 ,97,,,$20.07 ,$35.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.07 ,55,,,$20.07 ,$35.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.84 ,90,,,$20.07 ,$35.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.40 ,97,,,$20.07 ,$35.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.40 ,97,,,$20.07 ,$35.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.40 ,97,,,$20.07 ,$35.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.02 ,85,,,$20.07 ,$35.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.84 ,90,,,$20.07 ,$35.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.07 ,55,,,$20.07 ,$35.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.67 ,90,,,$20.07 ,$35.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.07 ,55,,,$20.07 ,$35.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.94 ,93,,,$20.07 ,$35.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT MED LEFT COLLES S,8785081,CDM,270,RC,,HCPCS,outpatient,,,$35.79 ,$26.84 ,,$32.93 ,92,,,$19.68 ,$34.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.68 ,$34.72 ,other,,Not applicable. No negotiated rates per contract,$30.78 ,86,,,$19.68 ,$34.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.63 ,80,,,$19.68 ,$34.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.84 ,75,,,$19.68 ,$34.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.28 ,93,,,$19.68 ,$34.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT MED RIGHT COLLES,8785084,CDM,270,RC,,HCPCS,outpatient,,,$34.91 ,$26.18 ,,$32.12 ,92,,,$19.20 ,$33.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.20 ,$33.86 ,other,,Not applicable. No negotiated rates per contract,$30.02 ,86,,,$19.20 ,$33.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.93 ,80,,,$19.20 ,$33.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,95,,,$19.20 ,$33.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.16 ,95,,,$19.20 ,$33.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.18 ,75,,,$19.20 ,$33.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.67 ,85,,,$19.20 ,$33.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.42 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.86 ,97,,,$19.20 ,$33.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.67 ,85,,,$19.20 ,$33.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.42 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,90,,,$19.20 ,$33.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.20 ,55,,,$19.20 ,$33.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.47 ,93,,,$19.20 ,$33.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT MED.BASEBALL SPLINT,8785426,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT SHORT EXTENSION SPLINT,8786182,CDM,270,RC,,HCPCS,outpatient,,,$82.00 ,$61.50 ,,$75.44 ,92,,,$45.10 ,$79.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.10 ,$79.54 ,other,,Not applicable. No negotiated rates per contract,$70.52 ,86,,,$45.10 ,$79.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.60 ,80,,,$45.10 ,$79.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.90 ,95,,,$45.10 ,$79.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.50 ,75,,,$45.10 ,$79.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.54 ,97,,,$45.10 ,$79.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.70 ,85,,,$45.10 ,$79.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.80 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.90 ,90,,,$45.10 ,$79.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.10 ,55,,,$45.10 ,$79.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.26 ,93,,,$45.10 ,$79.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT SM LEFT COLLES SP,8785080,CDM,270,RC,,HCPCS,outpatient,,,$35.79 ,$26.84 ,,$32.93 ,92,,,$19.68 ,$34.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.68 ,$34.72 ,other,,Not applicable. No negotiated rates per contract,$30.78 ,86,,,$19.68 ,$34.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.63 ,80,,,$19.68 ,$34.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.84 ,75,,,$19.68 ,$34.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.28 ,93,,,$19.68 ,$34.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT SM RIGHT COLLES S,8785083,CDM,270,RC,,HCPCS,outpatient,,,$35.79 ,$26.84 ,,$32.93 ,92,,,$19.68 ,$34.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.68 ,$34.72 ,other,,Not applicable. No negotiated rates per contract,$30.78 ,86,,,$19.68 ,$34.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.63 ,80,,,$19.68 ,$34.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.84 ,75,,,$19.68 ,$34.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.28 ,93,,,$19.68 ,$34.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT SMALL CLAVICLE SPLINT,8785108,CDM,270,RC,,HCPCS,outpatient,,,$44.72 ,$33.54 ,,$41.14 ,92,,,$24.60 ,$43.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.60 ,$43.38 ,other,,Not applicable. No negotiated rates per contract,$38.46 ,86,,,$24.60 ,$43.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.78 ,80,,,$24.60 ,$43.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.48 ,95,,,$24.60 ,$43.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.54 ,75,,,$24.60 ,$43.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.38 ,97,,,$24.60 ,$43.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.01 ,85,,,$24.60 ,$43.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.25 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.48 ,90,,,$24.60 ,$43.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.60 ,55,,,$24.60 ,$43.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.59 ,93,,,$24.60 ,$43.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT XS CLAVICLE SPLIN,8785107,CDM,270,RC,,HCPCS,outpatient,,,$46.53 ,$34.90 ,,$42.81 ,92,,,$25.59 ,$45.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.59 ,$45.13 ,other,,Not applicable. No negotiated rates per contract,$40.02 ,86,,,$25.59 ,$45.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.22 ,80,,,$25.59 ,$45.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.90 ,75,,,$25.59 ,$45.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.27 ,93,,,$25.59 ,$45.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT XTRA-FAST SET PLASTER 3 X 15IN WHITE,9216786,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SPLINT XTRA-FAST SET PLASTER 5"" x30""  WHITE (7392)",10950434,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8786163,CDM,270,RC,,HCPCS,outpatient,,,$538.60 ,$403.95 ,,$495.51 ,92,,,$296.23 ,$522.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$296.23 ,55,,,$296.23 ,$522.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$296.23 ,$522.44 ,other,,Not applicable. No negotiated rates per contract,$463.20 ,86,,,$296.23 ,$522.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$430.88 ,80,,,$296.23 ,$522.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$296.23 ,55,,,$296.23 ,$522.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$511.67 ,95,,,$296.23 ,$522.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$511.67 ,95,,,$296.23 ,$522.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$403.95 ,75,,,$296.23 ,$522.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$457.81 ,85,,,$296.23 ,$522.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$522.44 ,97,,,$296.23 ,$522.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$296.23 ,55,,,$296.23 ,$522.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$484.74 ,90,,,$296.23 ,$522.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.44 ,97,,,$296.23 ,$522.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$522.44 ,97,,,$296.23 ,$522.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$522.44 ,97,,,$296.23 ,$522.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$457.81 ,85,,,$296.23 ,$522.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$484.74 ,90,,,$296.23 ,$522.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$296.23 ,55,,,$296.23 ,$522.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$511.67 ,90,,,$296.23 ,$522.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$296.23 ,55,,,$296.23 ,$522.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$500.90 ,93,,,$296.23 ,$522.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8786159,CDM,270,RC,,HCPCS,outpatient,,,$369.56 ,$277.17 ,,$340.00 ,92,,,$203.26 ,$358.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$203.26 ,55,,,$203.26 ,$358.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$203.26 ,$358.47 ,other,,Not applicable. No negotiated rates per contract,$317.82 ,86,,,$203.26 ,$358.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$295.65 ,80,,,$203.26 ,$358.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$203.26 ,55,,,$203.26 ,$358.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.08 ,95,,,$203.26 ,$358.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$351.08 ,95,,,$203.26 ,$358.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$277.17 ,75,,,$203.26 ,$358.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$314.13 ,85,,,$203.26 ,$358.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$358.47 ,97,,,$203.26 ,$358.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$203.26 ,55,,,$203.26 ,$358.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$332.60 ,90,,,$203.26 ,$358.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$358.47 ,97,,,$203.26 ,$358.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.47 ,97,,,$203.26 ,$358.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$358.47 ,97,,,$203.26 ,$358.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$314.13 ,85,,,$203.26 ,$358.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$332.60 ,90,,,$203.26 ,$358.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.26 ,55,,,$203.26 ,$358.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.08 ,90,,,$203.26 ,$358.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$203.26 ,55,,,$203.26 ,$358.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$343.69 ,93,,,$203.26 ,$358.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785066,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785067,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785068,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785070,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785069,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8785071,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8786174,CDM,270,RC,,HCPCS,outpatient,,,$80.69 ,$60.52 ,,$74.23 ,92,,,$44.38 ,$78.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.38 ,$78.27 ,other,,Not applicable. No negotiated rates per contract,$69.39 ,86,,,$44.38 ,$78.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.55 ,80,,,$44.38 ,$78.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.66 ,95,,,$44.38 ,$78.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.66 ,95,,,$44.38 ,$78.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.52 ,75,,,$44.38 ,$78.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.59 ,85,,,$44.38 ,$78.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.62 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.59 ,85,,,$44.38 ,$78.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.62 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.66 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.04 ,93,,,$44.38 ,$78.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,8786175,CDM,270,RC,,HCPCS,outpatient,,,$80.69 ,$60.52 ,,$74.23 ,92,,,$44.38 ,$78.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.38 ,$78.27 ,other,,Not applicable. No negotiated rates per contract,$69.39 ,86,,,$44.38 ,$78.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.55 ,80,,,$44.38 ,$78.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.66 ,95,,,$44.38 ,$78.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.66 ,95,,,$44.38 ,$78.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.52 ,75,,,$44.38 ,$78.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.59 ,85,,,$44.38 ,$78.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.62 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.27 ,97,,,$44.38 ,$78.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.59 ,85,,,$44.38 ,$78.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.62 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.66 ,90,,,$44.38 ,$78.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.38 ,55,,,$44.38 ,$78.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.04 ,93,,,$44.38 ,$78.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPONGE 4 X 4  PACKS (12PKS,8785800,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPONGE DETECTABLE LAPAROTOMY DISP.,8785654,CDM,270,RC,,HCPCS,outpatient,,,$27.65 ,$20.74 ,,$25.44 ,92,,,$15.21 ,$26.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.21 ,55,,,$15.21 ,$26.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.21 ,$26.82 ,other,,Not applicable. No negotiated rates per contract,$23.78 ,86,,,$15.21 ,$26.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.12 ,80,,,$15.21 ,$26.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.21 ,55,,,$15.21 ,$26.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.27 ,95,,,$15.21 ,$26.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.27 ,95,,,$15.21 ,$26.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$20.74 ,75,,,$15.21 ,$26.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.50 ,85,,,$15.21 ,$26.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.82 ,97,,,$15.21 ,$26.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.21 ,55,,,$15.21 ,$26.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.89 ,90,,,$15.21 ,$26.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.82 ,97,,,$15.21 ,$26.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.82 ,97,,,$15.21 ,$26.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.82 ,97,,,$15.21 ,$26.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.50 ,85,,,$15.21 ,$26.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.89 ,90,,,$15.21 ,$26.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.21 ,55,,,$15.21 ,$26.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.27 ,90,,,$15.21 ,$26.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.21 ,55,,,$15.21 ,$26.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.71 ,93,,,$15.21 ,$26.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPONGE X-RAY DETECTABLE,8785505,CDM,270,RC,,HCPCS,outpatient,,,$35.61 ,$26.71 ,,$32.76 ,92,,,$19.59 ,$34.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.59 ,55,,,$19.59 ,$34.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.59 ,$34.54 ,other,,Not applicable. No negotiated rates per contract,$30.62 ,86,,,$19.59 ,$34.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.49 ,80,,,$19.59 ,$34.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.59 ,55,,,$19.59 ,$34.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.83 ,95,,,$19.59 ,$34.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.83 ,95,,,$19.59 ,$34.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.71 ,75,,,$19.59 ,$34.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.27 ,85,,,$19.59 ,$34.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.54 ,97,,,$19.59 ,$34.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.59 ,55,,,$19.59 ,$34.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.05 ,90,,,$19.59 ,$34.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.54 ,97,,,$19.59 ,$34.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.54 ,97,,,$19.59 ,$34.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.54 ,97,,,$19.59 ,$34.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.27 ,85,,,$19.59 ,$34.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.05 ,90,,,$19.59 ,$34.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.59 ,55,,,$19.59 ,$34.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.83 ,90,,,$19.59 ,$34.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.59 ,55,,,$19.59 ,$34.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.12 ,93,,,$19.59 ,$34.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STABILIZATION SHOULDER K,8945579,CDM,270,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
"STANDARD SAND BAG 6""W X",8782076,CDM,270,RC,,HCPCS,outpatient,,,$221.00 ,$165.75 ,,$203.32 ,92,,,$121.55 ,$214.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.55 ,$214.37 ,other,,Not applicable. No negotiated rates per contract,$190.06 ,86,,,$121.55 ,$214.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$176.80 ,80,,,$121.55 ,$214.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$209.95 ,95,,,$121.55 ,$214.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$165.75 ,75,,,$121.55 ,$214.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.37 ,97,,,$121.55 ,$214.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$187.85 ,85,,,$121.55 ,$214.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$198.90 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.95 ,90,,,$121.55 ,$214.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.55 ,55,,,$121.55 ,$214.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.53 ,93,,,$121.55 ,$214.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STAPLER SKIN DISPOSABLE,8785469,CDM,270,RC,,HCPCS,outpatient,,,$44.55 ,$33.41 ,,$40.99 ,92,,,$24.50 ,$43.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.50 ,$43.21 ,other,,Not applicable. No negotiated rates per contract,$38.31 ,86,,,$24.50 ,$43.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.64 ,80,,,$24.50 ,$43.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.41 ,75,,,$24.50 ,$43.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.43 ,93,,,$24.50 ,$43.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STAPLER SKIN PROXIMATE PLUS WIDE 35 (OR),8785255,CDM,270,RC,,HCPCS,outpatient,,,$42.90 ,$32.18 ,,$39.47 ,92,,,$23.60 ,$41.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.60 ,$41.61 ,other,,Not applicable. No negotiated rates per contract,$36.89 ,86,,,$23.60 ,$41.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.32 ,80,,,$23.60 ,$41.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.76 ,95,,,$23.60 ,$41.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.76 ,95,,,$23.60 ,$41.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.18 ,75,,,$23.60 ,$41.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.47 ,85,,,$23.60 ,$41.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.61 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.47 ,85,,,$23.60 ,$41.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.61 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.76 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,93,,,$23.60 ,$41.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STAPLER SKIN PROXIMATE PX 35 WIDE (OR),8785257,CDM,270,RC,,HCPCS,outpatient,,,$58.66 ,$44.00 ,,$53.97 ,92,,,$32.26 ,$56.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.26 ,55,,,$32.26 ,$56.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.26 ,$56.90 ,other,,Not applicable. No negotiated rates per contract,$50.45 ,86,,,$32.26 ,$56.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.93 ,80,,,$32.26 ,$56.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.26 ,55,,,$32.26 ,$56.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.73 ,95,,,$32.26 ,$56.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.73 ,95,,,$32.26 ,$56.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.00 ,75,,,$32.26 ,$56.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$49.86 ,85,,,$32.26 ,$56.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$56.90 ,97,,,$32.26 ,$56.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.26 ,55,,,$32.26 ,$56.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.79 ,90,,,$32.26 ,$56.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.90 ,97,,,$32.26 ,$56.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.90 ,97,,,$32.26 ,$56.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.90 ,97,,,$32.26 ,$56.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.86 ,85,,,$32.26 ,$56.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.79 ,90,,,$32.26 ,$56.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.26 ,55,,,$32.26 ,$56.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.73 ,90,,,$32.26 ,$56.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.26 ,55,,,$32.26 ,$56.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.55 ,93,,,$32.26 ,$56.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP 3/32"" X 9"" (T-093-S) OR (NEW)",8786577,CDM,270,RC,,HCPCS,outpatient,,,$32.11 ,$24.08 ,,$29.54 ,92,,,$17.66 ,$31.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.66 ,$31.15 ,other,,Not applicable. No negotiated rates per contract,$27.61 ,86,,,$17.66 ,$31.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.69 ,80,,,$17.66 ,$31.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.50 ,95,,,$17.66 ,$31.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.08 ,75,,,$17.66 ,$31.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.15 ,97,,,$17.66 ,$31.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.29 ,85,,,$17.66 ,$31.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.90 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.50 ,90,,,$17.66 ,$31.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.66 ,55,,,$17.66 ,$31.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.86 ,93,,,$17.66 ,$31.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP 7/64"" X 9"" (T-109-S) OR (NEW)",8786578,CDM,270,RC,,HCPCS,outpatient,,,$39.03 ,$29.27 ,,$35.91 ,92,,,$21.47 ,$37.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.47 ,55,,,$21.47 ,$37.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.47 ,$37.86 ,other,,Not applicable. No negotiated rates per contract,$33.57 ,86,,,$21.47 ,$37.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.22 ,80,,,$21.47 ,$37.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.47 ,55,,,$21.47 ,$37.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.08 ,95,,,$21.47 ,$37.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.08 ,95,,,$21.47 ,$37.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.27 ,75,,,$21.47 ,$37.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.18 ,85,,,$21.47 ,$37.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.86 ,97,,,$21.47 ,$37.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.47 ,55,,,$21.47 ,$37.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.13 ,90,,,$21.47 ,$37.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.86 ,97,,,$21.47 ,$37.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.86 ,97,,,$21.47 ,$37.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.86 ,97,,,$21.47 ,$37.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.18 ,85,,,$21.47 ,$37.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.13 ,90,,,$21.47 ,$37.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.47 ,55,,,$21.47 ,$37.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.08 ,90,,,$21.47 ,$37.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.47 ,55,,,$21.47 ,$37.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.30 ,93,,,$21.47 ,$37.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP 1/8"" X 9"" (T-125-S) OR (NEW)",8786579,CDM,270,RC,,HCPCS,outpatient,,,$41.58 ,$31.19 ,,$38.25 ,92,,,$22.87 ,$40.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.87 ,55,,,$22.87 ,$40.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.87 ,$40.33 ,other,,Not applicable. No negotiated rates per contract,$35.76 ,86,,,$22.87 ,$40.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.26 ,80,,,$22.87 ,$40.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.87 ,55,,,$22.87 ,$40.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.50 ,95,,,$22.87 ,$40.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.50 ,95,,,$22.87 ,$40.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.19 ,75,,,$22.87 ,$40.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.34 ,85,,,$22.87 ,$40.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.33 ,97,,,$22.87 ,$40.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.87 ,55,,,$22.87 ,$40.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.42 ,90,,,$22.87 ,$40.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.33 ,97,,,$22.87 ,$40.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.33 ,97,,,$22.87 ,$40.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.33 ,97,,,$22.87 ,$40.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.34 ,85,,,$22.87 ,$40.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.42 ,90,,,$22.87 ,$40.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.87 ,55,,,$22.87 ,$40.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.50 ,90,,,$22.87 ,$40.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.87 ,55,,,$22.87 ,$40.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.67 ,93,,,$22.87 ,$40.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP 9/64"" X 9"" (T-140-S) OR (NEW)",8786580,CDM,270,RC,,HCPCS,outpatient,,,$46.78 ,$35.09 ,,$43.04 ,92,,,$25.73 ,$45.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.73 ,$45.38 ,other,,Not applicable. No negotiated rates per contract,$40.23 ,86,,,$25.73 ,$45.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.42 ,80,,,$25.73 ,$45.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.44 ,95,,,$25.73 ,$45.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.09 ,75,,,$25.73 ,$45.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.38 ,97,,,$25.73 ,$45.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.76 ,85,,,$25.73 ,$45.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.10 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.44 ,90,,,$25.73 ,$45.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.73 ,55,,,$25.73 ,$45.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.51 ,93,,,$25.73 ,$45.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP5/32"" X 9"" (T-156-S) OR (NEW)",8786581,CDM,270,RC,,HCPCS,outpatient,,,$53.30 ,$39.98 ,,$49.04 ,92,,,$29.32 ,$51.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.32 ,55,,,$29.32 ,$51.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.32 ,$51.70 ,other,,Not applicable. No negotiated rates per contract,$45.84 ,86,,,$29.32 ,$51.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.64 ,80,,,$29.32 ,$51.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.32 ,55,,,$29.32 ,$51.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.64 ,95,,,$29.32 ,$51.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.64 ,95,,,$29.32 ,$51.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.98 ,75,,,$29.32 ,$51.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.31 ,85,,,$29.32 ,$51.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.70 ,97,,,$29.32 ,$51.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.32 ,55,,,$29.32 ,$51.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.97 ,90,,,$29.32 ,$51.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$51.70 ,97,,,$29.32 ,$51.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,97,,,$29.32 ,$51.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.70 ,97,,,$29.32 ,$51.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.31 ,85,,,$29.32 ,$51.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.97 ,90,,,$29.32 ,$51.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.32 ,55,,,$29.32 ,$51.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.64 ,90,,,$29.32 ,$51.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.32 ,55,,,$29.32 ,$51.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.57 ,93,,,$29.32 ,$51.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"STEINMANN PIN SMOOTH TROCAR SINGLE TIP .177"" X 9"" (T-177-S) OR (NEW)",8786582,CDM,270,RC,,HCPCS,outpatient,,,$59.81 ,$44.86 ,,$55.03 ,92,,,$32.90 ,$58.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.90 ,55,,,$32.90 ,$58.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.90 ,$58.02 ,other,,Not applicable. No negotiated rates per contract,$51.44 ,86,,,$32.90 ,$58.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.85 ,80,,,$32.90 ,$58.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.90 ,55,,,$32.90 ,$58.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.82 ,95,,,$32.90 ,$58.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.82 ,95,,,$32.90 ,$58.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.86 ,75,,,$32.90 ,$58.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.84 ,85,,,$32.90 ,$58.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.02 ,97,,,$32.90 ,$58.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.90 ,55,,,$32.90 ,$58.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.83 ,90,,,$32.90 ,$58.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.02 ,97,,,$32.90 ,$58.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.02 ,97,,,$32.90 ,$58.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.02 ,97,,,$32.90 ,$58.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.84 ,85,,,$32.90 ,$58.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.83 ,90,,,$32.90 ,$58.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.90 ,55,,,$32.90 ,$58.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.82 ,90,,,$32.90 ,$58.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.90 ,55,,,$32.90 ,$58.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.62 ,93,,,$32.90 ,$58.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STERILE HOOK/TRIANGLE BLADE (PACK),10116404,CDM,270,RC,,HCPCS,outpatient,,,"$1,593.75 ","$1,195.31 ",,"$1,466.25 ",92,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$876.56 ,"$1,545.94 ",other,,Not applicable. No negotiated rates per contract,"$1,370.63 ",86,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,275.00 ",80,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.06 ",95,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,514.06 ",95,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,195.31 ",75,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,354.69 ",85,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,434.38 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,545.94 ",97,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,354.69 ",85,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,434.38 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,514.06 ",90,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$876.56 ,55,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,482.19 ",93,,,$876.56 ,"$1,545.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STERILE MARKING PEN,9152048,CDM,272,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STERILE WATER IRRIGATION 1000ML,8782628,CDM,270,RC,,HCPCS,outpatient,,,$36.84 ,$27.63 ,,$33.89 ,92,,,$20.26 ,$35.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.26 ,$35.73 ,other,,Not applicable. No negotiated rates per contract,$31.68 ,86,,,$20.26 ,$35.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.47 ,80,,,$20.26 ,$35.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.00 ,95,,,$20.26 ,$35.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.00 ,95,,,$20.26 ,$35.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.63 ,75,,,$20.26 ,$35.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.31 ,85,,,$20.26 ,$35.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.16 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.73 ,97,,,$20.26 ,$35.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.31 ,85,,,$20.26 ,$35.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.16 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.00 ,90,,,$20.26 ,$35.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.26 ,55,,,$20.26 ,$35.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.26 ,93,,,$20.26 ,$35.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STOCKINETTE IMPERVIOUS LG,8785567,CDM,270,RC,,HCPCS,outpatient,,,$70.21 ,$52.66 ,,$64.59 ,92,,,$38.62 ,$68.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.62 ,55,,,$38.62 ,$68.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.62 ,$68.10 ,other,,Not applicable. No negotiated rates per contract,$60.38 ,86,,,$38.62 ,$68.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.17 ,80,,,$38.62 ,$68.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.62 ,55,,,$38.62 ,$68.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.70 ,95,,,$38.62 ,$68.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.70 ,95,,,$38.62 ,$68.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.66 ,75,,,$38.62 ,$68.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.68 ,85,,,$38.62 ,$68.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.10 ,97,,,$38.62 ,$68.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.62 ,55,,,$38.62 ,$68.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.19 ,90,,,$38.62 ,$68.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.10 ,97,,,$38.62 ,$68.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.10 ,97,,,$38.62 ,$68.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.10 ,97,,,$38.62 ,$68.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.68 ,85,,,$38.62 ,$68.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.19 ,90,,,$38.62 ,$68.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.62 ,55,,,$38.62 ,$68.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.70 ,90,,,$38.62 ,$68.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.62 ,55,,,$38.62 ,$68.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.30 ,93,,,$38.62 ,$68.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STOPCOCK FLO 3 -WAY,8781952,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRAINER  URINE,8781899,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRAPS-HEAD & CHIN,8786504,CDM,270,RC,,HCPCS,outpatient,,,$115.63 ,$86.72 ,,$106.38 ,92,,,$63.60 ,$112.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.60 ,55,,,$63.60 ,$112.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.60 ,$112.16 ,other,,Not applicable. No negotiated rates per contract,$99.44 ,86,,,$63.60 ,$112.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.50 ,80,,,$63.60 ,$112.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.60 ,55,,,$63.60 ,$112.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.85 ,95,,,$63.60 ,$112.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.85 ,95,,,$63.60 ,$112.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.72 ,75,,,$63.60 ,$112.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$98.29 ,85,,,$63.60 ,$112.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$112.16 ,97,,,$63.60 ,$112.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.60 ,55,,,$63.60 ,$112.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.07 ,90,,,$63.60 ,$112.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.16 ,97,,,$63.60 ,$112.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.16 ,97,,,$63.60 ,$112.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.16 ,97,,,$63.60 ,$112.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.29 ,85,,,$63.60 ,$112.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$104.07 ,90,,,$63.60 ,$112.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.60 ,55,,,$63.60 ,$112.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.85 ,90,,,$63.60 ,$112.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.60 ,55,,,$63.60 ,$112.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.54 ,93,,,$63.60 ,$112.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRY5  RECIPROCATING SAW BLADSA,8787046,CDM,270,RC,,HCPCS,outpatient,,,$745.75 ,$559.31 ,,$686.09 ,92,,,$410.16 ,$723.38 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$410.16 ,55,,,$410.16 ,$723.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$410.16 ,$723.38 ,other,,Not applicable. No negotiated rates per contract,$641.35 ,86,,,$410.16 ,$723.38 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$596.60 ,80,,,$410.16 ,$723.38 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$410.16 ,55,,,$410.16 ,$723.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.46 ,95,,,$410.16 ,$723.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.46 ,95,,,$410.16 ,$723.38 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$559.31 ,75,,,$410.16 ,$723.38 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$633.89 ,85,,,$410.16 ,$723.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$723.38 ,97,,,$410.16 ,$723.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$410.16 ,55,,,$410.16 ,$723.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$671.18 ,90,,,$410.16 ,$723.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$723.38 ,97,,,$410.16 ,$723.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$723.38 ,97,,,$410.16 ,$723.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$723.38 ,97,,,$410.16 ,$723.38 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$633.89 ,85,,,$410.16 ,$723.38 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$671.18 ,90,,,$410.16 ,$723.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$410.16 ,55,,,$410.16 ,$723.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$708.46 ,90,,,$410.16 ,$723.38 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$410.16 ,55,,,$410.16 ,$723.38 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$693.55 ,93,,,$410.16 ,$723.38 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYK 76542K 19 X 90 X 1.27G,8787047,CDM,270,RC,,HCPCS,outpatient,,,$850.25 ,$637.69 ,,$782.23 ,92,,,$467.64 ,$824.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$467.64 ,$824.74 ,other,,Not applicable. No negotiated rates per contract,$731.22 ,86,,,$467.64 ,$824.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$680.20 ,80,,,$467.64 ,$824.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$807.74 ,95,,,$467.64 ,$824.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$807.74 ,95,,,$467.64 ,$824.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$637.69 ,75,,,$467.64 ,$824.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$722.71 ,85,,,$467.64 ,$824.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$765.23 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$824.74 ,97,,,$467.64 ,$824.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$722.71 ,85,,,$467.64 ,$824.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$765.23 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$807.74 ,90,,,$467.64 ,$824.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$467.64 ,55,,,$467.64 ,$824.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$790.73 ,93,,,$467.64 ,$824.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER AHTO TUBE SET,8786762,CDM,270,RC,,HCPCS,outpatient,,,$472.69 ,$354.52 ,,$434.87 ,92,,,$259.98 ,$458.51 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$259.98 ,55,,,$259.98 ,$458.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$259.98 ,$458.51 ,other,,Not applicable. No negotiated rates per contract,$406.51 ,86,,,$259.98 ,$458.51 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$378.15 ,80,,,$259.98 ,$458.51 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$259.98 ,55,,,$259.98 ,$458.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$449.06 ,95,,,$259.98 ,$458.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$449.06 ,95,,,$259.98 ,$458.51 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$354.52 ,75,,,$259.98 ,$458.51 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$401.79 ,85,,,$259.98 ,$458.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$458.51 ,97,,,$259.98 ,$458.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$259.98 ,55,,,$259.98 ,$458.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$425.42 ,90,,,$259.98 ,$458.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$458.51 ,97,,,$259.98 ,$458.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$458.51 ,97,,,$259.98 ,$458.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$458.51 ,97,,,$259.98 ,$458.51 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$401.79 ,85,,,$259.98 ,$458.51 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$425.42 ,90,,,$259.98 ,$458.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.98 ,55,,,$259.98 ,$458.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$449.06 ,90,,,$259.98 ,$458.51 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$259.98 ,55,,,$259.98 ,$458.51 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$439.60 ,93,,,$259.98 ,$458.51 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER CORE MICRO DRILL,8786854,CDM,270,RC,,HCPCS,outpatient,,,"$6,337.50 ","$4,753.13 ",,"$5,830.50 ",92,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,485.63 ",55,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,485.63 ","$6,147.38 ",other,,Not applicable. No negotiated rates per contract,"$5,450.25 ",86,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,070.00 ",80,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,485.63 ",55,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,020.63 ",95,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,020.63 ",95,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,753.13 ",75,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,386.88 ",85,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,147.38 ",97,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,485.63 ",55,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,703.75 ",90,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,147.38 ",97,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,147.38 ",97,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,147.38 ",97,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,386.88 ",85,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,703.75 ",90,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,485.63 ",55,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,020.63 ",90,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,485.63 ",55,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,893.88 ",93,,,"$3,485.63 ","$6,147.38 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER INSTRUMENT,9173395,CDM,272,RC,,HCPCS,outpatient,,,"$1,168.75 ",$876.56 ,,"$1,075.25 ",92,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$642.81 ,55,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$642.81 ,"$1,133.69 ",other,,Not applicable. No negotiated rates per contract,"$1,005.13 ",86,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$935.00 ,80,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$642.81 ,55,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.31 ",95,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,110.31 ",95,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$876.56 ,75,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$993.44 ,85,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,133.69 ",97,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$642.81 ,55,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,051.88 ",90,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,133.69 ",97,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,133.69 ",97,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,133.69 ",97,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$993.44 ,85,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,051.88 ",90,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$642.81 ,55,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,110.31 ",90,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$642.81 ,55,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,086.94 ",93,,,$642.81 ,"$1,133.69 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER INSTRUMENTS PREC. FALCON 2.0 TIP SAW CART.,8998666,CDM,270,RC,,HCPCS,outpatient,,,$886.13 ,$664.60 ,,$815.24 ,92,,,$487.37 ,$859.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$487.37 ,55,,,$487.37 ,$859.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$487.37 ,$859.55 ,other,,Not applicable. No negotiated rates per contract,$762.07 ,86,,,$487.37 ,$859.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$708.90 ,80,,,$487.37 ,$859.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$487.37 ,55,,,$487.37 ,$859.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$841.82 ,95,,,$487.37 ,$859.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$841.82 ,95,,,$487.37 ,$859.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$664.60 ,75,,,$487.37 ,$859.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$753.21 ,85,,,$487.37 ,$859.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$859.55 ,97,,,$487.37 ,$859.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$487.37 ,55,,,$487.37 ,$859.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$797.52 ,90,,,$487.37 ,$859.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$859.55 ,97,,,$487.37 ,$859.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$859.55 ,97,,,$487.37 ,$859.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$859.55 ,97,,,$487.37 ,$859.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$753.21 ,85,,,$487.37 ,$859.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$797.52 ,90,,,$487.37 ,$859.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$487.37 ,55,,,$487.37 ,$859.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$841.82 ,90,,,$487.37 ,$859.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$487.37 ,55,,,$487.37 ,$859.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$824.10 ,93,,,$487.37 ,$859.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORHOPAEDICS TRIDENT X3 0 DEGREE POLYETHLENE INSERT ID 36MM ALPH CODE E,9068113,CDM,278,RC,,HCPCS,both,,,"$5,068.20 ","$3,801.15 ",,"$4,662.74 ",92,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,787.51 ","$4,916.15 ",other,,Not applicable. No negotiated rates per contract,"$4,358.65 ",86,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,054.56 ",80,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,801.15 ",75,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,713.43 ",93,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO 6.5MM LOW PROLIE HEX SCREW DIA 6.5MM LNGTH 35MM,9199200,CDM,278,RC,,HCPCS,both,,,$630.63 ,$472.97 ,,$580.18 ,92,,,$346.85 ,$611.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$346.85 ,$611.71 ,other,,Not applicable. No negotiated rates per contract,$542.34 ,86,,,$346.85 ,$611.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$504.50 ,80,,,$346.85 ,$611.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.97 ,75,,,$346.85 ,$611.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$586.49 ,93,,,$346.85 ,$611.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO ASNIS III 1.4 X 150MM GUIDE WIRE,9396684,CDM,272,RC,,HCPCS,outpatient,,,$783.75 ,$587.81 ,,$721.05 ,92,,,$431.06 ,$760.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$431.06 ,$760.24 ,other,,Not applicable. No negotiated rates per contract,$674.03 ,86,,,$431.06 ,$760.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$627.00 ,80,,,$431.06 ,$760.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$744.56 ,95,,,$431.06 ,$760.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$587.81 ,75,,,$431.06 ,$760.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$760.24 ,97,,,$431.06 ,$760.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,85,,,$431.06 ,$760.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$705.38 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$744.56 ,90,,,$431.06 ,$760.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$431.06 ,55,,,$431.06 ,$760.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$728.89 ,93,,,$431.06 ,$760.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO BONE SCREW T10 FULL THREAD 3.5MM/L16MM,9396678,CDM,272,RC,,HCPCS,outpatient,,,$945.25 ,$708.94 ,,$869.63 ,92,,,$519.89 ,$916.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$519.89 ,$916.89 ,other,,Not applicable. No negotiated rates per contract,$812.92 ,86,,,$519.89 ,$916.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$756.20 ,80,,,$519.89 ,$916.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.94 ,75,,,$519.89 ,$916.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.08 ,93,,,$519.89 ,$916.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO CANN 2.7MM TWIST DRILL W/AO F,9396681,CDM,272,RC,,HCPCS,outpatient,,,"$2,762.50 ","$2,071.88 ",,"$2,541.50 ",92,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,519.38 ","$2,679.63 ",other,,Not applicable. No negotiated rates per contract,"$2,375.75 ",86,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,210.00 ",80,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,624.38 ",95,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,071.88 ",75,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,679.63 ",97,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,348.13 ",85,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,486.25 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,624.38 ",90,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,519.38 ",55,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,569.13 ",93,,,"$1,519.38 ","$2,679.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO DRILL BIT AO DIA 2.6MM X 135MM SCALED,9396686,CDM,272,RC,,HCPCS,outpatient,,,"$1,423.75 ","$1,067.81 ",,"$1,309.85 ",92,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$783.06 ,"$1,381.04 ",other,,Not applicable. No negotiated rates per contract,"$1,224.43 ",86,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,139.00 ",80,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.56 ",95,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,352.56 ",95,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,067.81 ",75,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,210.19 ",85,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,281.38 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,210.19 ",85,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,281.38 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.56 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,324.09 ",93,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO OVERDRILL AO DIA 2.7MM X 122MM,9396687,CDM,272,RC,,HCPCS,outpatient,,,"$1,385.50 ","$1,039.13 ",,"$1,274.66 ",92,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$762.03 ,55,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$762.03 ,"$1,343.94 ",other,,Not applicable. No negotiated rates per contract,"$1,191.53 ",86,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,108.40 ",80,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$762.03 ,55,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.23 ",95,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,316.23 ",95,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,039.13 ",75,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,177.68 ",85,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,343.94 ",97,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$762.03 ,55,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,246.95 ",90,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,343.94 ",97,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,343.94 ",97,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,343.94 ",97,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,177.68 ",85,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,246.95 ",90,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.03 ,55,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,316.23 ",90,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$762.03 ,55,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,288.52 ",93,,,$762.03 ,"$1,343.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO TRIDENT II TRITANIUM CLUSTERHOLE ACETABULAR SHELL SZ 46MM ALPH CODE C,10068681,CDM,278,RC,,HCPCS,both,,,"$5,517.53 ","$4,138.15 ",,"$5,076.13 ",92,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,034.64 ","$5,352.00 ",other,,Not applicable. No negotiated rates per contract,"$4,745.08 ",86,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,414.02 ",80,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,241.65 ",95,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,241.65 ",95,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,138.15 ",75,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,689.90 ",85,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,965.78 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,689.90 ",85,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,965.78 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,241.65 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,131.30 ",93,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,10491522,CDM,278,RC,55950,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,11128074,CDM,278,RC,56186,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9396675,CDM,272,RC,,HCPCS,outpatient,,,"$1,895.50 ","$1,421.63 ",,"$1,743.86 ",92,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.53 ","$1,838.64 ",other,,Not applicable. No negotiated rates per contract,"$1,630.13 ",86,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.40 ",80,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.73 ",95,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,800.73 ",95,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,421.63 ",75,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,611.18 ",85,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.95 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.18 ",85,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,705.95 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.73 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.82 ",93,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9396676,CDM,272,RC,,HCPCS,outpatient,,,"$1,895.50 ","$1,421.63 ",,"$1,743.86 ",92,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.53 ","$1,838.64 ",other,,Not applicable. No negotiated rates per contract,"$1,630.13 ",86,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.40 ",80,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.73 ",95,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,800.73 ",95,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,421.63 ",75,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,611.18 ",85,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,705.95 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,838.64 ",97,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.18 ",85,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,705.95 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,800.73 ",90,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.53 ",55,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,762.82 ",93,,,"$1,042.53 ","$1,838.64 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,10068794,CDM,278,RC,55705,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9199199,CDM,278,RC,54890,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,10068790,CDM,278,RC,55703,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9199198,CDM,278,RC,54889,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9611451,CDM,278,RC,55293,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,10068788,CDM,278,RC,55702,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9396677,CDM,272,RC,,HCPCS,outpatient,,,$945.25 ,$708.94 ,,$869.63 ,92,,,$519.89 ,$916.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$519.89 ,$916.89 ,other,,Not applicable. No negotiated rates per contract,$812.92 ,86,,,$519.89 ,$916.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$756.20 ,80,,,$519.89 ,$916.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.94 ,75,,,$519.89 ,$916.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.08 ,93,,,$519.89 ,$916.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9396680,CDM,272,RC,,HCPCS,outpatient,,,$945.25 ,$708.94 ,,$869.63 ,92,,,$519.89 ,$916.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$519.89 ,$916.89 ,other,,Not applicable. No negotiated rates per contract,$812.92 ,86,,,$519.89 ,$916.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$756.20 ,80,,,$519.89 ,$916.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.94 ,75,,,$519.89 ,$916.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.08 ,93,,,$519.89 ,$916.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9396683,CDM,272,RC,,HCPCS,outpatient,,,$945.25 ,$708.94 ,,$869.63 ,92,,,$519.89 ,$916.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$519.89 ,$916.89 ,other,,Not applicable. No negotiated rates per contract,$812.92 ,86,,,$519.89 ,$916.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$756.20 ,80,,,$519.89 ,$916.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$897.99 ,95,,,$519.89 ,$916.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$708.94 ,75,,,$519.89 ,$916.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$916.89 ,97,,,$519.89 ,$916.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$803.46 ,85,,,$519.89 ,$916.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$850.73 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$897.99 ,90,,,$519.89 ,$916.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.89 ,55,,,$519.89 ,$916.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$879.08 ,93,,,$519.89 ,$916.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9953144,CDM,278,RC,,HCPCS,both,,,$871.25 ,$653.44 ,,$801.55 ,92,,,$479.19 ,$845.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$479.19 ,$845.11 ,other,,Not applicable. No negotiated rates per contract,$749.28 ,86,,,$479.19 ,$845.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$697.00 ,80,,,$479.19 ,$845.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$653.44 ,75,,,$479.19 ,$845.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.26 ,93,,,$479.19 ,$845.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9953147,CDM,278,RC,,HCPCS,both,,,$871.25 ,$653.44 ,,$801.55 ,92,,,$479.19 ,$845.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$479.19 ,$845.11 ,other,,Not applicable. No negotiated rates per contract,$749.28 ,86,,,$479.19 ,$845.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$697.00 ,80,,,$479.19 ,$845.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$827.69 ,95,,,$479.19 ,$845.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$653.44 ,75,,,$479.19 ,$845.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$845.11 ,97,,,$479.19 ,$845.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$740.56 ,85,,,$479.19 ,$845.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$784.13 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$827.69 ,90,,,$479.19 ,$845.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$479.19 ,55,,,$479.19 ,$845.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$810.26 ,93,,,$479.19 ,$845.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9235469,CDM,278,RC,54933,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9793615,CDM,278,RC,55410,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9396674,CDM,272,RC,,HCPCS,outpatient,,,"$5,115.00 ","$3,836.25 ",,"$4,705.80 ",92,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,813.25 ",55,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,813.25 ","$4,961.55 ",other,,Not applicable. No negotiated rates per contract,"$4,398.90 ",86,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,092.00 ",80,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,813.25 ",55,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,859.25 ",95,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,859.25 ",95,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,836.25 ",75,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,347.75 ",85,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,961.55 ",97,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,813.25 ",55,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,603.50 ",90,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,961.55 ",97,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,961.55 ",97,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,961.55 ",97,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,347.75 ",85,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,603.50 ",90,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,813.25 ",55,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,859.25 ",90,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,813.25 ",55,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,756.95 ",93,,,"$2,813.25 ","$4,961.55 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9361859,CDM,278,RC,55012,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9361857,CDM,278,RC,55010,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9953142,CDM,278,RC,,HCPCS,both,,,"$1,598.00 ","$1,198.50 ",,"$1,470.16 ",92,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$878.90 ,"$1,550.06 ",other,,Not applicable. No negotiated rates per contract,"$1,374.28 ",86,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,278.40 ",80,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,518.10 ",95,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,518.10 ",95,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,198.50 ",75,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,358.30 ",85,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,438.20 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,358.30 ",85,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,438.20 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,518.10 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,486.14 ",93,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9953143,CDM,278,RC,,HCPCS,both,,,"$1,598.00 ","$1,198.50 ",,"$1,470.16 ",92,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$878.90 ,"$1,550.06 ",other,,Not applicable. No negotiated rates per contract,"$1,374.28 ",86,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,278.40 ",80,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,518.10 ",95,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,518.10 ",95,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,198.50 ",75,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,358.30 ",85,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,438.20 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,550.06 ",97,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,358.30 ",85,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,438.20 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,518.10 ",90,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$878.90 ,55,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,486.14 ",93,,,$878.90 ,"$1,550.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9953136,CDM,278,RC,,HCPCS,both,,,"$6,534.00 ","$4,900.50 ",,"$6,011.28 ",92,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,593.70 ",55,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,593.70 ","$6,337.98 ",other,,Not applicable. No negotiated rates per contract,"$5,619.24 ",86,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,227.20 ",80,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,593.70 ",55,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,207.30 ",95,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,207.30 ",95,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,900.50 ",75,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,553.90 ",85,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,337.98 ",97,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,593.70 ",55,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,880.60 ",90,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,337.98 ",97,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,337.98 ",97,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,337.98 ",97,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,553.90 ",85,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,880.60 ",90,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,593.70 ",55,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,207.30 ",90,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,593.70 ",55,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,076.62 ",93,,,"$3,593.70 ","$6,337.98 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHO,9199197,CDM,278,RC,54887,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9611449,CDM,278,RC,55292,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9199202,CDM,272,RC,54893,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHO,9548214,CDM,278,RC,55195,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDIC TRIATHLON CRUCIATE RETAINING FEMORAL SZ#3 SIDE LEFT,9130729,CDM,278,RC,,HCPCS,both,,,"$6,487.26 ","$4,865.45 ",,"$5,968.28 ",92,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,567.99 ",55,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,567.99 ","$6,292.64 ",other,,Not applicable. No negotiated rates per contract,"$5,579.04 ",86,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,189.81 ",80,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,567.99 ",55,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,162.90 ",95,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,162.90 ",95,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,865.45 ",75,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,514.17 ",85,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,292.64 ",97,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,567.99 ",55,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,838.53 ",90,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,292.64 ",97,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,292.64 ",97,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,292.64 ",97,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,514.17 ",85,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,838.53 ",90,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,567.99 ",55,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,162.90 ",90,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,567.99 ",55,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,033.15 ",93,,,"$3,567.99 ","$6,292.64 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS ACCOLADE II 127 DEGREE NECK ANGLE HIP STEM,9071469,CDM,270,RC,54724,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDICS SIMPLEX BONE CEMENT,9130737,CDM,278,RC,,HCPCS,both,,,$535.50 ,$401.63 ,,$492.66 ,92,,,$294.53 ,$519.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$294.53 ,55,,,$294.53 ,$519.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$294.53 ,$519.44 ,other,,Not applicable. No negotiated rates per contract,$460.53 ,86,,,$294.53 ,$519.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$428.40 ,80,,,$294.53 ,$519.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$294.53 ,55,,,$294.53 ,$519.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.73 ,95,,,$294.53 ,$519.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$508.73 ,95,,,$294.53 ,$519.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$401.63 ,75,,,$294.53 ,$519.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$455.18 ,85,,,$294.53 ,$519.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$519.44 ,97,,,$294.53 ,$519.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.53 ,55,,,$294.53 ,$519.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$481.95 ,90,,,$294.53 ,$519.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$519.44 ,97,,,$294.53 ,$519.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.44 ,97,,,$294.53 ,$519.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$519.44 ,97,,,$294.53 ,$519.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$455.18 ,85,,,$294.53 ,$519.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$481.95 ,90,,,$294.53 ,$519.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.53 ,55,,,$294.53 ,$519.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.73 ,90,,,$294.53 ,$519.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$294.53 ,55,,,$294.53 ,$519.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$498.02 ,93,,,$294.53 ,$519.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TORX CANCELLOUS BONE SCREW 8.5MM 20MM,9068106,CDM,270,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDICS TORX CANCELLOUS BONE SCREW 6.5MM 20MM,9068107,CDM,270,RC,,HCPCS,outpatient,,,$630.63 ,$472.97 ,,$580.18 ,92,,,$346.85 ,$611.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$346.85 ,$611.71 ,other,,Not applicable. No negotiated rates per contract,$542.34 ,86,,,$346.85 ,$611.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$504.50 ,80,,,$346.85 ,$611.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.97 ,75,,,$346.85 ,$611.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$586.49 ,93,,,$346.85 ,$611.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TORX CANCELLOUS BONE SCREW 6.5MM 30MM,9068110,CDM,270,RC,,HCPCS,outpatient,,,$630.63 ,$472.97 ,,$580.18 ,92,,,$346.85 ,$611.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$346.85 ,$611.71 ,other,,Not applicable. No negotiated rates per contract,$542.34 ,86,,,$346.85 ,$611.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$504.50 ,80,,,$346.85 ,$611.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$599.10 ,95,,,$346.85 ,$611.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$472.97 ,75,,,$346.85 ,$611.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$611.71 ,97,,,$346.85 ,$611.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$536.04 ,85,,,$346.85 ,$611.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$567.57 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$599.10 ,90,,,$346.85 ,$611.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$346.85 ,55,,,$346.85 ,$611.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$586.49 ,93,,,$346.85 ,$611.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TRIATHLON CRUCIATE RETAINING FEMORAL SZ #6,9077886,CDM,278,RC,54728,HCPCS,both,,,"$6,457.26 ","$4,842.95 ",,"$5,940.68 ",92,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,551.49 ",55,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,551.49 ","$6,263.54 ",other,,Not applicable. No negotiated rates per contract,"$5,553.24 ",86,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,165.81 ",80,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,551.49 ",55,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,134.40 ",95,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,134.40 ",95,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,842.95 ",75,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,488.67 ",85,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,263.54 ",97,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,551.49 ",55,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,811.53 ",90,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,263.54 ",97,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,263.54 ",97,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,263.54 ",97,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,488.67 ",85,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,811.53 ",90,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,551.49 ",55,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,134.40 ",90,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,551.49 ",55,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,005.25 ",93,,,"$3,551.49 ","$6,263.54 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TRIATHLON X3,9077889,CDM,278,RC,54729,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDICS TRIATHLON PRIMARY TIBIAL BASEPLATE,9077892,CDM,278,RC,,HCPCS,both,,,"$5,068.20 ","$3,801.15 ",,"$4,662.74 ",92,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,787.51 ","$4,916.15 ",other,,Not applicable. No negotiated rates per contract,"$4,358.65 ",86,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,054.56 ",80,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,801.15 ",75,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,713.43 ",93,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TRIATHLON X3 ASYMMETRIC PATELLSZ A35,9077895,CDM,278,RC,,HCPCS,both,,,"$3,316.11 ","$2,487.08 ",,"$3,050.82 ",92,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,823.86 ",55,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,823.86 ","$3,216.63 ",other,,Not applicable. No negotiated rates per contract,"$2,851.85 ",86,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,652.89 ",80,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,823.86 ",55,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,150.30 ",95,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,150.30 ",95,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,487.08 ",75,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,818.69 ",85,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,216.63 ",97,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,823.86 ",55,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,984.50 ",90,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,216.63 ",97,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,216.63 ",97,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,216.63 ",97,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,818.69 ",85,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,984.50 ",90,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,823.86 ",55,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,150.30 ",90,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,823.86 ",55,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,083.98 ",93,,,"$1,823.86 ","$3,216.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TRIDENT PSL HA CLUSTER ACETABULAR SHELL SZ 52MM ALPH CODE E,9055124,CDM,270,RC,,HCPCS,outpatient,,,"$5,068.20 ","$3,801.15 ",,"$4,662.74 ",92,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,787.51 ","$4,916.15 ",other,,Not applicable. No negotiated rates per contract,"$4,358.65 ",86,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,054.56 ",80,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,814.79 ",95,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,801.15 ",75,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,916.15 ",97,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,307.97 ",85,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,561.38 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,814.79 ",90,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,787.51 ",55,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,713.43 ",93,,,"$2,787.51 ","$4,916.15 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS TRIDENT II TRITANIUM CLUSTERHOLE ACETABULAR SHELL SZ 52MM ALPH CODE E,9071472,CDM,278,RC,,HCPCS,both,,,"$5,517.53 ","$4,138.15 ",,"$5,076.13 ",92,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,034.64 ","$5,352.00 ",other,,Not applicable. No negotiated rates per contract,"$4,745.08 ",86,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,414.02 ",80,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,241.65 ",95,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,241.65 ",95,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,138.15 ",75,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,689.90 ",85,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,965.78 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,352.00 ",97,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,689.90 ",85,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,965.78 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,241.65 ",90,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,034.64 ",55,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,131.30 ",93,,,"$3,034.64 ","$5,352.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS,9077898,CDM,270,RC,54732,HCPCS,outpatient,,,"$2,101.63 ","$1,576.22 ",,"$1,933.50 ",92,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,155.90 ",55,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,155.90 ","$2,038.58 ",other,,Not applicable. No negotiated rates per contract,"$1,807.40 ",86,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,681.30 ",80,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,155.90 ",55,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,996.55 ",95,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,996.55 ",95,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,576.22 ",75,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,786.39 ",85,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,038.58 ",97,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,155.90 ",55,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,891.47 ",90,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,038.58 ",97,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,038.58 ",97,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,038.58 ",97,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,786.39 ",85,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,891.47 ",90,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.90 ",55,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,996.55 ",90,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,155.90 ",55,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,954.52 ",93,,,"$1,155.90 ","$2,038.58 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS,10094251,CDM,278,RC,55723,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDICS,9953145,CDM,272,RC,,HCPCS,outpatient,,,"$1,423.75 ","$1,067.81 ",,"$1,309.85 ",92,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$783.06 ,"$1,381.04 ",other,,Not applicable. No negotiated rates per contract,"$1,224.43 ",86,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,139.00 ",80,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.56 ",95,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,352.56 ",95,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,067.81 ",75,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,210.19 ",85,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,281.38 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,381.04 ",97,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,210.19 ",85,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,281.38 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,352.56 ",90,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$783.06 ,55,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,324.09 ",93,,,$783.06 ,"$1,381.04 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER ORTHOPAEDICS,9071466,CDM,278,RC,54723,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER ORTHOPAEDICS,9170003,CDM,278,RC,54850,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STRYKER REPAIR/ CORE MIR,8786755,CDM,270,RC,,HCPCS,outpatient,,,"$4,106.25 ","$3,079.69 ",,"$3,777.75 ",92,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,258.44 ",55,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,258.44 ","$3,983.06 ",other,,Not applicable. No negotiated rates per contract,"$3,531.38 ",86,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,285.00 ",80,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,258.44 ",55,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,900.94 ",95,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,900.94 ",95,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,079.69 ",75,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,490.31 ",85,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,983.06 ",97,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,258.44 ",55,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,695.63 ",90,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,983.06 ",97,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,983.06 ",97,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,983.06 ",97,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,490.31 ",85,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,695.63 ",90,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,258.44 ",55,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,900.94 ",90,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,258.44 ",55,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,818.81 ",93,,,"$2,258.44 ","$3,983.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER,9130739,CDM,270,RC,,HCPCS,outpatient,,,$315.50 ,$236.63 ,,$290.26 ,92,,,$173.53 ,$306.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$173.53 ,$306.04 ,other,,Not applicable. No negotiated rates per contract,$271.33 ,86,,,$173.53 ,$306.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$252.40 ,80,,,$173.53 ,$306.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.73 ,95,,,$173.53 ,$306.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.73 ,95,,,$173.53 ,$306.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$236.63 ,75,,,$173.53 ,$306.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$268.18 ,85,,,$173.53 ,$306.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$283.95 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.04 ,97,,,$173.53 ,$306.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.18 ,85,,,$173.53 ,$306.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$283.95 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$299.73 ,90,,,$173.53 ,$306.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.53 ,55,,,$173.53 ,$306.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.42 ,93,,,$173.53 ,$306.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER,8786801,CDM,270,RC,,HCPCS,outpatient,,,$171.83 ,$128.87 ,,$158.08 ,92,,,$94.51 ,$166.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.51 ,$166.68 ,other,,Not applicable. No negotiated rates per contract,$147.77 ,86,,,$94.51 ,$166.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.46 ,80,,,$94.51 ,$166.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.87 ,75,,,$94.51 ,$166.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.80 ,93,,,$94.51 ,$166.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STRYKER,8786802,CDM,270,RC,,HCPCS,outpatient,,,$171.83 ,$128.87 ,,$158.08 ,92,,,$94.51 ,$166.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.51 ,$166.68 ,other,,Not applicable. No negotiated rates per contract,$147.77 ,86,,,$94.51 ,$166.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.46 ,80,,,$94.51 ,$166.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.24 ,95,,,$94.51 ,$166.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.87 ,75,,,$94.51 ,$166.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.68 ,97,,,$94.51 ,$166.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.06 ,85,,,$94.51 ,$166.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.65 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.24 ,90,,,$94.51 ,$166.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.51 ,55,,,$94.51 ,$166.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.80 ,93,,,$94.51 ,$166.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
STYKER ORTHO,9199196,CDM,278,RC,54886,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
STYKER ORTHO,9611447,CDM,278,RC,55291,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
SUCTION 10FR SUCTION CAT,8783048,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 12FR SUCTION CATH,8785044,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 14FR SUCTION CATH,8785045,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 16 FR SUCTION CATH,8783013,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 18FR SUCTION CAT,8783047,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 5/6 FR SUCTION C,8783049,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION 8FR SUCTION CATH,8785043,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION CANISTER 1200ML,8785656,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION CANISTER 2000ML,8785657,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION COAGULATOR 12FR,8781931,CDM,270,RC,,HCPCS,outpatient,,,$88.43 ,$66.32 ,,$81.36 ,92,,,$48.64 ,$85.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$48.64 ,55,,,$48.64 ,$85.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$48.64 ,$85.78 ,other,,Not applicable. No negotiated rates per contract,$76.05 ,86,,,$48.64 ,$85.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$70.74 ,80,,,$48.64 ,$85.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$48.64 ,55,,,$48.64 ,$85.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.01 ,95,,,$48.64 ,$85.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.01 ,95,,,$48.64 ,$85.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.32 ,75,,,$48.64 ,$85.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.17 ,85,,,$48.64 ,$85.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$85.78 ,97,,,$48.64 ,$85.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.64 ,55,,,$48.64 ,$85.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$79.59 ,90,,,$48.64 ,$85.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.78 ,97,,,$48.64 ,$85.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.78 ,97,,,$48.64 ,$85.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.78 ,97,,,$48.64 ,$85.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.17 ,85,,,$48.64 ,$85.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.59 ,90,,,$48.64 ,$85.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.64 ,55,,,$48.64 ,$85.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.01 ,90,,,$48.64 ,$85.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.64 ,55,,,$48.64 ,$85.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.24 ,93,,,$48.64 ,$85.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTION TUBING N610,8785583,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUCTON YANKUER,8785747,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUPPORT  8"" RIB BELT MALE UN",8785122,CDM,270,RC,,HCPCS,outpatient,,,$59.48 ,$44.61 ,,$54.72 ,92,,,$32.71 ,$57.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.71 ,55,,,$32.71 ,$57.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.71 ,$57.70 ,other,,Not applicable. No negotiated rates per contract,$51.15 ,86,,,$32.71 ,$57.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.58 ,80,,,$32.71 ,$57.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.71 ,55,,,$32.71 ,$57.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.51 ,95,,,$32.71 ,$57.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.51 ,95,,,$32.71 ,$57.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.61 ,75,,,$32.71 ,$57.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.56 ,85,,,$32.71 ,$57.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.70 ,97,,,$32.71 ,$57.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.71 ,55,,,$32.71 ,$57.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.53 ,90,,,$32.71 ,$57.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.70 ,97,,,$32.71 ,$57.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.70 ,97,,,$32.71 ,$57.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.70 ,97,,,$32.71 ,$57.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.56 ,85,,,$32.71 ,$57.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.53 ,90,,,$32.71 ,$57.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.71 ,55,,,$32.71 ,$57.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.51 ,90,,,$32.71 ,$57.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.71 ,55,,,$32.71 ,$57.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.32 ,93,,,$32.71 ,$57.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT  X-SMALL LEFT CTS WRIST,8785117,CDM,270,RC,,HCPCS,outpatient,,,$45.95 ,$34.46 ,,$42.27 ,92,,,$25.27 ,$44.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.27 ,55,,,$25.27 ,$44.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.27 ,$44.57 ,other,,Not applicable. No negotiated rates per contract,$39.52 ,86,,,$25.27 ,$44.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.76 ,80,,,$25.27 ,$44.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.27 ,55,,,$25.27 ,$44.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.65 ,95,,,$25.27 ,$44.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.65 ,95,,,$25.27 ,$44.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.46 ,75,,,$25.27 ,$44.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.06 ,85,,,$25.27 ,$44.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.57 ,97,,,$25.27 ,$44.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.27 ,55,,,$25.27 ,$44.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.36 ,90,,,$25.27 ,$44.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.57 ,97,,,$25.27 ,$44.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.57 ,97,,,$25.27 ,$44.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.57 ,97,,,$25.27 ,$44.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.06 ,85,,,$25.27 ,$44.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.36 ,90,,,$25.27 ,$44.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.27 ,55,,,$25.27 ,$44.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.65 ,90,,,$25.27 ,$44.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.27 ,55,,,$25.27 ,$44.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.73 ,93,,,$25.27 ,$44.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST LG LEFT,8785120,CDM,270,RC,,HCPCS,outpatient,,,$48.51 ,$36.38 ,,$44.63 ,92,,,$26.68 ,$47.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.68 ,$47.05 ,other,,Not applicable. No negotiated rates per contract,$41.72 ,86,,,$26.68 ,$47.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.81 ,80,,,$26.68 ,$47.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.08 ,95,,,$26.68 ,$47.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.08 ,95,,,$26.68 ,$47.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.38 ,75,,,$26.68 ,$47.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.23 ,85,,,$26.68 ,$47.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.66 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.23 ,85,,,$26.68 ,$47.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.66 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.08 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.11 ,93,,,$26.68 ,$47.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST LG RIGHT (79-87157 ),8785115,CDM,270,RC,,HCPCS,outpatient,,,$47.36 ,$35.52 ,,$43.57 ,92,,,$26.05 ,$45.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.05 ,$45.94 ,other,,Not applicable. No negotiated rates per contract,$40.73 ,86,,,$26.05 ,$45.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.89 ,80,,,$26.05 ,$45.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.99 ,95,,,$26.05 ,$45.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.99 ,95,,,$26.05 ,$45.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.52 ,75,,,$26.05 ,$45.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.26 ,85,,,$26.05 ,$45.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.62 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,85,,,$26.05 ,$45.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.62 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.99 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.04 ,93,,,$26.05 ,$45.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST MED LEFT (79-87165),8785119,CDM,270,RC,,HCPCS,outpatient,,,$47.44 ,$35.58 ,,$43.64 ,92,,,$26.09 ,$46.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.09 ,55,,,$26.09 ,$46.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.09 ,$46.02 ,other,,Not applicable. No negotiated rates per contract,$40.80 ,86,,,$26.09 ,$46.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.95 ,80,,,$26.09 ,$46.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.09 ,55,,,$26.09 ,$46.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.07 ,95,,,$26.09 ,$46.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.07 ,95,,,$26.09 ,$46.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.58 ,75,,,$26.09 ,$46.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.32 ,85,,,$26.09 ,$46.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.02 ,97,,,$26.09 ,$46.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.09 ,55,,,$26.09 ,$46.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.70 ,90,,,$26.09 ,$46.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.02 ,97,,,$26.09 ,$46.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.02 ,97,,,$26.09 ,$46.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.02 ,97,,,$26.09 ,$46.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.32 ,85,,,$26.09 ,$46.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.70 ,90,,,$26.09 ,$46.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.09 ,55,,,$26.09 ,$46.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.07 ,90,,,$26.09 ,$46.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.09 ,55,,,$26.09 ,$46.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.12 ,93,,,$26.09 ,$46.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST MED RIGHT (79-87155),8785114,CDM,270,RC,,HCPCS,outpatient,,,$47.11 ,$35.33 ,,$43.34 ,92,,,$25.91 ,$45.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.91 ,55,,,$25.91 ,$45.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.91 ,$45.70 ,other,,Not applicable. No negotiated rates per contract,$40.51 ,86,,,$25.91 ,$45.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.69 ,80,,,$25.91 ,$45.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.91 ,55,,,$25.91 ,$45.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.75 ,95,,,$25.91 ,$45.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.75 ,95,,,$25.91 ,$45.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.33 ,75,,,$25.91 ,$45.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.04 ,85,,,$25.91 ,$45.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.70 ,97,,,$25.91 ,$45.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.91 ,55,,,$25.91 ,$45.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.40 ,90,,,$25.91 ,$45.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.70 ,97,,,$25.91 ,$45.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.70 ,97,,,$25.91 ,$45.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.70 ,97,,,$25.91 ,$45.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.04 ,85,,,$25.91 ,$45.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.40 ,90,,,$25.91 ,$45.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.91 ,55,,,$25.91 ,$45.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.75 ,90,,,$25.91 ,$45.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.91 ,55,,,$25.91 ,$45.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.81 ,93,,,$25.91 ,$45.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST XLG LE,8785121,CDM,270,RC,,HCPCS,outpatient,,,$46.53 ,$34.90 ,,$42.81 ,92,,,$25.59 ,$45.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.59 ,$45.13 ,other,,Not applicable. No negotiated rates per contract,$40.02 ,86,,,$25.59 ,$45.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.22 ,80,,,$25.59 ,$45.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.20 ,95,,,$25.59 ,$45.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.90 ,75,,,$25.59 ,$45.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.13 ,97,,,$25.59 ,$45.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.55 ,85,,,$25.59 ,$45.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.88 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.20 ,90,,,$25.59 ,$45.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.59 ,55,,,$25.59 ,$45.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.27 ,93,,,$25.59 ,$45.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT CTS WRIST XLG RIGHT,8785116,CDM,270,RC,L3809,HCPCS,outpatient,,,$47.36 ,$35.52 ,,$43.57 ,92,,,$26.05 ,$45.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.05 ,$45.94 ,other,,Not applicable. No negotiated rates per contract,$40.73 ,86,,,$26.05 ,$45.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.89 ,80,,,$26.05 ,$45.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.99 ,95,,,$26.05 ,$45.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.99 ,95,,,$26.05 ,$45.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.52 ,75,,,$26.05 ,$45.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.26 ,85,,,$26.05 ,$45.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.62 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.94 ,97,,,$26.05 ,$45.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,85,,,$26.05 ,$45.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.62 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.99 ,90,,,$26.05 ,$45.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.05 ,55,,,$26.05 ,$45.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.04 ,93,,,$26.05 ,$45.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT HEELBO,8785422,CDM,270,RC,,HCPCS,outpatient,,,$74.66 ,$56.00 ,,$68.69 ,92,,,$41.06 ,$72.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.06 ,55,,,$41.06 ,$72.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.06 ,$72.42 ,other,,Not applicable. No negotiated rates per contract,$64.21 ,86,,,$41.06 ,$72.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.73 ,80,,,$41.06 ,$72.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.06 ,55,,,$41.06 ,$72.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.93 ,95,,,$41.06 ,$72.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.93 ,95,,,$41.06 ,$72.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.00 ,75,,,$41.06 ,$72.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.46 ,85,,,$41.06 ,$72.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.42 ,97,,,$41.06 ,$72.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.06 ,55,,,$41.06 ,$72.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$67.19 ,90,,,$41.06 ,$72.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$72.42 ,97,,,$41.06 ,$72.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.42 ,97,,,$41.06 ,$72.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$72.42 ,97,,,$41.06 ,$72.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.46 ,85,,,$41.06 ,$72.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.19 ,90,,,$41.06 ,$72.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.06 ,55,,,$41.06 ,$72.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.93 ,90,,,$41.06 ,$72.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.06 ,55,,,$41.06 ,$72.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.43 ,93,,,$41.06 ,$72.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT KNEE J-LAT LATER,8786139,CDM,270,RC,,HCPCS,outpatient,,,$206.99 ,$155.24 ,,$190.43 ,92,,,$113.84 ,$200.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$113.84 ,55,,,$113.84 ,$200.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$113.84 ,$200.78 ,other,,Not applicable. No negotiated rates per contract,$178.01 ,86,,,$113.84 ,$200.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$165.59 ,80,,,$113.84 ,$200.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$113.84 ,55,,,$113.84 ,$200.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.64 ,95,,,$113.84 ,$200.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$196.64 ,95,,,$113.84 ,$200.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$155.24 ,75,,,$113.84 ,$200.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$175.94 ,85,,,$113.84 ,$200.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$200.78 ,97,,,$113.84 ,$200.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.84 ,55,,,$113.84 ,$200.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$186.29 ,90,,,$113.84 ,$200.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$200.78 ,97,,,$113.84 ,$200.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.78 ,97,,,$113.84 ,$200.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.78 ,97,,,$113.84 ,$200.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$175.94 ,85,,,$113.84 ,$200.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.29 ,90,,,$113.84 ,$200.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.84 ,55,,,$113.84 ,$200.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.64 ,90,,,$113.84 ,$200.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$113.84 ,55,,,$113.84 ,$200.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$192.50 ,93,,,$113.84 ,$200.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT NEOPRENE TENNIS,8786127,CDM,270,RC,,HCPCS,outpatient,,,$64.76 ,$48.57 ,,$59.58 ,92,,,$35.62 ,$62.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$35.62 ,55,,,$35.62 ,$62.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$35.62 ,$62.82 ,other,,Not applicable. No negotiated rates per contract,$55.69 ,86,,,$35.62 ,$62.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$51.81 ,80,,,$35.62 ,$62.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$35.62 ,55,,,$35.62 ,$62.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.52 ,95,,,$35.62 ,$62.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.52 ,95,,,$35.62 ,$62.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.57 ,75,,,$35.62 ,$62.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$55.05 ,85,,,$35.62 ,$62.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.82 ,97,,,$35.62 ,$62.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.62 ,55,,,$35.62 ,$62.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$58.28 ,90,,,$35.62 ,$62.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.82 ,97,,,$35.62 ,$62.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.82 ,97,,,$35.62 ,$62.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.82 ,97,,,$35.62 ,$62.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.05 ,85,,,$35.62 ,$62.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.28 ,90,,,$35.62 ,$62.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.62 ,55,,,$35.62 ,$62.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.52 ,90,,,$35.62 ,$62.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.62 ,55,,,$35.62 ,$62.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.23 ,93,,,$35.62 ,$62.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT SMALL LEFT CTS WRIST,8785118,CDM,270,RC,,HCPCS,outpatient,,,$46.86 ,$35.15 ,,$43.11 ,92,,,$25.77 ,$45.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.77 ,$45.45 ,other,,Not applicable. No negotiated rates per contract,$40.30 ,86,,,$25.77 ,$45.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.49 ,80,,,$25.77 ,$45.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.52 ,95,,,$25.77 ,$45.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.52 ,95,,,$25.77 ,$45.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,75,,,$25.77 ,$45.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.83 ,85,,,$25.77 ,$45.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.17 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.45 ,97,,,$25.77 ,$45.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.83 ,85,,,$25.77 ,$45.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.17 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.52 ,90,,,$25.77 ,$45.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.77 ,55,,,$25.77 ,$45.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.58 ,93,,,$25.77 ,$45.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUPPORT SMALL RIGHT CTS WRIST (79-87153),8785113,CDM,270,RC,,HCPCS,outpatient,,,$47.19 ,$35.39 ,,$43.41 ,92,,,$25.95 ,$45.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.95 ,$45.77 ,other,,Not applicable. No negotiated rates per contract,$40.58 ,86,,,$25.95 ,$45.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.75 ,80,,,$25.95 ,$45.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.83 ,95,,,$25.95 ,$45.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.39 ,75,,,$25.95 ,$45.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.77 ,97,,,$25.95 ,$45.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.11 ,85,,,$25.95 ,$45.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.47 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.83 ,90,,,$25.95 ,$45.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.95 ,55,,,$25.95 ,$45.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.89 ,93,,,$25.95 ,$45.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUPPORT UNIV.  6"" RIB  BELT",8785137,CDM,270,RC,,HCPCS,outpatient,,,$42.90 ,$32.18 ,,$39.47 ,92,,,$23.60 ,$41.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.60 ,$41.61 ,other,,Not applicable. No negotiated rates per contract,$36.89 ,86,,,$23.60 ,$41.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.32 ,80,,,$23.60 ,$41.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.76 ,95,,,$23.60 ,$41.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.76 ,95,,,$23.60 ,$41.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.18 ,75,,,$23.60 ,$41.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.47 ,85,,,$23.60 ,$41.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.61 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.61 ,97,,,$23.60 ,$41.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.47 ,85,,,$23.60 ,$41.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.61 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.76 ,90,,,$23.60 ,$41.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.60 ,55,,,$23.60 ,$41.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.90 ,93,,,$23.60 ,$41.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUREFIRE SCORPION NEEDLE,9383618,CDM,272,RC,,HCPCS,outpatient,,,$741.00 ,$555.75 ,,$681.72 ,92,,,$407.55 ,$718.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$407.55 ,55,,,$407.55 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$407.55 ,$718.77 ,other,,Not applicable. No negotiated rates per contract,$637.26 ,86,,,$407.55 ,$718.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$592.80 ,80,,,$407.55 ,$718.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$407.55 ,55,,,$407.55 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.95 ,95,,,$407.55 ,$718.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$703.95 ,95,,,$407.55 ,$718.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$555.75 ,75,,,$407.55 ,$718.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$629.85 ,85,,,$407.55 ,$718.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$718.77 ,97,,,$407.55 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$407.55 ,55,,,$407.55 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$666.90 ,90,,,$407.55 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$718.77 ,97,,,$407.55 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$718.77 ,97,,,$407.55 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$718.77 ,97,,,$407.55 ,$718.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$629.85 ,85,,,$407.55 ,$718.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$666.90 ,90,,,$407.55 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.55 ,55,,,$407.55 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$703.95 ,90,,,$407.55 ,$718.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$407.55 ,55,,,$407.55 ,$718.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$689.13 ,93,,,$407.55 ,$718.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SURGICAL EYE SPEARS ( OR,8785380,CDM,270,RC,,HCPCS,outpatient,,,$26.60 ,$19.95 ,,$24.47 ,92,,,$14.63 ,$25.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.63 ,55,,,$14.63 ,$25.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.63 ,$25.80 ,other,,Not applicable. No negotiated rates per contract,$22.88 ,86,,,$14.63 ,$25.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.28 ,80,,,$14.63 ,$25.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.63 ,55,,,$14.63 ,$25.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.27 ,95,,,$14.63 ,$25.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.27 ,95,,,$14.63 ,$25.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.95 ,75,,,$14.63 ,$25.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.61 ,85,,,$14.63 ,$25.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.80 ,97,,,$14.63 ,$25.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.63 ,55,,,$14.63 ,$25.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.94 ,90,,,$14.63 ,$25.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.80 ,97,,,$14.63 ,$25.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.80 ,97,,,$14.63 ,$25.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.80 ,97,,,$14.63 ,$25.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.61 ,85,,,$14.63 ,$25.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.94 ,90,,,$14.63 ,$25.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.63 ,55,,,$14.63 ,$25.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.27 ,90,,,$14.63 ,$25.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.63 ,55,,,$14.63 ,$25.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.74 ,93,,,$14.63 ,$25.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SURGICAL TAPE MICROFOAM 4"" (1528-4)",9055150,CDM,270,RC,,HCPCS,outpatient,,,$54.95 ,$41.21 ,,$50.55 ,92,,,$30.22 ,$53.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$30.22 ,55,,,$30.22 ,$53.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$30.22 ,$53.30 ,other,,Not applicable. No negotiated rates per contract,$47.26 ,86,,,$30.22 ,$53.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$43.96 ,80,,,$30.22 ,$53.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$30.22 ,55,,,$30.22 ,$53.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,95,,,$30.22 ,$53.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.20 ,95,,,$30.22 ,$53.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.21 ,75,,,$30.22 ,$53.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$46.71 ,85,,,$30.22 ,$53.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.30 ,97,,,$30.22 ,$53.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.22 ,55,,,$30.22 ,$53.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.46 ,90,,,$30.22 ,$53.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.30 ,97,,,$30.22 ,$53.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.30 ,97,,,$30.22 ,$53.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.30 ,97,,,$30.22 ,$53.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.71 ,85,,,$30.22 ,$53.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$49.46 ,90,,,$30.22 ,$53.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.22 ,55,,,$30.22 ,$53.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$52.20 ,90,,,$30.22 ,$53.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.22 ,55,,,$30.22 ,$53.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.10 ,93,,,$30.22 ,$53.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SURGICEL,8785421,CDM,270,RC,51161,HCPCS,outpatient,,,$528.99 ,$396.74 ,,$486.67 ,92,,,$290.94 ,$513.12 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$290.94 ,55,,,$290.94 ,$513.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$290.94 ,$513.12 ,other,,Not applicable. No negotiated rates per contract,$454.93 ,86,,,$290.94 ,$513.12 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$423.19 ,80,,,$290.94 ,$513.12 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$290.94 ,55,,,$290.94 ,$513.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$502.54 ,95,,,$290.94 ,$513.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$502.54 ,95,,,$290.94 ,$513.12 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$396.74 ,75,,,$290.94 ,$513.12 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$449.64 ,85,,,$290.94 ,$513.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$513.12 ,97,,,$290.94 ,$513.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$290.94 ,55,,,$290.94 ,$513.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$476.09 ,90,,,$290.94 ,$513.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$513.12 ,97,,,$290.94 ,$513.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.12 ,97,,,$290.94 ,$513.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$513.12 ,97,,,$290.94 ,$513.12 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$449.64 ,85,,,$290.94 ,$513.12 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$476.09 ,90,,,$290.94 ,$513.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.94 ,55,,,$290.94 ,$513.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$502.54 ,90,,,$290.94 ,$513.12 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$290.94 ,55,,,$290.94 ,$513.12 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$491.96 ,93,,,$290.94 ,$513.12 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SURGIMESH WN (OR),8782184,CDM,270,RC,,HCPCS,outpatient,,,"$1,806.25 ","$1,354.69 ",,"$1,661.75 ",92,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$993.44 ,55,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$993.44 ,"$1,752.06 ",other,,Not applicable. No negotiated rates per contract,"$1,553.38 ",86,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,445.00 ",80,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$993.44 ,55,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,715.94 ",95,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,715.94 ",95,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,354.69 ",75,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,535.31 ",85,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,752.06 ",97,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$993.44 ,55,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,625.63 ",90,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,752.06 ",97,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,752.06 ",97,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,752.06 ",97,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,535.31 ",85,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,625.63 ",90,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$993.44 ,55,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,715.94 ",90,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$993.44 ,55,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,679.81 ",93,,,$993.44 ,"$1,752.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SURGIMESH XB (OR),8782183,CDM,270,RC,,HCPCS,outpatient,,,"$3,612.50 ","$2,709.38 ",,"$3,323.50 ",92,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,986.88 ",55,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,986.88 ","$3,504.13 ",other,,Not applicable. No negotiated rates per contract,"$3,106.75 ",86,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,890.00 ",80,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,986.88 ",55,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,431.88 ",95,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,431.88 ",95,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,709.38 ",75,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,070.63 ",85,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,504.13 ",97,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,986.88 ",55,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,251.25 ",90,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,504.13 ",97,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,504.13 ",97,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,504.13 ",97,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,070.63 ",85,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,251.25 ",90,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,986.88 ",55,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,431.88 ",90,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,986.88 ",55,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,359.63 ",93,,,"$1,986.88 ","$3,504.13 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SURIFLO HEMOSTATIC AGENT THROMB,8783774,CDM,270,RC,,HCPCS,outpatient,,,"$5,178.32 ","$3,883.74 ",,"$4,764.05 ",92,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,848.08 ",55,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,848.08 ","$5,022.97 ",other,,Not applicable. No negotiated rates per contract,"$4,453.36 ",86,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$4,142.66 ",80,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,848.08 ",55,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,919.40 ",95,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,919.40 ",95,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,883.74 ",75,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$4,401.57 ",85,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,022.97 ",97,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,848.08 ",55,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,660.49 ",90,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$5,022.97 ",97,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,022.97 ",97,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,022.97 ",97,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,401.57 ",85,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,660.49 ",90,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,848.08 ",55,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,919.40 ",90,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,848.08 ",55,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,815.84 ",93,,,"$2,848.08 ","$5,022.97 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUSPENSION SHOULD TRAY II,9372019,CDM,272,RC,,HCPCS,outpatient,,,$111.37 ,$83.53 ,,$102.46 ,92,,,$61.25 ,$108.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.25 ,55,,,$61.25 ,$108.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$61.25 ,$108.03 ,other,,Not applicable. No negotiated rates per contract,$95.78 ,86,,,$61.25 ,$108.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$89.10 ,80,,,$61.25 ,$108.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.25 ,55,,,$61.25 ,$108.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.80 ,95,,,$61.25 ,$108.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.80 ,95,,,$61.25 ,$108.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.53 ,75,,,$61.25 ,$108.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$94.66 ,85,,,$61.25 ,$108.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.03 ,97,,,$61.25 ,$108.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.25 ,55,,,$61.25 ,$108.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$100.23 ,90,,,$61.25 ,$108.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.03 ,97,,,$61.25 ,$108.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.03 ,97,,,$61.25 ,$108.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.03 ,97,,,$61.25 ,$108.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.66 ,85,,,$61.25 ,$108.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.23 ,90,,,$61.25 ,$108.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.25 ,55,,,$61.25 ,$108.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.80 ,90,,,$61.25 ,$108.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.25 ,55,,,$61.25 ,$108.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.57 ,93,,,$61.25 ,$108.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE  2-0 CT-1 MONOCRYL PLUS (MCP945H),8785634,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE  ETHILON 4-0 699H,8785603,CDM,270,RC,,HCPCS,outpatient,,,$33.69 ,$25.27 ,,$30.99 ,92,,,$18.53 ,$32.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.53 ,55,,,$18.53 ,$32.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.53 ,$32.68 ,other,,Not applicable. No negotiated rates per contract,$28.97 ,86,,,$18.53 ,$32.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.95 ,80,,,$18.53 ,$32.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.53 ,55,,,$18.53 ,$32.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.01 ,95,,,$18.53 ,$32.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.01 ,95,,,$18.53 ,$32.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.27 ,75,,,$18.53 ,$32.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.64 ,85,,,$18.53 ,$32.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.68 ,97,,,$18.53 ,$32.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.53 ,55,,,$18.53 ,$32.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.32 ,90,,,$18.53 ,$32.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.68 ,97,,,$18.53 ,$32.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.68 ,97,,,$18.53 ,$32.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.68 ,97,,,$18.53 ,$32.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.64 ,85,,,$18.53 ,$32.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.32 ,90,,,$18.53 ,$32.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.53 ,55,,,$18.53 ,$32.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.01 ,90,,,$18.53 ,$32.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.53 ,55,,,$18.53 ,$32.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.33 ,93,,,$18.53 ,$32.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE  FIBERWIRE 2  38""",8782100,CDM,270,RC,,HCPCS,outpatient,,,$282.75 ,$212.06 ,,$260.13 ,92,,,$155.51 ,$274.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$155.51 ,$274.27 ,other,,Not applicable. No negotiated rates per contract,$243.17 ,86,,,$155.51 ,$274.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$226.20 ,80,,,$155.51 ,$274.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.61 ,95,,,$155.51 ,$274.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$268.61 ,95,,,$155.51 ,$274.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.06 ,75,,,$155.51 ,$274.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$240.34 ,85,,,$155.51 ,$274.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.48 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.34 ,85,,,$155.51 ,$274.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.48 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.61 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.96 ,93,,,$155.51 ,$274.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE  PERMA-HAND SILK 2-0 FS 18"" (",8785472,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE  PERMA-HAND SILK 3-0 684G,8785442,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE  PERMA-HAND SILK 3-0 18"" SH 8",8785474,CDM,270,RC,,HCPCS,outpatient,,,$63.94 ,$47.96 ,,$58.82 ,92,,,$35.17 ,$62.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$35.17 ,55,,,$35.17 ,$62.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$35.17 ,$62.02 ,other,,Not applicable. No negotiated rates per contract,$54.99 ,86,,,$35.17 ,$62.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$51.15 ,80,,,$35.17 ,$62.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$35.17 ,55,,,$35.17 ,$62.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.74 ,95,,,$35.17 ,$62.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.74 ,95,,,$35.17 ,$62.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.96 ,75,,,$35.17 ,$62.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$54.35 ,85,,,$35.17 ,$62.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.02 ,97,,,$35.17 ,$62.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.17 ,55,,,$35.17 ,$62.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.55 ,90,,,$35.17 ,$62.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$62.02 ,97,,,$35.17 ,$62.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.02 ,97,,,$35.17 ,$62.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.02 ,97,,,$35.17 ,$62.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.35 ,85,,,$35.17 ,$62.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.55 ,90,,,$35.17 ,$62.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.17 ,55,,,$35.17 ,$62.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.74 ,90,,,$35.17 ,$62.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.17 ,55,,,$35.17 ,$62.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.46 ,93,,,$35.17 ,$62.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE  PERMA-HAND SILK 6-0 P-1 18 I,8785439,CDM,270,RC,,HCPCS,outpatient,,,$37.10 ,$27.83 ,,$34.13 ,92,,,$20.41 ,$35.99 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.41 ,55,,,$20.41 ,$35.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.41 ,$35.99 ,other,,Not applicable. No negotiated rates per contract,$31.91 ,86,,,$20.41 ,$35.99 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.68 ,80,,,$20.41 ,$35.99 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.41 ,55,,,$20.41 ,$35.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.25 ,95,,,$20.41 ,$35.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,95,,,$20.41 ,$35.99 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.83 ,75,,,$20.41 ,$35.99 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.54 ,85,,,$20.41 ,$35.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.99 ,97,,,$20.41 ,$35.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.41 ,55,,,$20.41 ,$35.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.39 ,90,,,$20.41 ,$35.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.99 ,97,,,$20.41 ,$35.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.99 ,97,,,$20.41 ,$35.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.99 ,97,,,$20.41 ,$35.99 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.54 ,85,,,$20.41 ,$35.99 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.39 ,90,,,$20.41 ,$35.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.41 ,55,,,$20.41 ,$35.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.25 ,90,,,$20.41 ,$35.99 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.41 ,55,,,$20.41 ,$35.99 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.50 ,93,,,$20.41 ,$35.99 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE #1 CT-1 8425H PROLENE BLUE,8785609,CDM,270,RC,,HCPCS,outpatient,,,$32.55 ,$24.41 ,,$29.95 ,92,,,$17.90 ,$31.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.90 ,$31.57 ,other,,Not applicable. No negotiated rates per contract,$27.99 ,86,,,$17.90 ,$31.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.04 ,80,,,$17.90 ,$31.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.92 ,95,,,$17.90 ,$31.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.92 ,95,,,$17.90 ,$31.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.41 ,75,,,$17.90 ,$31.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.67 ,85,,,$17.90 ,$31.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.30 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.57 ,97,,,$17.90 ,$31.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.67 ,85,,,$17.90 ,$31.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.30 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.92 ,90,,,$17.90 ,$31.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.90 ,55,,,$17.90 ,$31.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.27 ,93,,,$17.90 ,$31.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE #2 MO-7 ORTHOCORD VIOLET,8785419,CDM,270,RC,,HCPCS,outpatient,,,$259.26 ,$194.45 ,,$238.52 ,92,,,$142.59 ,$251.48 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.59 ,55,,,$142.59 ,$251.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.59 ,$251.48 ,other,,Not applicable. No negotiated rates per contract,$222.96 ,86,,,$142.59 ,$251.48 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.41 ,80,,,$142.59 ,$251.48 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.59 ,55,,,$142.59 ,$251.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.30 ,95,,,$142.59 ,$251.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.30 ,95,,,$142.59 ,$251.48 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.45 ,75,,,$142.59 ,$251.48 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.37 ,85,,,$142.59 ,$251.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.48 ,97,,,$142.59 ,$251.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.59 ,55,,,$142.59 ,$251.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.33 ,90,,,$142.59 ,$251.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.48 ,97,,,$142.59 ,$251.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.48 ,97,,,$142.59 ,$251.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.48 ,97,,,$142.59 ,$251.48 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.37 ,85,,,$142.59 ,$251.48 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.33 ,90,,,$142.59 ,$251.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.59 ,55,,,$142.59 ,$251.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.30 ,90,,,$142.59 ,$251.48 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.59 ,55,,,$142.59 ,$251.48 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.11 ,93,,,$142.59 ,$251.48 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 0 CT-1 J946H VICRYL,8785623,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 0 CTB-1 VCPB946H VICRYL,8785466,CDM,270,RC,,HCPCS,outpatient,,,$69.38 ,$52.04 ,,$63.83 ,92,,,$38.16 ,$67.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.16 ,55,,,$38.16 ,$67.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.16 ,$67.30 ,other,,Not applicable. No negotiated rates per contract,$59.67 ,86,,,$38.16 ,$67.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.50 ,80,,,$38.16 ,$67.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.16 ,55,,,$38.16 ,$67.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.91 ,95,,,$38.16 ,$67.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.91 ,95,,,$38.16 ,$67.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.04 ,75,,,$38.16 ,$67.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.97 ,85,,,$38.16 ,$67.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.30 ,97,,,$38.16 ,$67.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.16 ,55,,,$38.16 ,$67.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.44 ,90,,,$38.16 ,$67.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.30 ,97,,,$38.16 ,$67.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.30 ,97,,,$38.16 ,$67.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.30 ,97,,,$38.16 ,$67.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.97 ,85,,,$38.16 ,$67.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.44 ,90,,,$38.16 ,$67.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.16 ,55,,,$38.16 ,$67.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.91 ,90,,,$38.16 ,$67.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.16 ,55,,,$38.16 ,$67.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.52 ,93,,,$38.16 ,$67.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 0 STRATAFIX SPIRIL PGS-PCL,8998367,CDM,270,RC,,HCPCS,outpatient,,,$164.50 ,$123.38 ,,$151.34 ,92,,,$90.48 ,$159.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$90.48 ,$159.57 ,other,,Not applicable. No negotiated rates per contract,$141.47 ,86,,,$90.48 ,$159.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$131.60 ,80,,,$90.48 ,$159.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.28 ,95,,,$90.48 ,$159.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.28 ,95,,,$90.48 ,$159.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$123.38 ,75,,,$90.48 ,$159.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$139.83 ,85,,,$90.48 ,$159.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.05 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.57 ,97,,,$90.48 ,$159.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$139.83 ,85,,,$90.48 ,$159.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.05 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$156.28 ,90,,,$90.48 ,$159.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$90.48 ,55,,,$90.48 ,$159.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.99 ,93,,,$90.48 ,$159.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 0 UR-6 VCP603H VICRYL PLU,8785639,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 0 VICRYL CT-2 UNDYED 27,8998366,CDM,270,RC,,HCPCS,outpatient,,,$32.20 ,$24.15 ,,$29.62 ,92,,,$17.71 ,$31.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.71 ,55,,,$17.71 ,$31.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.71 ,$31.23 ,other,,Not applicable. No negotiated rates per contract,$27.69 ,86,,,$17.71 ,$31.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.76 ,80,,,$17.71 ,$31.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.71 ,55,,,$17.71 ,$31.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.59 ,95,,,$17.71 ,$31.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.59 ,95,,,$17.71 ,$31.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.15 ,75,,,$17.71 ,$31.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.37 ,85,,,$17.71 ,$31.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.23 ,97,,,$17.71 ,$31.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.71 ,55,,,$17.71 ,$31.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.98 ,90,,,$17.71 ,$31.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.23 ,97,,,$17.71 ,$31.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.23 ,97,,,$17.71 ,$31.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.23 ,97,,,$17.71 ,$31.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.37 ,85,,,$17.71 ,$31.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.98 ,90,,,$17.71 ,$31.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.71 ,55,,,$17.71 ,$31.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.59 ,90,,,$17.71 ,$31.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.71 ,55,,,$17.71 ,$31.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.95 ,93,,,$17.71 ,$31.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 1 CT-1 PDS II Z341H,8987118,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 1 CT-1 VCP261H VICRYL PLUS,8785637,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 1 CTX  VCP977H VICRYL PLUS,8785640,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 1 PDO #2 STRATAFIX,8998369,CDM,270,RC,,HCPCS,outpatient,,,$165.52 ,$124.14 ,,$152.28 ,92,,,$91.04 ,$160.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$91.04 ,55,,,$91.04 ,$160.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$91.04 ,$160.55 ,other,,Not applicable. No negotiated rates per contract,$142.35 ,86,,,$91.04 ,$160.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$132.42 ,80,,,$91.04 ,$160.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$91.04 ,55,,,$91.04 ,$160.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.24 ,95,,,$91.04 ,$160.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$157.24 ,95,,,$91.04 ,$160.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.14 ,75,,,$91.04 ,$160.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$140.69 ,85,,,$91.04 ,$160.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.55 ,97,,,$91.04 ,$160.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$91.04 ,55,,,$91.04 ,$160.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$148.97 ,90,,,$91.04 ,$160.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$160.55 ,97,,,$91.04 ,$160.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.55 ,97,,,$91.04 ,$160.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.55 ,97,,,$91.04 ,$160.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.69 ,85,,,$91.04 ,$160.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.97 ,90,,,$91.04 ,$160.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.04 ,55,,,$91.04 ,$160.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.24 ,90,,,$91.04 ,$160.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$91.04 ,55,,,$91.04 ,$160.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.93 ,93,,,$91.04 ,$160.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0  FS 8685H PROLENE,8785611,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0  FS ETHILON BLK M,8785601,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0  SH VCP317 VICRYL PLUS,8785638,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0 CT-1 VCP259H VICRYL,8785636,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0 CT-2 J269H  VICRYL,8785618,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0 J533H VICRYL,8783784,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 2-0 SH   8833H PROLENE,8785604,CDM,270,RC,,HCPCS,outpatient,,,$28.09 ,$21.07 ,,$25.84 ,92,,,$15.45 ,$27.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.45 ,$27.25 ,other,,Not applicable. No negotiated rates per contract,$24.16 ,86,,,$15.45 ,$27.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.47 ,80,,,$15.45 ,$27.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.07 ,75,,,$15.45 ,$27.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.12 ,93,,,$15.45 ,$27.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 27 VICRYL 3-0  PL,8785641,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0  CT-1 27IN VICRYL,8785635,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0  ETHIBOND EXC,8785643,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE 3-0 30"" ETHILON PSL",8785607,CDM,270,RC,,HCPCS,outpatient,,,$30.98 ,$23.24 ,,$28.50 ,92,,,$17.04 ,$30.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.04 ,$30.05 ,other,,Not applicable. No negotiated rates per contract,$26.64 ,86,,,$17.04 ,$30.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.78 ,80,,,$17.04 ,$30.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.24 ,75,,,$17.04 ,$30.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.81 ,93,,,$17.04 ,$30.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0 PS-2 8687H PROLENE,8785612,CDM,270,RC,,HCPCS,outpatient,,,$43.23 ,$32.42 ,,$39.77 ,92,,,$23.78 ,$41.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.78 ,55,,,$23.78 ,$41.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.78 ,$41.93 ,other,,Not applicable. No negotiated rates per contract,$37.18 ,86,,,$23.78 ,$41.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.58 ,80,,,$23.78 ,$41.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.78 ,55,,,$23.78 ,$41.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.07 ,95,,,$23.78 ,$41.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.07 ,95,,,$23.78 ,$41.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.42 ,75,,,$23.78 ,$41.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.75 ,85,,,$23.78 ,$41.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.93 ,97,,,$23.78 ,$41.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.78 ,55,,,$23.78 ,$41.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.91 ,90,,,$23.78 ,$41.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.93 ,97,,,$23.78 ,$41.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.93 ,97,,,$23.78 ,$41.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.93 ,97,,,$23.78 ,$41.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.75 ,85,,,$23.78 ,$41.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.91 ,90,,,$23.78 ,$41.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.78 ,55,,,$23.78 ,$41.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.07 ,90,,,$23.78 ,$41.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.78 ,55,,,$23.78 ,$41.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.20 ,93,,,$23.78 ,$41.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0 STRATAFIX SPIRIL,8998368,CDM,270,RC,,HCPCS,outpatient,,,$150.44 ,$112.83 ,,$138.40 ,92,,,$82.74 ,$145.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.74 ,55,,,$82.74 ,$145.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.74 ,$145.93 ,other,,Not applicable. No negotiated rates per contract,$129.38 ,86,,,$82.74 ,$145.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.35 ,80,,,$82.74 ,$145.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.74 ,55,,,$82.74 ,$145.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.92 ,95,,,$82.74 ,$145.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$142.92 ,95,,,$82.74 ,$145.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.83 ,75,,,$82.74 ,$145.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$127.87 ,85,,,$82.74 ,$145.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.93 ,97,,,$82.74 ,$145.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.74 ,55,,,$82.74 ,$145.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.40 ,90,,,$82.74 ,$145.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.93 ,97,,,$82.74 ,$145.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.93 ,97,,,$82.74 ,$145.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.93 ,97,,,$82.74 ,$145.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$127.87 ,85,,,$82.74 ,$145.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.40 ,90,,,$82.74 ,$145.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.74 ,55,,,$82.74 ,$145.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.92 ,90,,,$82.74 ,$145.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.74 ,55,,,$82.74 ,$145.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.91 ,93,,,$82.74 ,$145.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0 VICRYL  J423H UNDYED,8785622,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 3-0 VICRYL J316H,8785619,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE 4-0  J109T VICRYL 18"" (",8785536,CDM,270,RC,,HCPCS,outpatient,,,$63.86 ,$47.90 ,,$58.75 ,92,,,$35.12 ,$61.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$35.12 ,55,,,$35.12 ,$61.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$35.12 ,$61.94 ,other,,Not applicable. No negotiated rates per contract,$54.92 ,86,,,$35.12 ,$61.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$51.09 ,80,,,$35.12 ,$61.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$35.12 ,55,,,$35.12 ,$61.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.67 ,95,,,$35.12 ,$61.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.67 ,95,,,$35.12 ,$61.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.90 ,75,,,$35.12 ,$61.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$54.28 ,85,,,$35.12 ,$61.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.94 ,97,,,$35.12 ,$61.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.12 ,55,,,$35.12 ,$61.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.47 ,90,,,$35.12 ,$61.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.94 ,97,,,$35.12 ,$61.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.94 ,97,,,$35.12 ,$61.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.94 ,97,,,$35.12 ,$61.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$54.28 ,85,,,$35.12 ,$61.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.47 ,90,,,$35.12 ,$61.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.12 ,55,,,$35.12 ,$61.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$60.67 ,90,,,$35.12 ,$61.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.12 ,55,,,$35.12 ,$61.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$59.39 ,93,,,$35.12 ,$61.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0  PS-1 STRATAFIX SPIRAL MONOCRYL PLUS 45CM,9055048,CDM,270,RC,,HCPCS,outpatient,,,$214.75 ,$161.06 ,,$197.57 ,92,,,$118.11 ,$208.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.11 ,55,,,$118.11 ,$208.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$118.11 ,$208.31 ,other,,Not applicable. No negotiated rates per contract,$184.69 ,86,,,$118.11 ,$208.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$171.80 ,80,,,$118.11 ,$208.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.11 ,55,,,$118.11 ,$208.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.01 ,95,,,$118.11 ,$208.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.01 ,95,,,$118.11 ,$208.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.06 ,75,,,$118.11 ,$208.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.54 ,85,,,$118.11 ,$208.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.31 ,97,,,$118.11 ,$208.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.11 ,55,,,$118.11 ,$208.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.28 ,90,,,$118.11 ,$208.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.31 ,97,,,$118.11 ,$208.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.31 ,97,,,$118.11 ,$208.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.31 ,97,,,$118.11 ,$208.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.54 ,85,,,$118.11 ,$208.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.28 ,90,,,$118.11 ,$208.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.11 ,55,,,$118.11 ,$208.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.01 ,90,,,$118.11 ,$208.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.11 ,55,,,$118.11 ,$208.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.72 ,93,,,$118.11 ,$208.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 662H,8785599,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 FS-1 ETHILON BLK M,8785605,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 J496G VICRYL (OR),8785460,CDM,270,RC,,HCPCS,outpatient,,,$38.68 ,$29.01 ,,$35.59 ,92,,,$21.27 ,$37.52 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.27 ,55,,,$21.27 ,$37.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.27 ,$37.52 ,other,,Not applicable. No negotiated rates per contract,$33.26 ,86,,,$21.27 ,$37.52 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.94 ,80,,,$21.27 ,$37.52 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.27 ,55,,,$21.27 ,$37.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.75 ,95,,,$21.27 ,$37.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.75 ,95,,,$21.27 ,$37.52 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.01 ,75,,,$21.27 ,$37.52 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.88 ,85,,,$21.27 ,$37.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.52 ,97,,,$21.27 ,$37.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.27 ,55,,,$21.27 ,$37.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.81 ,90,,,$21.27 ,$37.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.52 ,97,,,$21.27 ,$37.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.52 ,97,,,$21.27 ,$37.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.52 ,97,,,$21.27 ,$37.52 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.88 ,85,,,$21.27 ,$37.52 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.81 ,90,,,$21.27 ,$37.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.27 ,55,,,$21.27 ,$37.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.75 ,90,,,$21.27 ,$37.52 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.27 ,55,,,$21.27 ,$37.52 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.97 ,93,,,$21.27 ,$37.52 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 PROLENE P-3 (8699G,8785473,CDM,270,RC,,HCPCS,outpatient,,,$43.07 ,$32.30 ,,$39.62 ,92,,,$23.69 ,$41.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.69 ,55,,,$23.69 ,$41.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.69 ,$41.78 ,other,,Not applicable. No negotiated rates per contract,$37.04 ,86,,,$23.69 ,$41.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.46 ,80,,,$23.69 ,$41.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.69 ,55,,,$23.69 ,$41.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.92 ,95,,,$23.69 ,$41.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.92 ,95,,,$23.69 ,$41.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.30 ,75,,,$23.69 ,$41.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.61 ,85,,,$23.69 ,$41.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.78 ,97,,,$23.69 ,$41.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.69 ,55,,,$23.69 ,$41.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.76 ,90,,,$23.69 ,$41.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.78 ,97,,,$23.69 ,$41.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.78 ,97,,,$23.69 ,$41.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.78 ,97,,,$23.69 ,$41.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.61 ,85,,,$23.69 ,$41.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.76 ,90,,,$23.69 ,$41.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.69 ,55,,,$23.69 ,$41.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.92 ,90,,,$23.69 ,$41.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.69 ,55,,,$23.69 ,$41.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.06 ,93,,,$23.69 ,$41.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 PS-2  8682G PROLENE,8785451,CDM,270,RC,,HCPCS,outpatient,,,$41.50 ,$31.13 ,,$38.18 ,92,,,$22.83 ,$40.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.83 ,$40.26 ,other,,Not applicable. No negotiated rates per contract,$35.69 ,86,,,$22.83 ,$40.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.20 ,80,,,$22.83 ,$40.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.43 ,95,,,$22.83 ,$40.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.43 ,95,,,$22.83 ,$40.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.13 ,75,,,$22.83 ,$40.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.28 ,85,,,$22.83 ,$40.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.35 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.28 ,85,,,$22.83 ,$40.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.35 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.43 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.60 ,93,,,$22.83 ,$40.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 RB-1   U203 CHROMIC GUT,8785626,CDM,270,RC,,HCPCS,outpatient,,,$25.46 ,$19.10 ,,$23.42 ,92,,,$14.00 ,$24.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.00 ,55,,,$14.00 ,$24.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.00 ,$24.70 ,other,,Not applicable. No negotiated rates per contract,$21.90 ,86,,,$14.00 ,$24.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.37 ,80,,,$14.00 ,$24.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.00 ,55,,,$14.00 ,$24.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.19 ,95,,,$14.00 ,$24.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.19 ,95,,,$14.00 ,$24.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.10 ,75,,,$14.00 ,$24.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.64 ,85,,,$14.00 ,$24.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.70 ,97,,,$14.00 ,$24.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.00 ,55,,,$14.00 ,$24.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.91 ,90,,,$14.00 ,$24.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.70 ,97,,,$14.00 ,$24.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.70 ,97,,,$14.00 ,$24.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.70 ,97,,,$14.00 ,$24.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.64 ,85,,,$14.00 ,$24.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.91 ,90,,,$14.00 ,$24.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.00 ,55,,,$14.00 ,$24.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.19 ,90,,,$14.00 ,$24.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.00 ,55,,,$14.00 ,$24.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.68 ,93,,,$14.00 ,$24.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 SILK 683G,8785602,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 VICRYL J214H,8785617,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 4-0 VICRYL J422H,8785621,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5 ETHIBOND EXCEL,8785535,CDM,270,RC,,HCPCS,outpatient,,,$28.09 ,$21.07 ,,$25.84 ,92,,,$15.45 ,$27.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.45 ,$27.25 ,other,,Not applicable. No negotiated rates per contract,$24.16 ,86,,,$15.45 ,$27.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.47 ,80,,,$15.45 ,$27.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.69 ,95,,,$15.45 ,$27.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.07 ,75,,,$15.45 ,$27.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.25 ,97,,,$15.45 ,$27.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.88 ,85,,,$15.45 ,$27.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.28 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.69 ,90,,,$15.45 ,$27.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.45 ,55,,,$15.45 ,$27.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.12 ,93,,,$15.45 ,$27.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5-0  ETHLON  MONO 668G,8785441,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5-0 ETHILON PS-2 (1666H),8785598,CDM,270,RC,,HCPCS,outpatient,,,$32.38 ,$24.29 ,,$29.79 ,92,,,$17.81 ,$31.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.81 ,$31.41 ,other,,Not applicable. No negotiated rates per contract,$27.85 ,86,,,$17.81 ,$31.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.90 ,80,,,$17.81 ,$31.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.76 ,95,,,$17.81 ,$31.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.76 ,95,,,$17.81 ,$31.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.29 ,75,,,$17.81 ,$31.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.52 ,85,,,$17.81 ,$31.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.14 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.52 ,85,,,$17.81 ,$31.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.14 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.76 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.11 ,93,,,$17.81 ,$31.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5-0 FS-2 ETHILON,8785440,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5-0 J493G VICRYL,8785459,CDM,270,RC,,HCPCS,outpatient,,,$37.36 ,$28.02 ,,$34.37 ,92,,,$20.55 ,$36.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.55 ,$36.24 ,other,,Not applicable. No negotiated rates per contract,$32.13 ,86,,,$20.55 ,$36.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.89 ,80,,,$20.55 ,$36.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.49 ,95,,,$20.55 ,$36.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.49 ,95,,,$20.55 ,$36.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.02 ,75,,,$20.55 ,$36.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.76 ,85,,,$20.55 ,$36.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.62 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.24 ,97,,,$20.55 ,$36.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.76 ,85,,,$20.55 ,$36.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.62 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.49 ,90,,,$20.55 ,$36.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.55 ,55,,,$20.55 ,$36.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.74 ,93,,,$20.55 ,$36.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 5-0 VICRYL J213H,8785616,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE 6-0 1665G SUTURE 18"" PS-3 NEEDLE",8785448,CDM,270,RC,,HCPCS,outpatient,,,$29.93 ,$22.45 ,,$27.54 ,92,,,$16.46 ,$29.03 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.46 ,$29.03 ,other,,Not applicable. No negotiated rates per contract,$25.74 ,86,,,$16.46 ,$29.03 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.94 ,80,,,$16.46 ,$29.03 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.43 ,95,,,$16.46 ,$29.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.43 ,95,,,$16.46 ,$29.03 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.45 ,75,,,$16.46 ,$29.03 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.44 ,85,,,$16.46 ,$29.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.94 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.03 ,97,,,$16.46 ,$29.03 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.44 ,85,,,$16.46 ,$29.03 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$26.94 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.43 ,90,,,$16.46 ,$29.03 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.46 ,55,,,$16.46 ,$29.03 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.83 ,93,,,$16.46 ,$29.03 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 6-0 697G,8785443,CDM,270,RC,,HCPCS,outpatient,,,$34.13 ,$25.60 ,,$31.40 ,92,,,$18.77 ,$33.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.77 ,55,,,$18.77 ,$33.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.77 ,$33.11 ,other,,Not applicable. No negotiated rates per contract,$29.35 ,86,,,$18.77 ,$33.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.30 ,80,,,$18.77 ,$33.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.77 ,55,,,$18.77 ,$33.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.42 ,95,,,$18.77 ,$33.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.42 ,95,,,$18.77 ,$33.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.60 ,75,,,$18.77 ,$33.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.01 ,85,,,$18.77 ,$33.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.11 ,97,,,$18.77 ,$33.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.77 ,55,,,$18.77 ,$33.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.72 ,90,,,$18.77 ,$33.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.11 ,97,,,$18.77 ,$33.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.11 ,97,,,$18.77 ,$33.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.11 ,97,,,$18.77 ,$33.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.01 ,85,,,$18.77 ,$33.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.72 ,90,,,$18.77 ,$33.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.77 ,55,,,$18.77 ,$33.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.42 ,90,,,$18.77 ,$33.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.77 ,55,,,$18.77 ,$33.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.74 ,93,,,$18.77 ,$33.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 6-0 PROLENE 8695G,8785450,CDM,270,RC,,HCPCS,outpatient,,,$45.62 ,$34.22 ,,$41.97 ,92,,,$25.09 ,$44.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.09 ,55,,,$25.09 ,$44.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.09 ,$44.25 ,other,,Not applicable. No negotiated rates per contract,$39.23 ,86,,,$25.09 ,$44.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.50 ,80,,,$25.09 ,$44.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.09 ,55,,,$25.09 ,$44.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.34 ,95,,,$25.09 ,$44.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.34 ,95,,,$25.09 ,$44.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.22 ,75,,,$25.09 ,$44.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.78 ,85,,,$25.09 ,$44.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.25 ,97,,,$25.09 ,$44.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.09 ,55,,,$25.09 ,$44.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.06 ,90,,,$25.09 ,$44.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.25 ,97,,,$25.09 ,$44.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.25 ,97,,,$25.09 ,$44.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.25 ,97,,,$25.09 ,$44.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.78 ,85,,,$25.09 ,$44.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.06 ,90,,,$25.09 ,$44.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.09 ,55,,,$25.09 ,$44.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.34 ,90,,,$25.09 ,$44.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.09 ,55,,,$25.09 ,$44.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.43 ,93,,,$25.09 ,$44.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE 6-0 VICRYL J489G,8785458,CDM,270,RC,,HCPCS,outpatient,,,$39.46 ,$29.60 ,,$36.30 ,92,,,$21.70 ,$38.28 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.70 ,$38.28 ,other,,Not applicable. No negotiated rates per contract,$33.94 ,86,,,$21.70 ,$38.28 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.57 ,80,,,$21.70 ,$38.28 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.49 ,95,,,$21.70 ,$38.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.49 ,95,,,$21.70 ,$38.28 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.60 ,75,,,$21.70 ,$38.28 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.54 ,85,,,$21.70 ,$38.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.51 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.28 ,97,,,$21.70 ,$38.28 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.54 ,85,,,$21.70 ,$38.28 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.51 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.49 ,90,,,$21.70 ,$38.28 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.70 ,55,,,$21.70 ,$38.28 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.70 ,93,,,$21.70 ,$38.28 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8942870,CDM,270,RC,,HCPCS,outpatient,,,"$1,896.18 ","$1,422.14 ",,"$1,744.49 ",92,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,042.90 ",55,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,042.90 ","$1,839.29 ",other,,Not applicable. No negotiated rates per contract,"$1,630.71 ",86,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,516.94 ",80,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,042.90 ",55,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,801.37 ",95,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,801.37 ",95,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,422.14 ",75,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,611.75 ",85,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,839.29 ",97,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,042.90 ",55,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,706.56 ",90,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,839.29 ",97,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,839.29 ",97,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,839.29 ",97,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,611.75 ",85,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,706.56 ",90,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.90 ",55,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,801.37 ",90,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,042.90 ",55,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,763.45 ",93,,,"$1,042.90 ","$1,839.29 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8782094,CDM,270,RC,51362,HCPCS,outpatient,,,"$1,211.25 ",$908.44 ,,"$1,114.35 ",92,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$666.19 ,55,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$666.19 ,"$1,174.91 ",other,,Not applicable. No negotiated rates per contract,"$1,041.68 ",86,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$969.00 ,80,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$666.19 ,55,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,150.69 ",95,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,150.69 ",95,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$908.44 ,75,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,029.56 ",85,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,174.91 ",97,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$666.19 ,55,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,090.13 ",90,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,174.91 ",97,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.91 ",97,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,174.91 ",97,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,029.56 ",85,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,090.13 ",90,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$666.19 ,55,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,150.69 ",90,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$666.19 ,55,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,126.46 ",93,,,$666.19 ,"$1,174.91 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8942871,CDM,270,RC,,HCPCS,outpatient,,,"$1,551.25 ","$1,163.44 ",,"$1,427.15 ",92,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$853.19 ,55,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$853.19 ,"$1,504.71 ",other,,Not applicable. No negotiated rates per contract,"$1,334.08 ",86,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,241.00 ",80,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$853.19 ,55,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,473.69 ",95,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,473.69 ",95,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,163.44 ",75,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,318.56 ",85,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,504.71 ",97,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$853.19 ,55,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,396.13 ",90,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,504.71 ",97,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,504.71 ",97,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,504.71 ",97,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,318.56 ",85,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,396.13 ",90,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$853.19 ,55,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,473.69 ",90,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$853.19 ,55,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,442.66 ",93,,,$853.19 ,"$1,504.71 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8782876,CDM,270,RC,,HCPCS,outpatient,,,"$2,338.18 ","$1,753.64 ",,"$2,151.13 ",92,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,286.00 ",55,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,286.00 ","$2,268.03 ",other,,Not applicable. No negotiated rates per contract,"$2,010.83 ",86,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,870.54 ",80,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,286.00 ",55,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,221.27 ",95,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,221.27 ",95,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,753.64 ",75,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,987.45 ",85,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,268.03 ",97,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,286.00 ",55,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,104.36 ",90,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,268.03 ",97,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,268.03 ",97,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,268.03 ",97,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,987.45 ",85,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,104.36 ",90,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,286.00 ",55,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,221.27 ",90,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,286.00 ",55,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,174.51 ",93,,,"$1,286.00 ","$2,268.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8782093,CDM,270,RC,51361,HCPCS,outpatient,,,$878.75 ,$659.06 ,,$808.45 ,92,,,$483.31 ,$852.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$483.31 ,55,,,$483.31 ,$852.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$483.31 ,$852.39 ,other,,Not applicable. No negotiated rates per contract,$755.73 ,86,,,$483.31 ,$852.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$703.00 ,80,,,$483.31 ,$852.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$483.31 ,55,,,$483.31 ,$852.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$834.81 ,95,,,$483.31 ,$852.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$834.81 ,95,,,$483.31 ,$852.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$659.06 ,75,,,$483.31 ,$852.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$746.94 ,85,,,$483.31 ,$852.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$852.39 ,97,,,$483.31 ,$852.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.31 ,55,,,$483.31 ,$852.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$790.88 ,90,,,$483.31 ,$852.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$852.39 ,97,,,$483.31 ,$852.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$852.39 ,97,,,$483.31 ,$852.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$852.39 ,97,,,$483.31 ,$852.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$746.94 ,85,,,$483.31 ,$852.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$790.88 ,90,,,$483.31 ,$852.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.31 ,55,,,$483.31 ,$852.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$834.81 ,90,,,$483.31 ,$852.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.31 ,55,,,$483.31 ,$852.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$817.24 ,93,,,$483.31 ,$852.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8786669,CDM,270,RC,,HCPCS,outpatient,,,"$1,982.71 ","$1,487.03 ",,"$1,824.09 ",92,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,090.49 ",55,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,090.49 ","$1,923.23 ",other,,Not applicable. No negotiated rates per contract,"$1,705.13 ",86,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,586.17 ",80,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,090.49 ",55,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,883.57 ",95,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,883.57 ",95,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,487.03 ",75,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,685.30 ",85,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,923.23 ",97,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,090.49 ",55,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,784.44 ",90,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,923.23 ",97,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,923.23 ",97,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,923.23 ",97,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,685.30 ",85,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,784.44 ",90,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,090.49 ",55,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,883.57 ",90,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,090.49 ",55,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,843.92 ",93,,,"$1,090.49 ","$1,923.23 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8786658,CDM,270,RC,,HCPCS,outpatient,,,"$2,188.75 ","$1,641.56 ",,"$2,013.65 ",92,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,203.81 ","$2,123.09 ",other,,Not applicable. No negotiated rates per contract,"$1,882.33 ",86,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,751.00 ",80,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,079.31 ",95,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,079.31 ",95,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,641.56 ",75,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,860.44 ",85,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,969.88 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,860.44 ",85,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,969.88 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,079.31 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,035.54 ",93,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8786659,CDM,270,RC,,HCPCS,outpatient,,,"$2,188.75 ","$1,641.56 ",,"$2,013.65 ",92,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,203.81 ","$2,123.09 ",other,,Not applicable. No negotiated rates per contract,"$1,882.33 ",86,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,751.00 ",80,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,079.31 ",95,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,079.31 ",95,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,641.56 ",75,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,860.44 ",85,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,969.88 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,123.09 ",97,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,860.44 ",85,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,969.88 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,079.31 ",90,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,203.81 ",55,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,035.54 ",93,,,"$1,203.81 ","$2,123.09 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ANCHOR,8782874,CDM,270,RC,,HCPCS,outpatient,,,"$2,203.80 ","$1,652.85 ",,"$2,027.50 ",92,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,212.09 ",55,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,212.09 ","$2,137.69 ",other,,Not applicable. No negotiated rates per contract,"$1,895.27 ",86,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,763.04 ",80,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,212.09 ",55,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,093.61 ",95,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,093.61 ",95,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,652.85 ",75,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,873.23 ",85,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,137.69 ",97,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,212.09 ",55,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,983.42 ",90,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,137.69 ",97,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,137.69 ",97,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,137.69 ",97,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,873.23 ",85,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,983.42 ",90,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,212.09 ",55,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,093.61 ",90,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,212.09 ",55,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,049.53 ",93,,,"$1,212.09 ","$2,137.69 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CHROMIC GUT 2-0 S,8785633,CDM,270,RC,,HCPCS,outpatient,,,$31.76 ,$23.82 ,,$29.22 ,92,,,$17.47 ,$30.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.47 ,$30.81 ,other,,Not applicable. No negotiated rates per contract,$27.31 ,86,,,$17.47 ,$30.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.41 ,80,,,$17.47 ,$30.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.17 ,95,,,$17.47 ,$30.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.82 ,75,,,$17.47 ,$30.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.81 ,97,,,$17.47 ,$30.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.00 ,85,,,$17.47 ,$30.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.58 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.17 ,90,,,$17.47 ,$30.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.47 ,55,,,$17.47 ,$30.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.54 ,93,,,$17.47 ,$30.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CHROMIC GUT 3-0 SH27,8785615,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CHROMIC GUT 5-0 P,8785447,CDM,270,RC,,HCPCS,outpatient,,,$43.14 ,$32.36 ,,$39.69 ,92,,,$23.73 ,$41.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.73 ,55,,,$23.73 ,$41.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.73 ,$41.85 ,other,,Not applicable. No negotiated rates per contract,$37.10 ,86,,,$23.73 ,$41.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.51 ,80,,,$23.73 ,$41.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.73 ,55,,,$23.73 ,$41.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.98 ,95,,,$23.73 ,$41.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.98 ,95,,,$23.73 ,$41.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.36 ,75,,,$23.73 ,$41.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.67 ,85,,,$23.73 ,$41.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.85 ,97,,,$23.73 ,$41.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.73 ,55,,,$23.73 ,$41.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.83 ,90,,,$23.73 ,$41.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.85 ,97,,,$23.73 ,$41.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.85 ,97,,,$23.73 ,$41.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.85 ,97,,,$23.73 ,$41.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.67 ,85,,,$23.73 ,$41.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.83 ,90,,,$23.73 ,$41.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.73 ,55,,,$23.73 ,$41.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.98 ,90,,,$23.73 ,$41.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.73 ,55,,,$23.73 ,$41.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.12 ,93,,,$23.73 ,$41.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CHROMIC GUT 6-0 PS-6 (1816G),8785449,CDM,270,RC,,HCPCS,outpatient,,,$45.79 ,$34.34 ,,$42.13 ,92,,,$25.18 ,$44.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.18 ,55,,,$25.18 ,$44.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.18 ,$44.42 ,other,,Not applicable. No negotiated rates per contract,$39.38 ,86,,,$25.18 ,$44.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.63 ,80,,,$25.18 ,$44.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.18 ,55,,,$25.18 ,$44.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.50 ,95,,,$25.18 ,$44.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.50 ,95,,,$25.18 ,$44.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.34 ,75,,,$25.18 ,$44.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$38.92 ,85,,,$25.18 ,$44.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.42 ,97,,,$25.18 ,$44.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.18 ,55,,,$25.18 ,$44.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.21 ,90,,,$25.18 ,$44.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.42 ,97,,,$25.18 ,$44.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.42 ,97,,,$25.18 ,$44.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.42 ,97,,,$25.18 ,$44.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.92 ,85,,,$25.18 ,$44.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.21 ,90,,,$25.18 ,$44.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.18 ,55,,,$25.18 ,$44.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.50 ,90,,,$25.18 ,$44.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.18 ,55,,,$25.18 ,$44.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.58 ,93,,,$25.18 ,$44.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CHROMICE GUT 5-0,8785438,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CROSSFT 5.5MM ANC,8782873,CDM,270,RC,,HCPCS,outpatient,,,"$1,933.96 ","$1,450.47 ",,"$1,779.24 ",92,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,063.68 ",55,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,063.68 ","$1,875.94 ",other,,Not applicable. No negotiated rates per contract,"$1,663.21 ",86,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,547.17 ",80,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,063.68 ",55,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.26 ",95,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,837.26 ",95,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,450.47 ",75,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,643.87 ",85,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,875.94 ",97,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,063.68 ",55,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,740.56 ",90,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,875.94 ",97,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.94 ",97,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,875.94 ",97,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,643.87 ",85,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,740.56 ",90,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.68 ",55,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.26 ",90,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,063.68 ",55,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,798.58 ",93,,,"$1,063.68 ","$1,875.94 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CTD VICRYL 2-0 UND BR X-1,9055149,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CTD VICRYL 3-0  J,8785538,CDM,270,RC,,HCPCS,outpatient,,,$57.50 ,$43.13 ,,$52.90 ,92,,,$31.63 ,$55.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$31.63 ,$55.78 ,other,,Not applicable. No negotiated rates per contract,$49.45 ,86,,,$31.63 ,$55.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$46.00 ,80,,,$31.63 ,$55.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.63 ,95,,,$31.63 ,$55.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$54.63 ,95,,,$31.63 ,$55.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.13 ,75,,,$31.63 ,$55.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$48.88 ,85,,,$31.63 ,$55.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$51.75 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$55.78 ,97,,,$31.63 ,$55.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.88 ,85,,,$31.63 ,$55.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$51.75 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.63 ,90,,,$31.63 ,$55.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.63 ,55,,,$31.63 ,$55.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.48 ,93,,,$31.63 ,$55.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE CTD VICRYL 4-0 UN,8785620,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE DERMABOND PEN (DNX12),8785456,CDM,270,RC,,HCPCS,outpatient,,,$145.78 ,$109.34 ,,$134.12 ,92,,,$80.18 ,$141.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.18 ,55,,,$80.18 ,$141.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.18 ,$141.41 ,other,,Not applicable. No negotiated rates per contract,$125.37 ,86,,,$80.18 ,$141.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$116.62 ,80,,,$80.18 ,$141.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.18 ,55,,,$80.18 ,$141.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.49 ,95,,,$80.18 ,$141.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.49 ,95,,,$80.18 ,$141.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.34 ,75,,,$80.18 ,$141.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$123.91 ,85,,,$80.18 ,$141.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$141.41 ,97,,,$80.18 ,$141.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.18 ,55,,,$80.18 ,$141.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$131.20 ,90,,,$80.18 ,$141.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.41 ,97,,,$80.18 ,$141.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.41 ,97,,,$80.18 ,$141.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.41 ,97,,,$80.18 ,$141.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.91 ,85,,,$80.18 ,$141.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$131.20 ,90,,,$80.18 ,$141.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.18 ,55,,,$80.18 ,$141.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.49 ,90,,,$80.18 ,$141.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.18 ,55,,,$80.18 ,$141.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.58 ,93,,,$80.18 ,$141.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ENDOLOOP COATED V,8785436,CDM,270,RC,,HCPCS,outpatient,,,$257.30 ,$192.98 ,,$236.72 ,92,,,$141.52 ,$249.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.52 ,55,,,$141.52 ,$249.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$141.52 ,$249.58 ,other,,Not applicable. No negotiated rates per contract,$221.28 ,86,,,$141.52 ,$249.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$205.84 ,80,,,$141.52 ,$249.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.52 ,55,,,$141.52 ,$249.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.44 ,95,,,$141.52 ,$249.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$244.44 ,95,,,$141.52 ,$249.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.98 ,75,,,$141.52 ,$249.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$218.71 ,85,,,$141.52 ,$249.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$249.58 ,97,,,$141.52 ,$249.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.52 ,55,,,$141.52 ,$249.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.57 ,90,,,$141.52 ,$249.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.58 ,97,,,$141.52 ,$249.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.58 ,97,,,$141.52 ,$249.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.58 ,97,,,$141.52 ,$249.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.71 ,85,,,$141.52 ,$249.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$231.57 ,90,,,$141.52 ,$249.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.52 ,55,,,$141.52 ,$249.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.44 ,90,,,$141.52 ,$249.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.52 ,55,,,$141.52 ,$249.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.29 ,93,,,$141.52 ,$249.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHIBOND #0 SH 30,8785642,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE ETHIBOND 0 18"" CR",8785455,CDM,270,RC,,HCPCS,outpatient,,,$95.64 ,$71.73 ,,$87.99 ,92,,,$52.60 ,$92.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$52.60 ,$92.77 ,other,,Not applicable. No negotiated rates per contract,$82.25 ,86,,,$52.60 ,$92.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$76.51 ,80,,,$52.60 ,$92.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.86 ,95,,,$52.60 ,$92.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.86 ,95,,,$52.60 ,$92.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$71.73 ,75,,,$52.60 ,$92.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$81.29 ,85,,,$52.60 ,$92.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.08 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.77 ,97,,,$52.60 ,$92.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.29 ,85,,,$52.60 ,$92.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.08 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$90.86 ,90,,,$52.60 ,$92.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.60 ,55,,,$52.60 ,$92.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.95 ,93,,,$52.60 ,$92.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHILON 3-0 663H,8785600,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHILON 4-0 MON P,8785445,CDM,270,RC,,HCPCS,outpatient,,,$69.30 ,$51.98 ,,$63.76 ,92,,,$38.12 ,$67.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.12 ,55,,,$38.12 ,$67.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.12 ,$67.22 ,other,,Not applicable. No negotiated rates per contract,$59.60 ,86,,,$38.12 ,$67.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.44 ,80,,,$38.12 ,$67.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.12 ,55,,,$38.12 ,$67.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.84 ,95,,,$38.12 ,$67.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.84 ,95,,,$38.12 ,$67.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.98 ,75,,,$38.12 ,$67.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.91 ,85,,,$38.12 ,$67.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.22 ,97,,,$38.12 ,$67.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.12 ,55,,,$38.12 ,$67.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.37 ,90,,,$38.12 ,$67.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.22 ,97,,,$38.12 ,$67.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.22 ,97,,,$38.12 ,$67.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.22 ,97,,,$38.12 ,$67.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.91 ,85,,,$38.12 ,$67.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.37 ,90,,,$38.12 ,$67.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.12 ,55,,,$38.12 ,$67.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.84 ,90,,,$38.12 ,$67.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.12 ,55,,,$38.12 ,$67.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.45 ,93,,,$38.12 ,$67.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHILON 4-0 PS-2 NEEDLE,8785606,CDM,270,RC,,HCPCS,outpatient,,,$32.03 ,$24.02 ,,$29.47 ,92,,,$17.62 ,$31.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.62 ,55,,,$17.62 ,$31.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.62 ,$31.07 ,other,,Not applicable. No negotiated rates per contract,$27.55 ,86,,,$17.62 ,$31.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.62 ,80,,,$17.62 ,$31.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.62 ,55,,,$17.62 ,$31.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.43 ,95,,,$17.62 ,$31.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.43 ,95,,,$17.62 ,$31.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.02 ,75,,,$17.62 ,$31.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.23 ,85,,,$17.62 ,$31.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.07 ,97,,,$17.62 ,$31.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.62 ,55,,,$17.62 ,$31.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.83 ,90,,,$17.62 ,$31.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.07 ,97,,,$17.62 ,$31.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.07 ,97,,,$17.62 ,$31.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.07 ,97,,,$17.62 ,$31.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.23 ,85,,,$17.62 ,$31.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.83 ,90,,,$17.62 ,$31.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.62 ,55,,,$17.62 ,$31.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.43 ,90,,,$17.62 ,$31.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.62 ,55,,,$17.62 ,$31.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.79 ,93,,,$17.62 ,$31.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHILON 5-0 P-1 G,8785457,CDM,270,RC,,HCPCS,outpatient,,,$35.35 ,$26.51 ,,$32.52 ,92,,,$19.44 ,$34.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.44 ,55,,,$19.44 ,$34.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.44 ,$34.29 ,other,,Not applicable. No negotiated rates per contract,$30.40 ,86,,,$19.44 ,$34.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.28 ,80,,,$19.44 ,$34.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.44 ,55,,,$19.44 ,$34.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.58 ,95,,,$19.44 ,$34.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.58 ,95,,,$19.44 ,$34.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.51 ,75,,,$19.44 ,$34.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.05 ,85,,,$19.44 ,$34.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.29 ,97,,,$19.44 ,$34.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.44 ,55,,,$19.44 ,$34.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.82 ,90,,,$19.44 ,$34.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.29 ,97,,,$19.44 ,$34.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.29 ,97,,,$19.44 ,$34.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.29 ,97,,,$19.44 ,$34.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,85,,,$19.44 ,$34.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.82 ,90,,,$19.44 ,$34.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.44 ,55,,,$19.44 ,$34.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.58 ,90,,,$19.44 ,$34.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.44 ,55,,,$19.44 ,$34.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.88 ,93,,,$19.44 ,$34.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE ETHTILON 1 BLK MO,8785446,CDM,270,RC,,HCPCS,outpatient,,,$26.34 ,$19.76 ,,$24.23 ,92,,,$14.49 ,$25.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$14.49 ,55,,,$14.49 ,$25.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$14.49 ,$25.55 ,other,,Not applicable. No negotiated rates per contract,$22.65 ,86,,,$14.49 ,$25.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$21.07 ,80,,,$14.49 ,$25.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$14.49 ,55,,,$14.49 ,$25.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.02 ,95,,,$14.49 ,$25.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.02 ,95,,,$14.49 ,$25.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.76 ,75,,,$14.49 ,$25.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$22.39 ,85,,,$14.49 ,$25.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.55 ,97,,,$14.49 ,$25.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$14.49 ,55,,,$14.49 ,$25.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.71 ,90,,,$14.49 ,$25.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.55 ,97,,,$14.49 ,$25.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.55 ,97,,,$14.49 ,$25.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.55 ,97,,,$14.49 ,$25.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.39 ,85,,,$14.49 ,$25.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$23.71 ,90,,,$14.49 ,$25.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.49 ,55,,,$14.49 ,$25.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.02 ,90,,,$14.49 ,$25.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$14.49 ,55,,,$14.49 ,$25.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.50 ,93,,,$14.49 ,$25.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE EXCEL ETHIBOND 30"" (75CM) 1 GREEN",8783782,CDM,270,RC,,HCPCS,outpatient,,,$25.38 ,$19.04 ,,$23.35 ,92,,,$13.96 ,$24.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.96 ,55,,,$13.96 ,$24.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.96 ,$24.62 ,other,,Not applicable. No negotiated rates per contract,$21.83 ,86,,,$13.96 ,$24.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.30 ,80,,,$13.96 ,$24.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.96 ,55,,,$13.96 ,$24.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.11 ,95,,,$13.96 ,$24.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.11 ,95,,,$13.96 ,$24.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$19.04 ,75,,,$13.96 ,$24.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.57 ,85,,,$13.96 ,$24.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.62 ,97,,,$13.96 ,$24.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.96 ,55,,,$13.96 ,$24.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.84 ,90,,,$13.96 ,$24.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.62 ,97,,,$13.96 ,$24.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.62 ,97,,,$13.96 ,$24.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.62 ,97,,,$13.96 ,$24.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.57 ,85,,,$13.96 ,$24.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.84 ,90,,,$13.96 ,$24.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.96 ,55,,,$13.96 ,$24.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.11 ,90,,,$13.96 ,$24.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.96 ,55,,,$13.96 ,$24.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.60 ,93,,,$13.96 ,$24.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE EXCEL ETHIBOND 30"" (75CM) 2-0",8783783,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE MONOCRYL 3-0 PS-1,8785631,CDM,270,RC,,HCPCS,outpatient,,,$47.27 ,$35.45 ,,$43.49 ,92,,,$26.00 ,$45.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.00 ,$45.85 ,other,,Not applicable. No negotiated rates per contract,$40.65 ,86,,,$26.00 ,$45.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.82 ,80,,,$26.00 ,$45.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.91 ,95,,,$26.00 ,$45.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.91 ,95,,,$26.00 ,$45.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.45 ,75,,,$26.00 ,$45.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.18 ,85,,,$26.00 ,$45.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.54 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.18 ,85,,,$26.00 ,$45.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.54 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.91 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.96 ,93,,,$26.00 ,$45.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE MONOCRYL 3-0 PS-2 UNDYED 1 X 18"" (Y497G) (OR)",8785463,CDM,270,RC,,HCPCS,outpatient,,,$41.21 ,$30.91 ,,$37.91 ,92,,,$22.67 ,$39.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.67 ,55,,,$22.67 ,$39.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.67 ,$39.97 ,other,,Not applicable. No negotiated rates per contract,$35.44 ,86,,,$22.67 ,$39.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.97 ,80,,,$22.67 ,$39.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.67 ,55,,,$22.67 ,$39.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.15 ,95,,,$22.67 ,$39.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.15 ,95,,,$22.67 ,$39.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.91 ,75,,,$22.67 ,$39.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.03 ,85,,,$22.67 ,$39.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.97 ,97,,,$22.67 ,$39.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.67 ,55,,,$22.67 ,$39.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.09 ,90,,,$22.67 ,$39.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.97 ,97,,,$22.67 ,$39.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.97 ,97,,,$22.67 ,$39.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.97 ,97,,,$22.67 ,$39.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.03 ,85,,,$22.67 ,$39.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.09 ,90,,,$22.67 ,$39.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.67 ,55,,,$22.67 ,$39.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.15 ,90,,,$22.67 ,$39.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.67 ,55,,,$22.67 ,$39.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.33 ,93,,,$22.67 ,$39.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE MONOCRYL 3-0 PS-2 UND MONO (OR),8785629,CDM,270,RC,,HCPCS,outpatient,,,$42.35 ,$31.76 ,,$38.96 ,92,,,$23.29 ,$41.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.29 ,$41.08 ,other,,Not applicable. No negotiated rates per contract,$36.42 ,86,,,$23.29 ,$41.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.88 ,80,,,$23.29 ,$41.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.23 ,95,,,$23.29 ,$41.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.23 ,95,,,$23.29 ,$41.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.76 ,75,,,$23.29 ,$41.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.00 ,85,,,$23.29 ,$41.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.12 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.08 ,97,,,$23.29 ,$41.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.00 ,85,,,$23.29 ,$41.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.12 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.23 ,90,,,$23.29 ,$41.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.29 ,55,,,$23.29 ,$41.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.39 ,93,,,$23.29 ,$41.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE MONOCRYL 4-0 PS-1,8785630,CDM,270,RC,,HCPCS,outpatient,,,$47.27 ,$35.45 ,,$43.49 ,92,,,$26.00 ,$45.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.00 ,$45.85 ,other,,Not applicable. No negotiated rates per contract,$40.65 ,86,,,$26.00 ,$45.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.82 ,80,,,$26.00 ,$45.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.91 ,95,,,$26.00 ,$45.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.91 ,95,,,$26.00 ,$45.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.45 ,75,,,$26.00 ,$45.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.18 ,85,,,$26.00 ,$45.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.54 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.85 ,97,,,$26.00 ,$45.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.18 ,85,,,$26.00 ,$45.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.54 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.91 ,90,,,$26.00 ,$45.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.00 ,55,,,$26.00 ,$45.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.96 ,93,,,$26.00 ,$45.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE MONOCRYL 4-0 PS-2,8785628,CDM,270,RC,,HCPCS,outpatient,,,$44.55 ,$33.41 ,,$40.99 ,92,,,$24.50 ,$43.21 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.50 ,$43.21 ,other,,Not applicable. No negotiated rates per contract,$38.31 ,86,,,$24.50 ,$43.21 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.64 ,80,,,$24.50 ,$43.21 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$42.32 ,95,,,$24.50 ,$43.21 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.41 ,75,,,$24.50 ,$43.21 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.21 ,97,,,$24.50 ,$43.21 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.87 ,85,,,$24.50 ,$43.21 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.10 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.32 ,90,,,$24.50 ,$43.21 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.50 ,55,,,$24.50 ,$43.21 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.43 ,93,,,$24.50 ,$43.21 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE MONOCRYLE 4-0 PS-2 UND,9471163,CDM,270,RC,,HCPCS,outpatient,,,$41.50 ,$31.13 ,,$38.18 ,92,,,$22.83 ,$40.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.83 ,$40.26 ,other,,Not applicable. No negotiated rates per contract,$35.69 ,86,,,$22.83 ,$40.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.20 ,80,,,$22.83 ,$40.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.43 ,95,,,$22.83 ,$40.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.43 ,95,,,$22.83 ,$40.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.13 ,75,,,$22.83 ,$40.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.28 ,85,,,$22.83 ,$40.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.35 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.26 ,97,,,$22.83 ,$40.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.28 ,85,,,$22.83 ,$40.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.35 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.43 ,90,,,$22.83 ,$40.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.83 ,55,,,$22.83 ,$40.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.60 ,93,,,$22.83 ,$40.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE NUROLON 0 CR/CT-2,8785454,CDM,270,RC,,HCPCS,outpatient,,,$103.23 ,$77.42 ,,$94.97 ,92,,,$56.78 ,$100.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$56.78 ,55,,,$56.78 ,$100.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$56.78 ,$100.13 ,other,,Not applicable. No negotiated rates per contract,$88.78 ,86,,,$56.78 ,$100.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$82.58 ,80,,,$56.78 ,$100.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$56.78 ,55,,,$56.78 ,$100.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.07 ,95,,,$56.78 ,$100.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.07 ,95,,,$56.78 ,$100.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.42 ,75,,,$56.78 ,$100.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$87.75 ,85,,,$56.78 ,$100.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$100.13 ,97,,,$56.78 ,$100.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$56.78 ,55,,,$56.78 ,$100.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$92.91 ,90,,,$56.78 ,$100.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$100.13 ,97,,,$56.78 ,$100.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.13 ,97,,,$56.78 ,$100.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$100.13 ,97,,,$56.78 ,$100.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$87.75 ,85,,,$56.78 ,$100.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$92.91 ,90,,,$56.78 ,$100.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.78 ,55,,,$56.78 ,$100.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$98.07 ,90,,,$56.78 ,$100.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$56.78 ,55,,,$56.78 ,$100.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$96.00 ,93,,,$56.78 ,$100.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE PERA-HAND SILK 2-0 18"" (OR)",8785614,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE PERMA-HAND SILK 3-0 12-18 LA,8785613,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE PERMA-HAND SILK 3-0 SH 30"" (",8785624,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE POS I I 0TIP-1 VI,8785464,CDM,270,RC,,HCPCS,outpatient,,,$53.63 ,$40.22 ,,$49.34 ,92,,,$29.50 ,$52.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$29.50 ,55,,,$29.50 ,$52.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$29.50 ,$52.02 ,other,,Not applicable. No negotiated rates per contract,$46.12 ,86,,,$29.50 ,$52.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$42.90 ,80,,,$29.50 ,$52.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$29.50 ,55,,,$29.50 ,$52.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.95 ,95,,,$29.50 ,$52.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$50.95 ,95,,,$29.50 ,$52.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.22 ,75,,,$29.50 ,$52.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$45.59 ,85,,,$29.50 ,$52.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$52.02 ,97,,,$29.50 ,$52.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.50 ,55,,,$29.50 ,$52.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.27 ,90,,,$29.50 ,$52.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$52.02 ,97,,,$29.50 ,$52.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.02 ,97,,,$29.50 ,$52.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$52.02 ,97,,,$29.50 ,$52.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,85,,,$29.50 ,$52.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.27 ,90,,,$29.50 ,$52.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.50 ,55,,,$29.50 ,$52.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$50.95 ,90,,,$29.50 ,$52.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.50 ,55,,,$29.50 ,$52.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.88 ,93,,,$29.50 ,$52.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE PROLENE 0 CTX BLU,8785610,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE PROLENE 5-0  P-3 (8698G),8785453,CDM,270,RC,,HCPCS,outpatient,,,$40.25 ,$30.19 ,,$37.03 ,92,,,$22.14 ,$39.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.14 ,$39.04 ,other,,Not applicable. No negotiated rates per contract,$34.62 ,86,,,$22.14 ,$39.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.20 ,80,,,$22.14 ,$39.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.24 ,95,,,$22.14 ,$39.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.24 ,95,,,$22.14 ,$39.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.19 ,75,,,$22.14 ,$39.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.21 ,85,,,$22.14 ,$39.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.23 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.04 ,97,,,$22.14 ,$39.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.21 ,85,,,$22.14 ,$39.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.23 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.24 ,90,,,$22.14 ,$39.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.14 ,55,,,$22.14 ,$39.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.43 ,93,,,$22.14 ,$39.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE PROLENE 6-0 18 P-,8785452,CDM,270,RC,,HCPCS,outpatient,,,$46.12 ,$34.59 ,,$42.43 ,92,,,$25.37 ,$44.74 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.37 ,55,,,$25.37 ,$44.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.37 ,$44.74 ,other,,Not applicable. No negotiated rates per contract,$39.66 ,86,,,$25.37 ,$44.74 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$36.90 ,80,,,$25.37 ,$44.74 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.37 ,55,,,$25.37 ,$44.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.81 ,95,,,$25.37 ,$44.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$43.81 ,95,,,$25.37 ,$44.74 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.59 ,75,,,$25.37 ,$44.74 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.20 ,85,,,$25.37 ,$44.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.74 ,97,,,$25.37 ,$44.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.37 ,55,,,$25.37 ,$44.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.51 ,90,,,$25.37 ,$44.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.74 ,97,,,$25.37 ,$44.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.74 ,97,,,$25.37 ,$44.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.74 ,97,,,$25.37 ,$44.74 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.20 ,85,,,$25.37 ,$44.74 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.51 ,90,,,$25.37 ,$44.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.37 ,55,,,$25.37 ,$44.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.81 ,90,,,$25.37 ,$44.74 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.37 ,55,,,$25.37 ,$44.74 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.89 ,93,,,$25.37 ,$44.74 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE SHUTTLE,8786652,CDM,270,RC,,HCPCS,outpatient,,,$709.96 ,$532.47 ,,$653.16 ,92,,,$390.48 ,$688.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$390.48 ,$688.66 ,other,,Not applicable. No negotiated rates per contract,$610.57 ,86,,,$390.48 ,$688.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$567.97 ,80,,,$390.48 ,$688.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.46 ,95,,,$390.48 ,$688.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$674.46 ,95,,,$390.48 ,$688.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.47 ,75,,,$390.48 ,$688.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$603.47 ,85,,,$390.48 ,$688.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.96 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$603.47 ,85,,,$390.48 ,$688.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$638.96 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.46 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$660.26 ,93,,,$390.48 ,$688.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE SHUTTLE 90,8783802,CDM,270,RC,,HCPCS,outpatient,,,"$1,027.40 ",$770.55 ,,$945.21 ,92,,,$565.07 ,$996.58 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$565.07 ,55,,,$565.07 ,$996.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$565.07 ,$996.58 ,other,,Not applicable. No negotiated rates per contract,$883.56 ,86,,,$565.07 ,$996.58 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$821.92 ,80,,,$565.07 ,$996.58 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$565.07 ,55,,,$565.07 ,$996.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$976.03 ,95,,,$565.07 ,$996.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$976.03 ,95,,,$565.07 ,$996.58 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$770.55 ,75,,,$565.07 ,$996.58 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$873.29 ,85,,,$565.07 ,$996.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$996.58 ,97,,,$565.07 ,$996.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$565.07 ,55,,,$565.07 ,$996.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$924.66 ,90,,,$565.07 ,$996.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$996.58 ,97,,,$565.07 ,$996.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.58 ,97,,,$565.07 ,$996.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$996.58 ,97,,,$565.07 ,$996.58 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$873.29 ,85,,,$565.07 ,$996.58 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$924.66 ,90,,,$565.07 ,$996.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$565.07 ,55,,,$565.07 ,$996.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$976.03 ,90,,,$565.07 ,$996.58 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$565.07 ,55,,,$565.07 ,$996.58 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$955.48 ,93,,,$565.07 ,$996.58 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE SILK 2-0 SH 30"" (",8785625,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STR ACCU-PASS 45,8786653,CDM,270,RC,,HCPCS,outpatient,,,$709.96 ,$532.47 ,,$653.16 ,92,,,$390.48 ,$688.66 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$390.48 ,$688.66 ,other,,Not applicable. No negotiated rates per contract,$610.57 ,86,,,$390.48 ,$688.66 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$567.97 ,80,,,$390.48 ,$688.66 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.46 ,95,,,$390.48 ,$688.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$674.46 ,95,,,$390.48 ,$688.66 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$532.47 ,75,,,$390.48 ,$688.66 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$603.47 ,85,,,$390.48 ,$688.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$638.96 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$688.66 ,97,,,$390.48 ,$688.66 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$603.47 ,85,,,$390.48 ,$688.66 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$638.96 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$674.46 ,90,,,$390.48 ,$688.66 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$390.48 ,55,,,$390.48 ,$688.66 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$660.26 ,93,,,$390.48 ,$688.66 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX #1 CT-1,8992683,CDM,270,RC,,HCPCS,outpatient,,,$153.41 ,$115.06 ,,$141.14 ,92,,,$84.38 ,$148.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$84.38 ,55,,,$84.38 ,$148.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$84.38 ,$148.81 ,other,,Not applicable. No negotiated rates per contract,$131.93 ,86,,,$84.38 ,$148.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$122.73 ,80,,,$84.38 ,$148.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$84.38 ,55,,,$84.38 ,$148.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.74 ,95,,,$84.38 ,$148.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.74 ,95,,,$84.38 ,$148.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.06 ,75,,,$84.38 ,$148.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$130.40 ,85,,,$84.38 ,$148.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$148.81 ,97,,,$84.38 ,$148.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.38 ,55,,,$84.38 ,$148.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.07 ,90,,,$84.38 ,$148.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$148.81 ,97,,,$84.38 ,$148.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.81 ,97,,,$84.38 ,$148.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.81 ,97,,,$84.38 ,$148.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.40 ,85,,,$84.38 ,$148.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$138.07 ,90,,,$84.38 ,$148.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.38 ,55,,,$84.38 ,$148.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.74 ,90,,,$84.38 ,$148.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.38 ,55,,,$84.38 ,$148.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$142.67 ,93,,,$84.38 ,$148.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX 1  OS-8,8783777,CDM,270,RC,,HCPCS,outpatient,,,$152.32 ,$114.24 ,,$140.13 ,92,,,$83.78 ,$147.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.78 ,55,,,$83.78 ,$147.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.78 ,$147.75 ,other,,Not applicable. No negotiated rates per contract,$131.00 ,86,,,$83.78 ,$147.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.86 ,80,,,$83.78 ,$147.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.78 ,55,,,$83.78 ,$147.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.70 ,95,,,$83.78 ,$147.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.70 ,95,,,$83.78 ,$147.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.24 ,75,,,$83.78 ,$147.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.47 ,85,,,$83.78 ,$147.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.75 ,97,,,$83.78 ,$147.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.78 ,55,,,$83.78 ,$147.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.09 ,90,,,$83.78 ,$147.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.75 ,97,,,$83.78 ,$147.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.75 ,97,,,$83.78 ,$147.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.75 ,97,,,$83.78 ,$147.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.47 ,85,,,$83.78 ,$147.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$137.09 ,90,,,$83.78 ,$147.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.78 ,55,,,$83.78 ,$147.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.70 ,90,,,$83.78 ,$147.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.78 ,55,,,$83.78 ,$147.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.66 ,93,,,$83.78 ,$147.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX 2/0 FS,8783779,CDM,270,RC,,HCPCS,outpatient,,,$148.12 ,$111.09 ,,$136.27 ,92,,,$81.47 ,$143.68 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.47 ,55,,,$81.47 ,$143.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.47 ,$143.68 ,other,,Not applicable. No negotiated rates per contract,$127.38 ,86,,,$81.47 ,$143.68 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.50 ,80,,,$81.47 ,$143.68 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.47 ,55,,,$81.47 ,$143.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.71 ,95,,,$81.47 ,$143.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.71 ,95,,,$81.47 ,$143.68 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.09 ,75,,,$81.47 ,$143.68 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.90 ,85,,,$81.47 ,$143.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.68 ,97,,,$81.47 ,$143.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.47 ,55,,,$81.47 ,$143.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.31 ,90,,,$81.47 ,$143.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.68 ,97,,,$81.47 ,$143.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.68 ,97,,,$81.47 ,$143.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.68 ,97,,,$81.47 ,$143.68 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.90 ,85,,,$81.47 ,$143.68 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.31 ,90,,,$81.47 ,$143.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.47 ,55,,,$81.47 ,$143.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.71 ,90,,,$81.47 ,$143.68 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.47 ,55,,,$81.47 ,$143.68 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.75 ,93,,,$81.47 ,$143.68 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX 3-0 PS-2 SPIRAL MONOCRYL PLUS,8992685,CDM,270,RC,,HCPCS,outpatient,,,$221.49 ,$166.12 ,,$203.77 ,92,,,$121.82 ,$214.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$121.82 ,55,,,$121.82 ,$214.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$121.82 ,$214.85 ,other,,Not applicable. No negotiated rates per contract,$190.48 ,86,,,$121.82 ,$214.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$177.19 ,80,,,$121.82 ,$214.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$121.82 ,55,,,$121.82 ,$214.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.42 ,95,,,$121.82 ,$214.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$210.42 ,95,,,$121.82 ,$214.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.12 ,75,,,$121.82 ,$214.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$188.27 ,85,,,$121.82 ,$214.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.85 ,97,,,$121.82 ,$214.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$121.82 ,55,,,$121.82 ,$214.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.34 ,90,,,$121.82 ,$214.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.85 ,97,,,$121.82 ,$214.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.85 ,97,,,$121.82 ,$214.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.85 ,97,,,$121.82 ,$214.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.27 ,85,,,$121.82 ,$214.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$199.34 ,90,,,$121.82 ,$214.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.82 ,55,,,$121.82 ,$214.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.42 ,90,,,$121.82 ,$214.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$121.82 ,55,,,$121.82 ,$214.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$205.99 ,93,,,$121.82 ,$214.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX 3/0 FS,8783778,CDM,270,RC,,HCPCS,outpatient,,,$152.03 ,$114.02 ,,$139.87 ,92,,,$83.62 ,$147.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.62 ,55,,,$83.62 ,$147.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.62 ,$147.47 ,other,,Not applicable. No negotiated rates per contract,$130.75 ,86,,,$83.62 ,$147.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$121.62 ,80,,,$83.62 ,$147.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.62 ,55,,,$83.62 ,$147.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.43 ,95,,,$83.62 ,$147.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.43 ,95,,,$83.62 ,$147.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.02 ,75,,,$83.62 ,$147.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$129.23 ,85,,,$83.62 ,$147.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$147.47 ,97,,,$83.62 ,$147.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.62 ,55,,,$83.62 ,$147.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.83 ,90,,,$83.62 ,$147.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$147.47 ,97,,,$83.62 ,$147.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.47 ,97,,,$83.62 ,$147.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$147.47 ,97,,,$83.62 ,$147.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.23 ,85,,,$83.62 ,$147.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$136.83 ,90,,,$83.62 ,$147.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.62 ,55,,,$83.62 ,$147.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.43 ,90,,,$83.62 ,$147.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.62 ,55,,,$83.62 ,$147.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.39 ,93,,,$83.62 ,$147.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX PDS PLUS 1 18,8783780,CDM,270,RC,,HCPCS,outpatient,,,$147.48 ,$110.61 ,,$135.68 ,92,,,$81.11 ,$143.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.11 ,55,,,$81.11 ,$143.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.11 ,$143.06 ,other,,Not applicable. No negotiated rates per contract,$126.83 ,86,,,$81.11 ,$143.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.98 ,80,,,$81.11 ,$143.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.11 ,55,,,$81.11 ,$143.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.11 ,95,,,$81.11 ,$143.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.11 ,95,,,$81.11 ,$143.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.61 ,75,,,$81.11 ,$143.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.36 ,85,,,$81.11 ,$143.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.06 ,97,,,$81.11 ,$143.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.11 ,55,,,$81.11 ,$143.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.73 ,90,,,$81.11 ,$143.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.06 ,97,,,$81.11 ,$143.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.06 ,97,,,$81.11 ,$143.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.06 ,97,,,$81.11 ,$143.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.36 ,85,,,$81.11 ,$143.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.73 ,90,,,$81.11 ,$143.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.11 ,55,,,$81.11 ,$143.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.11 ,90,,,$81.11 ,$143.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.11 ,55,,,$81.11 ,$143.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.16 ,93,,,$81.11 ,$143.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE STRATAFIX SPIRAL UNDYED,8783781,CDM,270,RC,,HCPCS,outpatient,,,$219.02 ,$164.27 ,,$201.50 ,92,,,$120.46 ,$212.45 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$120.46 ,55,,,$120.46 ,$212.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$120.46 ,$212.45 ,other,,Not applicable. No negotiated rates per contract,$188.36 ,86,,,$120.46 ,$212.45 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$175.22 ,80,,,$120.46 ,$212.45 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$120.46 ,55,,,$120.46 ,$212.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.07 ,95,,,$120.46 ,$212.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$208.07 ,95,,,$120.46 ,$212.45 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$164.27 ,75,,,$120.46 ,$212.45 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$186.17 ,85,,,$120.46 ,$212.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.45 ,97,,,$120.46 ,$212.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.46 ,55,,,$120.46 ,$212.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.12 ,90,,,$120.46 ,$212.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$212.45 ,97,,,$120.46 ,$212.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.45 ,97,,,$120.46 ,$212.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.45 ,97,,,$120.46 ,$212.45 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.17 ,85,,,$120.46 ,$212.45 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.12 ,90,,,$120.46 ,$212.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.46 ,55,,,$120.46 ,$212.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$208.07 ,90,,,$120.46 ,$212.45 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.46 ,55,,,$120.46 ,$212.45 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.69 ,93,,,$120.46 ,$212.45 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE VICRYL 2 0 CT 36IN UNDYE,8783786,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE VICRYL 2-0 J111T,8785537,CDM,270,RC,,HCPCS,outpatient,,,$74.17 ,$55.63 ,,$68.24 ,92,,,$40.79 ,$71.94 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$40.79 ,$71.94 ,other,,Not applicable. No negotiated rates per contract,$63.79 ,86,,,$40.79 ,$71.94 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.34 ,80,,,$40.79 ,$71.94 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.46 ,95,,,$40.79 ,$71.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.46 ,95,,,$40.79 ,$71.94 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.63 ,75,,,$40.79 ,$71.94 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$63.04 ,85,,,$40.79 ,$71.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.75 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.94 ,97,,,$40.79 ,$71.94 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.04 ,85,,,$40.79 ,$71.94 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.75 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.46 ,90,,,$40.79 ,$71.94 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.79 ,55,,,$40.79 ,$71.94 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.98 ,93,,,$40.79 ,$71.94 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"SUTURE VICRYL 3-0 27"" (26MM LENGTH/1/2"" CIRCLE (J416H)",9559716,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE VICRYL 3-0 8-18 I,8785465,CDM,270,RC,,HCPCS,outpatient,,,$126.87 ,$95.15 ,,$116.72 ,92,,,$69.78 ,$123.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.78 ,55,,,$69.78 ,$123.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.78 ,$123.06 ,other,,Not applicable. No negotiated rates per contract,$109.11 ,86,,,$69.78 ,$123.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.50 ,80,,,$69.78 ,$123.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.78 ,55,,,$69.78 ,$123.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.53 ,95,,,$69.78 ,$123.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.53 ,95,,,$69.78 ,$123.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.15 ,75,,,$69.78 ,$123.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$107.84 ,85,,,$69.78 ,$123.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.06 ,97,,,$69.78 ,$123.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.78 ,55,,,$69.78 ,$123.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.18 ,90,,,$69.78 ,$123.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.06 ,97,,,$69.78 ,$123.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.06 ,97,,,$69.78 ,$123.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.06 ,97,,,$69.78 ,$123.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.84 ,85,,,$69.78 ,$123.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.18 ,90,,,$69.78 ,$123.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.78 ,55,,,$69.78 ,$123.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.53 ,90,,,$69.78 ,$123.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.78 ,55,,,$69.78 ,$123.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.99 ,93,,,$69.78 ,$123.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE VICRYL PLUS 27 IN #1 CT-,8783785,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE#0 CT-1 8424H PROLENE,8785608,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,9049272,CDM,270,RC,54698,HCPCS,outpatient,,,$250.13 ,$187.60 ,,$230.12 ,92,,,$137.57 ,$242.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$137.57 ,$242.63 ,other,,Not applicable. No negotiated rates per contract,$215.11 ,86,,,$137.57 ,$242.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$200.10 ,80,,,$137.57 ,$242.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$187.60 ,75,,,$137.57 ,$242.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.62 ,93,,,$137.57 ,$242.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8785444,CDM,270,RC,,HCPCS,outpatient,,,$34.83 ,$26.12 ,,$32.04 ,92,,,$19.16 ,$33.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.16 ,$33.79 ,other,,Not applicable. No negotiated rates per contract,$29.95 ,86,,,$19.16 ,$33.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.86 ,80,,,$19.16 ,$33.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.09 ,95,,,$19.16 ,$33.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.09 ,95,,,$19.16 ,$33.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.12 ,75,,,$19.16 ,$33.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$29.61 ,85,,,$19.16 ,$33.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.35 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.79 ,97,,,$19.16 ,$33.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.61 ,85,,,$19.16 ,$33.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.35 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.09 ,90,,,$19.16 ,$33.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.16 ,55,,,$19.16 ,$33.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.39 ,93,,,$19.16 ,$33.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8785462,CDM,270,RC,,HCPCS,outpatient,,,$144.46 ,$108.35 ,,$132.90 ,92,,,$79.45 ,$140.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$79.45 ,55,,,$79.45 ,$140.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$79.45 ,$140.13 ,other,,Not applicable. No negotiated rates per contract,$124.24 ,86,,,$79.45 ,$140.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$115.57 ,80,,,$79.45 ,$140.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$79.45 ,55,,,$79.45 ,$140.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.24 ,95,,,$79.45 ,$140.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$137.24 ,95,,,$79.45 ,$140.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.35 ,75,,,$79.45 ,$140.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$122.79 ,85,,,$79.45 ,$140.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$140.13 ,97,,,$79.45 ,$140.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.45 ,55,,,$79.45 ,$140.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$130.01 ,90,,,$79.45 ,$140.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$140.13 ,97,,,$79.45 ,$140.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.13 ,97,,,$79.45 ,$140.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$140.13 ,97,,,$79.45 ,$140.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$122.79 ,85,,,$79.45 ,$140.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$130.01 ,90,,,$79.45 ,$140.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.45 ,55,,,$79.45 ,$140.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.24 ,90,,,$79.45 ,$140.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.45 ,55,,,$79.45 ,$140.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.35 ,93,,,$79.45 ,$140.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8785461,CDM,270,RC,,HCPCS,outpatient,,,$130.67 ,$98.00 ,,$120.22 ,92,,,$71.87 ,$126.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$71.87 ,55,,,$71.87 ,$126.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$71.87 ,$126.75 ,other,,Not applicable. No negotiated rates per contract,$112.38 ,86,,,$71.87 ,$126.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$104.54 ,80,,,$71.87 ,$126.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$71.87 ,55,,,$71.87 ,$126.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.14 ,95,,,$71.87 ,$126.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$124.14 ,95,,,$71.87 ,$126.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$98.00 ,75,,,$71.87 ,$126.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$111.07 ,85,,,$71.87 ,$126.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$126.75 ,97,,,$71.87 ,$126.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.87 ,55,,,$71.87 ,$126.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.60 ,90,,,$71.87 ,$126.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$126.75 ,97,,,$71.87 ,$126.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.75 ,97,,,$71.87 ,$126.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.75 ,97,,,$71.87 ,$126.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.07 ,85,,,$71.87 ,$126.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.60 ,90,,,$71.87 ,$126.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.87 ,55,,,$71.87 ,$126.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$124.14 ,90,,,$71.87 ,$126.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.87 ,55,,,$71.87 ,$126.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.52 ,93,,,$71.87 ,$126.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8785627,CDM,270,RC,,HCPCS,outpatient,,,$25.20 ,$18.90 ,,$23.18 ,92,,,$13.86 ,$24.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.86 ,55,,,$13.86 ,$24.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.86 ,$24.44 ,other,,Not applicable. No negotiated rates per contract,$21.67 ,86,,,$13.86 ,$24.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.16 ,80,,,$13.86 ,$24.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.86 ,55,,,$13.86 ,$24.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.94 ,95,,,$13.86 ,$24.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.94 ,95,,,$13.86 ,$24.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.90 ,75,,,$13.86 ,$24.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.42 ,85,,,$13.86 ,$24.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.44 ,97,,,$13.86 ,$24.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.86 ,55,,,$13.86 ,$24.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.68 ,90,,,$13.86 ,$24.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.44 ,97,,,$13.86 ,$24.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.44 ,97,,,$13.86 ,$24.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.44 ,97,,,$13.86 ,$24.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.42 ,85,,,$13.86 ,$24.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.68 ,90,,,$13.86 ,$24.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.86 ,55,,,$13.86 ,$24.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.94 ,90,,,$13.86 ,$24.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.86 ,55,,,$13.86 ,$24.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.44 ,93,,,$13.86 ,$24.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8782107,CDM,270,RC,,HCPCS,outpatient,,,$264.63 ,$198.47 ,,$243.46 ,92,,,$145.55 ,$256.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$145.55 ,$256.69 ,other,,Not applicable. No negotiated rates per contract,$227.58 ,86,,,$145.55 ,$256.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$211.70 ,80,,,$145.55 ,$256.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.40 ,95,,,$145.55 ,$256.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$251.40 ,95,,,$145.55 ,$256.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$198.47 ,75,,,$145.55 ,$256.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$224.94 ,85,,,$145.55 ,$256.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.17 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.69 ,97,,,$145.55 ,$256.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$224.94 ,85,,,$145.55 ,$256.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$238.17 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$251.40 ,90,,,$145.55 ,$256.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$145.55 ,55,,,$145.55 ,$256.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.11 ,93,,,$145.55 ,$256.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8785632,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,8786677,CDM,270,RC,,HCPCS,outpatient,,,$147.83 ,$110.87 ,,$136.00 ,92,,,$81.31 ,$143.40 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.31 ,55,,,$81.31 ,$143.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.31 ,$143.40 ,other,,Not applicable. No negotiated rates per contract,$127.13 ,86,,,$81.31 ,$143.40 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.26 ,80,,,$81.31 ,$143.40 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.31 ,55,,,$81.31 ,$143.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.44 ,95,,,$81.31 ,$143.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.44 ,95,,,$81.31 ,$143.40 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.87 ,75,,,$81.31 ,$143.40 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.66 ,85,,,$81.31 ,$143.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.40 ,97,,,$81.31 ,$143.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.31 ,55,,,$81.31 ,$143.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.05 ,90,,,$81.31 ,$143.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.40 ,97,,,$81.31 ,$143.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.40 ,97,,,$81.31 ,$143.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.40 ,97,,,$81.31 ,$143.40 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.66 ,85,,,$81.31 ,$143.40 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.05 ,90,,,$81.31 ,$143.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.31 ,55,,,$81.31 ,$143.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.44 ,90,,,$81.31 ,$143.40 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.31 ,55,,,$81.31 ,$143.40 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.48 ,93,,,$81.31 ,$143.40 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURE,9236583,CDM,272,RC,,HCPCS,outpatient,,,$330.00 ,$247.50 ,,$303.60 ,92,,,$181.50 ,$320.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$181.50 ,55,,,$181.50 ,$320.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$181.50 ,$320.10 ,other,,Not applicable. No negotiated rates per contract,$283.80 ,86,,,$181.50 ,$320.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$264.00 ,80,,,$181.50 ,$320.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$181.50 ,55,,,$181.50 ,$320.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.50 ,95,,,$181.50 ,$320.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$313.50 ,95,,,$181.50 ,$320.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.50 ,75,,,$181.50 ,$320.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$280.50 ,85,,,$181.50 ,$320.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$320.10 ,97,,,$181.50 ,$320.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$181.50 ,55,,,$181.50 ,$320.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.00 ,90,,,$181.50 ,$320.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$320.10 ,97,,,$181.50 ,$320.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$320.10 ,97,,,$181.50 ,$320.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$320.10 ,97,,,$181.50 ,$320.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$280.50 ,85,,,$181.50 ,$320.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.00 ,90,,,$181.50 ,$320.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.50 ,55,,,$181.50 ,$320.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.50 ,90,,,$181.50 ,$320.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$181.50 ,55,,,$181.50 ,$320.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$306.90 ,93,,,$181.50 ,$320.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTUREFIX ULTRA AHR S-2 UB STR (CB)  BLUE,8786661,CDM,270,RC,,HCPCS,outpatient,,,"$1,976.25 ","$1,482.19 ",,"$1,818.15 ",92,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,086.94 ","$1,916.96 ",other,,Not applicable. No negotiated rates per contract,"$1,699.58 ",86,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,581.00 ",80,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,877.44 ",95,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,877.44 ",95,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,482.19 ",75,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,679.81 ",85,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,778.63 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,916.96 ",97,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,679.81 ",85,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,778.63 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,877.44 ",90,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,086.94 ",55,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,837.91 ",93,,,"$1,086.94 ","$1,916.96 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTUREFIX ULTRA AHR S-2 UB STR   BLUE,8786662,CDM,270,RC,,HCPCS,outpatient,,,"$1,275.00 ",$956.25 ,,"$1,173.00 ",92,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$701.25 ,"$1,236.75 ",other,,Not applicable. No negotiated rates per contract,"$1,096.50 ",86,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,020.00 ",80,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,211.25 ",95,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,211.25 ",95,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$956.25 ,75,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,083.75 ",85,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,147.50 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,236.75 ",97,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,083.75 ",85,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,147.50 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,211.25 ",90,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$701.25 ,55,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,185.75 ",93,,,$701.25 ,"$1,236.75 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURETAPE 2-0,8942872,CDM,270,RC,,HCPCS,outpatient,,,$243.17 ,$182.38 ,,$223.72 ,92,,,$133.74 ,$235.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$133.74 ,55,,,$133.74 ,$235.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$133.74 ,$235.87 ,other,,Not applicable. No negotiated rates per contract,$209.13 ,86,,,$133.74 ,$235.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$194.54 ,80,,,$133.74 ,$235.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$133.74 ,55,,,$133.74 ,$235.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.01 ,95,,,$133.74 ,$235.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.01 ,95,,,$133.74 ,$235.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.38 ,75,,,$133.74 ,$235.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$206.69 ,85,,,$133.74 ,$235.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.87 ,97,,,$133.74 ,$235.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.74 ,55,,,$133.74 ,$235.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.85 ,90,,,$133.74 ,$235.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.87 ,97,,,$133.74 ,$235.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.87 ,97,,,$133.74 ,$235.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.87 ,97,,,$133.74 ,$235.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.69 ,85,,,$133.74 ,$235.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.85 ,90,,,$133.74 ,$235.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.74 ,55,,,$133.74 ,$235.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.01 ,90,,,$133.74 ,$235.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.74 ,55,,,$133.74 ,$235.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.15 ,93,,,$133.74 ,$235.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURETAPE TIGERLINK 1.3,8942873,CDM,270,RC,,HCPCS,outpatient,,,$547.17 ,$410.38 ,,$503.40 ,92,,,$300.94 ,$530.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$300.94 ,$530.75 ,other,,Not applicable. No negotiated rates per contract,$470.57 ,86,,,$300.94 ,$530.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$437.74 ,80,,,$300.94 ,$530.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.81 ,95,,,$300.94 ,$530.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$519.81 ,95,,,$300.94 ,$530.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$410.38 ,75,,,$300.94 ,$530.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$465.09 ,85,,,$300.94 ,$530.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$492.45 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$530.75 ,97,,,$300.94 ,$530.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$465.09 ,85,,,$300.94 ,$530.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$492.45 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$519.81 ,90,,,$300.94 ,$530.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$300.94 ,55,,,$300.94 ,$530.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$508.87 ,93,,,$300.94 ,$530.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SUTURETAPE1.3MM WITH NEE,8942874,CDM,270,RC,,HCPCS,outpatient,,,$282.75 ,$212.06 ,,$260.13 ,92,,,$155.51 ,$274.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$155.51 ,$274.27 ,other,,Not applicable. No negotiated rates per contract,$243.17 ,86,,,$155.51 ,$274.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$226.20 ,80,,,$155.51 ,$274.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.61 ,95,,,$155.51 ,$274.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$268.61 ,95,,,$155.51 ,$274.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.06 ,75,,,$155.51 ,$274.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$240.34 ,85,,,$155.51 ,$274.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.48 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$274.27 ,97,,,$155.51 ,$274.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$240.34 ,85,,,$155.51 ,$274.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$254.48 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$268.61 ,90,,,$155.51 ,$274.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$155.51 ,55,,,$155.51 ,$274.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$262.96 ,93,,,$155.51 ,$274.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SWAB STERILE FLEXIBLE MI,8785792,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SWITCH DRAPE,8786672,CDM,270,RC,,HCPCS,outpatient,,,$274.05 ,$205.54 ,,$252.13 ,92,,,$150.73 ,$265.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$150.73 ,55,,,$150.73 ,$265.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$150.73 ,$265.83 ,other,,Not applicable. No negotiated rates per contract,$235.68 ,86,,,$150.73 ,$265.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$219.24 ,80,,,$150.73 ,$265.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$150.73 ,55,,,$150.73 ,$265.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.35 ,95,,,$150.73 ,$265.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.35 ,95,,,$150.73 ,$265.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$205.54 ,75,,,$150.73 ,$265.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$232.94 ,85,,,$150.73 ,$265.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$265.83 ,97,,,$150.73 ,$265.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.73 ,55,,,$150.73 ,$265.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.65 ,90,,,$150.73 ,$265.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.83 ,97,,,$150.73 ,$265.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.83 ,97,,,$150.73 ,$265.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.83 ,97,,,$150.73 ,$265.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.94 ,85,,,$150.73 ,$265.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.65 ,90,,,$150.73 ,$265.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.73 ,55,,,$150.73 ,$265.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.35 ,90,,,$150.73 ,$265.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.73 ,55,,,$150.73 ,$265.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.87 ,93,,,$150.73 ,$265.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SWITCHED BLADE CURVED METZ SCI,8782748,CDM,270,RC,,HCPCS,outpatient,,,$399.13 ,$299.35 ,,$367.20 ,92,,,$219.52 ,$387.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.52 ,55,,,$219.52 ,$387.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.52 ,$387.16 ,other,,Not applicable. No negotiated rates per contract,$343.25 ,86,,,$219.52 ,$387.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$319.30 ,80,,,$219.52 ,$387.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.52 ,55,,,$219.52 ,$387.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.17 ,95,,,$219.52 ,$387.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$379.17 ,95,,,$219.52 ,$387.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.35 ,75,,,$219.52 ,$387.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$339.26 ,85,,,$219.52 ,$387.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.16 ,97,,,$219.52 ,$387.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.52 ,55,,,$219.52 ,$387.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.22 ,90,,,$219.52 ,$387.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$387.16 ,97,,,$219.52 ,$387.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.16 ,97,,,$219.52 ,$387.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.16 ,97,,,$219.52 ,$387.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.26 ,85,,,$219.52 ,$387.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$359.22 ,90,,,$219.52 ,$387.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.52 ,55,,,$219.52 ,$387.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.17 ,90,,,$219.52 ,$387.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.52 ,55,,,$219.52 ,$387.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.19 ,93,,,$219.52 ,$387.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYNTHES,9092529,CDM,278,RC,,HCPCS,both,,,"$1,807.70 ","$1,355.78 ",,"$1,663.08 ",92,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$994.24 ,55,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$994.24 ,"$1,753.47 ",other,,Not applicable. No negotiated rates per contract,"$1,554.62 ",86,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,446.16 ",80,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$994.24 ,55,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,717.32 ",95,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,717.32 ",95,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,355.78 ",75,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,536.55 ",85,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,753.47 ",97,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$994.24 ,55,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,626.93 ",90,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,753.47 ",97,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,753.47 ",97,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,753.47 ",97,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,536.55 ",85,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,626.93 ",90,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$994.24 ,55,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,717.32 ",90,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$994.24 ,55,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,681.16 ",93,,,$994.24 ,"$1,753.47 ",percent of total billed charges,,93% of total billed charges for outpatient setting
SYNTHES,9092526,CDM,278,RC,,HCPCS,both,,,$177.48 ,$133.11 ,,$163.28 ,92,,,$97.61 ,$172.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.61 ,55,,,$97.61 ,$172.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.61 ,$172.16 ,other,,Not applicable. No negotiated rates per contract,$152.63 ,86,,,$97.61 ,$172.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$141.98 ,80,,,$97.61 ,$172.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.61 ,55,,,$97.61 ,$172.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.61 ,95,,,$97.61 ,$172.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.61 ,95,,,$97.61 ,$172.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.11 ,75,,,$97.61 ,$172.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$150.86 ,85,,,$97.61 ,$172.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.16 ,97,,,$97.61 ,$172.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.61 ,55,,,$97.61 ,$172.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.73 ,90,,,$97.61 ,$172.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.16 ,97,,,$97.61 ,$172.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.16 ,97,,,$97.61 ,$172.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.16 ,97,,,$97.61 ,$172.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.86 ,85,,,$97.61 ,$172.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.73 ,90,,,$97.61 ,$172.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.61 ,55,,,$97.61 ,$172.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.61 ,90,,,$97.61 ,$172.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.61 ,55,,,$97.61 ,$172.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.06 ,93,,,$97.61 ,$172.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYRINGE  8ML PERIFIX LOR,8785738,CDM,270,RC,,HCPCS,outpatient,,,$41.75 ,$31.31 ,,$38.41 ,92,,,$22.96 ,$40.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.96 ,$40.50 ,other,,Not applicable. No negotiated rates per contract,$35.91 ,86,,,$22.96 ,$40.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$33.40 ,80,,,$22.96 ,$40.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.66 ,95,,,$22.96 ,$40.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.66 ,95,,,$22.96 ,$40.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.31 ,75,,,$22.96 ,$40.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$35.49 ,85,,,$22.96 ,$40.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.58 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.50 ,97,,,$22.96 ,$40.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.49 ,85,,,$22.96 ,$40.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.58 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.66 ,90,,,$22.96 ,$40.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.96 ,55,,,$22.96 ,$40.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.83 ,93,,,$22.96 ,$40.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYRINGE  SET MRI,8782135,CDM,270,RC,,HCPCS,outpatient,,,$127.88 ,$95.91 ,,$117.65 ,92,,,$70.33 ,$124.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.33 ,$124.04 ,other,,Not applicable. No negotiated rates per contract,$109.98 ,86,,,$70.33 ,$124.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.30 ,80,,,$70.33 ,$124.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.49 ,95,,,$70.33 ,$124.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.49 ,95,,,$70.33 ,$124.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.91 ,75,,,$70.33 ,$124.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.70 ,85,,,$70.33 ,$124.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.09 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.04 ,97,,,$70.33 ,$124.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.70 ,85,,,$70.33 ,$124.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.09 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.49 ,90,,,$70.33 ,$124.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.33 ,55,,,$70.33 ,$124.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.93 ,93,,,$70.33 ,$124.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYRINGE,9055119,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYRINGE/ ALLIANCE II,8782233,CDM,270,RC,,HCPCS,outpatient,,,$325.01 ,$243.76 ,,$299.01 ,92,,,$178.76 ,$315.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$178.76 ,55,,,$178.76 ,$315.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$178.76 ,$315.26 ,other,,Not applicable. No negotiated rates per contract,$279.51 ,86,,,$178.76 ,$315.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$260.01 ,80,,,$178.76 ,$315.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$178.76 ,55,,,$178.76 ,$315.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,95,,,$178.76 ,$315.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$308.76 ,95,,,$178.76 ,$315.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$243.76 ,75,,,$178.76 ,$315.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$276.26 ,85,,,$178.76 ,$315.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$315.26 ,97,,,$178.76 ,$315.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.76 ,55,,,$178.76 ,$315.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$292.51 ,90,,,$178.76 ,$315.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$315.26 ,97,,,$178.76 ,$315.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.26 ,97,,,$178.76 ,$315.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.26 ,97,,,$178.76 ,$315.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$276.26 ,85,,,$178.76 ,$315.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$292.51 ,90,,,$178.76 ,$315.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.76 ,55,,,$178.76 ,$315.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$308.76 ,90,,,$178.76 ,$315.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.76 ,55,,,$178.76 ,$315.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$302.26 ,93,,,$178.76 ,$315.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SYSTEM 7 POWER  SAW  RENTAL,8786812,CDM,270,RC,,HCPCS,outpatient,,,"$1,700.00 ","$1,275.00 ",,"$1,564.00 ",92,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$935.00 ,"$1,649.00 ",other,,Not applicable. No negotiated rates per contract,"$1,462.00 ",86,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,360.00 ",80,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,615.00 ",95,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,615.00 ",95,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,275.00 ",75,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,445.00 ",85,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,530.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,649.00 ",97,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,445.00 ",85,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,530.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,615.00 ",90,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$935.00 ,55,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,581.00 ",93,,,$935.00 ,"$1,649.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Surgical Photos,8855191,CDM,270,RC,,HCPCS,outpatient,,,$69.00 ,$51.75 ,,$63.48 ,92,,,$37.95 ,$66.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.95 ,$66.93 ,other,,Not applicable. No negotiated rates per contract,$59.34 ,86,,,$37.95 ,$66.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.20 ,80,,,$37.95 ,$66.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.75 ,75,,,$37.95 ,$66.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.17 ,93,,,$37.95 ,$66.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
T-TUBE (GOODE) 1.14 X 9,8784140,CDM,270,RC,,HCPCS,outpatient,,,$184.15 ,$138.11 ,,$169.42 ,92,,,$101.28 ,$178.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$101.28 ,$178.63 ,other,,Not applicable. No negotiated rates per contract,$158.37 ,86,,,$101.28 ,$178.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$147.32 ,80,,,$101.28 ,$178.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.94 ,95,,,$101.28 ,$178.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.94 ,95,,,$101.28 ,$178.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$138.11 ,75,,,$101.28 ,$178.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$156.53 ,85,,,$101.28 ,$178.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.74 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$178.63 ,97,,,$101.28 ,$178.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.53 ,85,,,$101.28 ,$178.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.74 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.94 ,90,,,$101.28 ,$178.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.28 ,55,,,$101.28 ,$178.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$171.26 ,93,,,$101.28 ,$178.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
T7 PLUS HOOD W/PEELAWAY SHIELD   New ones,9796241,CDM,272,RC,,HCPCS,outpatient,,,$294.91 ,$221.18 ,,$271.32 ,92,,,$162.20 ,$286.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$162.20 ,55,,,$162.20 ,$286.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$162.20 ,$286.06 ,other,,Not applicable. No negotiated rates per contract,$253.62 ,86,,,$162.20 ,$286.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$235.93 ,80,,,$162.20 ,$286.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$162.20 ,55,,,$162.20 ,$286.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.16 ,95,,,$162.20 ,$286.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$280.16 ,95,,,$162.20 ,$286.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.18 ,75,,,$162.20 ,$286.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$250.67 ,85,,,$162.20 ,$286.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$286.06 ,97,,,$162.20 ,$286.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$162.20 ,55,,,$162.20 ,$286.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.42 ,90,,,$162.20 ,$286.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$286.06 ,97,,,$162.20 ,$286.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.06 ,97,,,$162.20 ,$286.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$286.06 ,97,,,$162.20 ,$286.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$250.67 ,85,,,$162.20 ,$286.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$265.42 ,90,,,$162.20 ,$286.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.20 ,55,,,$162.20 ,$286.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$280.16 ,90,,,$162.20 ,$286.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$162.20 ,55,,,$162.20 ,$286.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$274.27 ,93,,,$162.20 ,$286.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPE 1 CLOTH,8785425,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPE 1 TRANSPORE,8785424,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"TAPE 2"" MICROPORE",8785244,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPE 3 CLOTH,8785212,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"TAPE 3"" DURAPORE (SURGIC",8785216,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPE,8785049,CDM,270,RC,,HCPCS,outpatient,,,$82.17 ,$61.63 ,,$75.60 ,92,,,$45.19 ,$79.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.19 ,55,,,$45.19 ,$79.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.19 ,$79.70 ,other,,Not applicable. No negotiated rates per contract,$70.67 ,86,,,$45.19 ,$79.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.74 ,80,,,$45.19 ,$79.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.19 ,55,,,$45.19 ,$79.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.06 ,95,,,$45.19 ,$79.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.06 ,95,,,$45.19 ,$79.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.63 ,75,,,$45.19 ,$79.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.84 ,85,,,$45.19 ,$79.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.70 ,97,,,$45.19 ,$79.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.19 ,55,,,$45.19 ,$79.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.95 ,90,,,$45.19 ,$79.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.70 ,97,,,$45.19 ,$79.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.70 ,97,,,$45.19 ,$79.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.70 ,97,,,$45.19 ,$79.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.84 ,85,,,$45.19 ,$79.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.95 ,90,,,$45.19 ,$79.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.19 ,55,,,$45.19 ,$79.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.06 ,90,,,$45.19 ,$79.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.19 ,55,,,$45.19 ,$79.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.42 ,93,,,$45.19 ,$79.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPE,8785423,CDM,270,RC,,HCPCS,outpatient,,,$92.61 ,$69.46 ,,$85.20 ,92,,,$50.94 ,$89.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.94 ,$89.83 ,other,,Not applicable. No negotiated rates per contract,$79.64 ,86,,,$50.94 ,$89.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$74.09 ,80,,,$50.94 ,$89.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.98 ,95,,,$50.94 ,$89.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$87.98 ,95,,,$50.94 ,$89.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$69.46 ,75,,,$50.94 ,$89.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$78.72 ,85,,,$50.94 ,$89.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$83.35 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.83 ,97,,,$50.94 ,$89.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.72 ,85,,,$50.94 ,$89.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$83.35 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$87.98 ,90,,,$50.94 ,$89.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.94 ,55,,,$50.94 ,$89.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.13 ,93,,,$50.94 ,$89.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAPERES CRVD NDL 26MM 1/,8942875,CDM,270,RC,,HCPCS,outpatient,,,$155.51 ,$116.63 ,,$143.07 ,92,,,$85.53 ,$150.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.53 ,55,,,$85.53 ,$150.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.53 ,$150.84 ,other,,Not applicable. No negotiated rates per contract,$133.74 ,86,,,$85.53 ,$150.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.41 ,80,,,$85.53 ,$150.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.53 ,55,,,$85.53 ,$150.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.73 ,95,,,$85.53 ,$150.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$147.73 ,95,,,$85.53 ,$150.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.63 ,75,,,$85.53 ,$150.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$132.18 ,85,,,$85.53 ,$150.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.84 ,97,,,$85.53 ,$150.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.53 ,55,,,$85.53 ,$150.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.96 ,90,,,$85.53 ,$150.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.84 ,97,,,$85.53 ,$150.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.84 ,97,,,$85.53 ,$150.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.84 ,97,,,$85.53 ,$150.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.18 ,85,,,$85.53 ,$150.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.96 ,90,,,$85.53 ,$150.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.53 ,55,,,$85.53 ,$150.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.73 ,90,,,$85.53 ,$150.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.53 ,55,,,$85.53 ,$150.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.62 ,93,,,$85.53 ,$150.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TAXO A STREPTOCOCCI BACITRACIN  (VIAL) NEW (4331042),8782468,CDM,270,RC,,HCPCS,outpatient,,,$149.34 ,$112.01 ,,$137.39 ,92,,,$82.14 ,$144.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$82.14 ,55,,,$82.14 ,$144.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$82.14 ,$144.86 ,other,,Not applicable. No negotiated rates per contract,$128.43 ,86,,,$82.14 ,$144.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$119.47 ,80,,,$82.14 ,$144.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$82.14 ,55,,,$82.14 ,$144.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.87 ,95,,,$82.14 ,$144.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.87 ,95,,,$82.14 ,$144.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$112.01 ,75,,,$82.14 ,$144.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.94 ,85,,,$82.14 ,$144.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$144.86 ,97,,,$82.14 ,$144.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$82.14 ,55,,,$82.14 ,$144.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$134.41 ,90,,,$82.14 ,$144.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$144.86 ,97,,,$82.14 ,$144.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.86 ,97,,,$82.14 ,$144.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.86 ,97,,,$82.14 ,$144.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.94 ,85,,,$82.14 ,$144.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$134.41 ,90,,,$82.14 ,$144.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.14 ,55,,,$82.14 ,$144.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$141.87 ,90,,,$82.14 ,$144.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$82.14 ,55,,,$82.14 ,$144.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$138.89 ,93,,,$82.14 ,$144.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE LG KNEE TED,8785027,CDM,270,RC,,HCPCS,outpatient,,,$38.41 ,$28.81 ,,$35.34 ,92,,,$21.13 ,$37.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.13 ,$37.26 ,other,,Not applicable. No negotiated rates per contract,$33.03 ,86,,,$21.13 ,$37.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.73 ,80,,,$21.13 ,$37.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.49 ,95,,,$21.13 ,$37.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.49 ,95,,,$21.13 ,$37.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.81 ,75,,,$21.13 ,$37.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.65 ,85,,,$21.13 ,$37.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.57 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.26 ,97,,,$21.13 ,$37.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.65 ,85,,,$21.13 ,$37.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.57 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.49 ,90,,,$21.13 ,$37.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.13 ,55,,,$21.13 ,$37.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.72 ,93,,,$21.13 ,$37.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE LG THIGH TED,8785172,CDM,270,RC,,HCPCS,outpatient,,,$76.07 ,$57.05 ,,$69.98 ,92,,,$41.84 ,$73.79 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.84 ,55,,,$41.84 ,$73.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.84 ,$73.79 ,other,,Not applicable. No negotiated rates per contract,$65.42 ,86,,,$41.84 ,$73.79 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.86 ,80,,,$41.84 ,$73.79 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.84 ,55,,,$41.84 ,$73.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.27 ,95,,,$41.84 ,$73.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.27 ,95,,,$41.84 ,$73.79 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.05 ,75,,,$41.84 ,$73.79 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.66 ,85,,,$41.84 ,$73.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.79 ,97,,,$41.84 ,$73.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.84 ,55,,,$41.84 ,$73.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.46 ,90,,,$41.84 ,$73.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.79 ,97,,,$41.84 ,$73.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.79 ,97,,,$41.84 ,$73.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.79 ,97,,,$41.84 ,$73.79 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.66 ,85,,,$41.84 ,$73.79 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.46 ,90,,,$41.84 ,$73.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.84 ,55,,,$41.84 ,$73.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.27 ,90,,,$41.84 ,$73.79 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.84 ,55,,,$41.84 ,$73.79 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.75 ,93,,,$41.84 ,$73.79 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE MED KNEE TED,8785040,CDM,270,RC,,HCPCS,outpatient,,,$41.04 ,$30.78 ,,$37.76 ,92,,,$22.57 ,$39.81 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.57 ,$39.81 ,other,,Not applicable. No negotiated rates per contract,$35.29 ,86,,,$22.57 ,$39.81 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.83 ,80,,,$22.57 ,$39.81 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.99 ,95,,,$22.57 ,$39.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.99 ,95,,,$22.57 ,$39.81 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.78 ,75,,,$22.57 ,$39.81 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.88 ,85,,,$22.57 ,$39.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.94 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.81 ,97,,,$22.57 ,$39.81 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.88 ,85,,,$22.57 ,$39.81 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.94 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.99 ,90,,,$22.57 ,$39.81 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.57 ,55,,,$22.57 ,$39.81 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.17 ,93,,,$22.57 ,$39.81 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE MED THIGH TED,8785167,CDM,270,RC,,HCPCS,outpatient,,,$69.22 ,$51.92 ,,$63.68 ,92,,,$38.07 ,$67.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.07 ,55,,,$38.07 ,$67.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$38.07 ,$67.14 ,other,,Not applicable. No negotiated rates per contract,$59.53 ,86,,,$38.07 ,$67.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.38 ,80,,,$38.07 ,$67.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.07 ,55,,,$38.07 ,$67.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.76 ,95,,,$38.07 ,$67.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.76 ,95,,,$38.07 ,$67.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.92 ,75,,,$38.07 ,$67.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.84 ,85,,,$38.07 ,$67.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.14 ,97,,,$38.07 ,$67.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.07 ,55,,,$38.07 ,$67.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.30 ,90,,,$38.07 ,$67.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.14 ,97,,,$38.07 ,$67.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.14 ,97,,,$38.07 ,$67.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.14 ,97,,,$38.07 ,$67.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.84 ,85,,,$38.07 ,$67.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.30 ,90,,,$38.07 ,$67.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.07 ,55,,,$38.07 ,$67.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.76 ,90,,,$38.07 ,$67.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.07 ,55,,,$38.07 ,$67.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.37 ,93,,,$38.07 ,$67.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE SM THIGH TED,8785026,CDM,270,RC,,HCPCS,outpatient,,,$76.15 ,$57.11 ,,$70.06 ,92,,,$41.88 ,$73.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.88 ,55,,,$41.88 ,$73.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.88 ,$73.87 ,other,,Not applicable. No negotiated rates per contract,$65.49 ,86,,,$41.88 ,$73.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.92 ,80,,,$41.88 ,$73.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.88 ,55,,,$41.88 ,$73.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.34 ,95,,,$41.88 ,$73.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.34 ,95,,,$41.88 ,$73.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.11 ,75,,,$41.88 ,$73.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.73 ,85,,,$41.88 ,$73.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.87 ,97,,,$41.88 ,$73.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.88 ,55,,,$41.88 ,$73.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.54 ,90,,,$41.88 ,$73.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.87 ,97,,,$41.88 ,$73.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.87 ,97,,,$41.88 ,$73.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.87 ,97,,,$41.88 ,$73.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.73 ,85,,,$41.88 ,$73.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.54 ,90,,,$41.88 ,$73.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.88 ,55,,,$41.88 ,$73.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.34 ,90,,,$41.88 ,$73.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.88 ,55,,,$41.88 ,$73.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.82 ,93,,,$41.88 ,$73.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE SM. KNEE TED,8785039,CDM,270,RC,,HCPCS,outpatient,,,$38.94 ,$29.21 ,,$35.82 ,92,,,$21.42 ,$37.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.42 ,$37.77 ,other,,Not applicable. No negotiated rates per contract,$33.49 ,86,,,$21.42 ,$37.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.15 ,80,,,$21.42 ,$37.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.99 ,95,,,$21.42 ,$37.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.99 ,95,,,$21.42 ,$37.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.21 ,75,,,$21.42 ,$37.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.10 ,85,,,$21.42 ,$37.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.05 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.77 ,97,,,$21.42 ,$37.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.10 ,85,,,$21.42 ,$37.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.05 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.99 ,90,,,$21.42 ,$37.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.42 ,55,,,$21.42 ,$37.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.21 ,93,,,$21.42 ,$37.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE XLG KNEE,8785028,CDM,270,RC,,HCPCS,outpatient,,,$39.55 ,$29.66 ,,$36.39 ,92,,,$21.75 ,$38.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.75 ,55,,,$21.75 ,$38.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.75 ,$38.36 ,other,,Not applicable. No negotiated rates per contract,$34.01 ,86,,,$21.75 ,$38.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.64 ,80,,,$21.75 ,$38.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.75 ,55,,,$21.75 ,$38.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.57 ,95,,,$21.75 ,$38.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.57 ,95,,,$21.75 ,$38.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.66 ,75,,,$21.75 ,$38.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.62 ,85,,,$21.75 ,$38.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.36 ,97,,,$21.75 ,$38.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.75 ,55,,,$21.75 ,$38.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.60 ,90,,,$21.75 ,$38.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.36 ,97,,,$21.75 ,$38.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.36 ,97,,,$21.75 ,$38.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.36 ,97,,,$21.75 ,$38.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.62 ,85,,,$21.75 ,$38.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.60 ,90,,,$21.75 ,$38.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.75 ,55,,,$21.75 ,$38.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.57 ,90,,,$21.75 ,$38.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.75 ,55,,,$21.75 ,$38.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.78 ,93,,,$21.75 ,$38.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE XLG THIGH TED SZ N,8785166,CDM,270,RC,,HCPCS,outpatient,,,$76.31 ,$57.23 ,,$70.21 ,92,,,$41.97 ,$74.02 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.97 ,55,,,$41.97 ,$74.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.97 ,$74.02 ,other,,Not applicable. No negotiated rates per contract,$65.63 ,86,,,$41.97 ,$74.02 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.05 ,80,,,$41.97 ,$74.02 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.97 ,55,,,$41.97 ,$74.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.49 ,95,,,$41.97 ,$74.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.49 ,95,,,$41.97 ,$74.02 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.23 ,75,,,$41.97 ,$74.02 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.86 ,85,,,$41.97 ,$74.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.02 ,97,,,$41.97 ,$74.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.97 ,55,,,$41.97 ,$74.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.68 ,90,,,$41.97 ,$74.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.02 ,97,,,$41.97 ,$74.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.02 ,97,,,$41.97 ,$74.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.02 ,97,,,$41.97 ,$74.02 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.86 ,85,,,$41.97 ,$74.02 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.68 ,90,,,$41.97 ,$74.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.97 ,55,,,$41.97 ,$74.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.49 ,90,,,$41.97 ,$74.02 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.97 ,55,,,$41.97 ,$74.02 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.97 ,93,,,$41.97 ,$74.02 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE XXLG KNEE (OR),8785433,CDM,270,RC,,HCPCS,outpatient,,,$28.79 ,$21.59 ,,$26.49 ,92,,,$15.83 ,$27.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.83 ,$27.93 ,other,,Not applicable. No negotiated rates per contract,$24.76 ,86,,,$15.83 ,$27.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$23.03 ,80,,,$15.83 ,$27.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.35 ,95,,,$15.83 ,$27.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.35 ,95,,,$15.83 ,$27.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.59 ,75,,,$15.83 ,$27.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$24.47 ,85,,,$15.83 ,$27.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.91 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.93 ,97,,,$15.83 ,$27.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.47 ,85,,,$15.83 ,$27.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.91 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.35 ,90,,,$15.83 ,$27.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.83 ,55,,,$15.83 ,$27.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.77 ,93,,,$15.83 ,$27.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TENDON ANTERIOR TIBIALIS,8782054,CDM,270,RC,,HCPCS,outpatient,,,"$6,300.00 ","$4,725.00 ",,"$5,796.00 ",92,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,465.00 ",55,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,465.00 ","$6,111.00 ",other,,Not applicable. No negotiated rates per contract,"$5,418.00 ",86,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,040.00 ",80,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,465.00 ",55,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,985.00 ",95,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,985.00 ",95,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,725.00 ",75,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,355.00 ",85,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,111.00 ",97,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,465.00 ",55,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,670.00 ",90,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,111.00 ",97,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,111.00 ",97,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,111.00 ",97,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,355.00 ",85,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,670.00 ",90,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,465.00 ",55,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,985.00 ",90,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,465.00 ",55,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,859.00 ",93,,,"$3,465.00 ","$6,111.00 ",percent of total billed charges,,93% of total billed charges for outpatient setting
TENNIS ELBOW BRACE L3702,8971146,CDM,270,RC,L3702,HCPCS,outpatient,,,$47.00 ,$35.25 ,,$43.24 ,92,,,$25.85 ,$45.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$25.85 ,$45.59 ,other,,Not applicable. No negotiated rates per contract,$40.42 ,86,,,$25.85 ,$45.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$37.60 ,80,,,$25.85 ,$45.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,95,,,$25.85 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.65 ,95,,,$25.85 ,$45.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.25 ,75,,,$25.85 ,$45.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$42.30 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.59 ,97,,,$25.85 ,$45.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.95 ,85,,,$25.85 ,$45.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.30 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.65 ,90,,,$25.85 ,$45.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$25.85 ,55,,,$25.85 ,$45.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.71 ,93,,,$25.85 ,$45.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TENOSLOK,8782872,CDM,270,RC,,HCPCS,outpatient,,,"$3,395.75 ","$2,546.81 ",,"$3,124.09 ",92,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,867.66 ","$3,293.88 ",other,,Not applicable. No negotiated rates per contract,"$2,920.35 ",86,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$2,716.60 ",80,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,225.96 ",95,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,225.96 ",95,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,546.81 ",75,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$2,886.39 ",85,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,056.18 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,293.88 ",97,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,886.39 ",85,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,056.18 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,225.96 ",90,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,867.66 ",55,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,158.05 ",93,,,"$1,867.66 ","$3,293.88 ",percent of total billed charges,,93% of total billed charges for outpatient setting
THERMACHOICE  CATH BLLN,8786719,CDM,270,RC,,HCPCS,outpatient,,,"$4,270.05 ","$3,202.54 ",,"$3,928.45 ",92,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,348.53 ",55,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,348.53 ","$4,141.95 ",other,,Not applicable. No negotiated rates per contract,"$3,672.24 ",86,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,416.04 ",80,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,348.53 ",55,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,056.55 ",95,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,056.55 ",95,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,202.54 ",75,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,629.54 ",85,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,141.95 ",97,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,348.53 ",55,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,843.05 ",90,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,141.95 ",97,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,141.95 ",97,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,141.95 ",97,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,629.54 ",85,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,843.05 ",90,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,348.53 ",55,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,056.55 ",90,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,348.53 ",55,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,971.15 ",93,,,"$2,348.53 ","$4,141.95 ",percent of total billed charges,,93% of total billed charges for outpatient setting
THERMOSKIN WRIST BRACE DORSAL LEFT  XX-LARGE,8786151,CDM,270,RC,,HCPCS,outpatient,,,$171.54 ,$128.66 ,,$157.82 ,92,,,$94.35 ,$166.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.35 ,55,,,$94.35 ,$166.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.35 ,$166.39 ,other,,Not applicable. No negotiated rates per contract,$147.52 ,86,,,$94.35 ,$166.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.23 ,80,,,$94.35 ,$166.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.35 ,55,,,$94.35 ,$166.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.96 ,95,,,$94.35 ,$166.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.96 ,95,,,$94.35 ,$166.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.66 ,75,,,$94.35 ,$166.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.81 ,85,,,$94.35 ,$166.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.39 ,97,,,$94.35 ,$166.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.35 ,55,,,$94.35 ,$166.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.39 ,90,,,$94.35 ,$166.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.39 ,97,,,$94.35 ,$166.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.39 ,97,,,$94.35 ,$166.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.39 ,97,,,$94.35 ,$166.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.81 ,85,,,$94.35 ,$166.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.39 ,90,,,$94.35 ,$166.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.35 ,55,,,$94.35 ,$166.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.96 ,90,,,$94.35 ,$166.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.35 ,55,,,$94.35 ,$166.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.53 ,93,,,$94.35 ,$166.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
THUMB SUPPORT UNIVERSAL,8786138,CDM,270,RC,,HCPCS,outpatient,,,$161.46 ,$121.10 ,,$148.54 ,92,,,$88.80 ,$156.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$88.80 ,55,,,$88.80 ,$156.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$88.80 ,$156.62 ,other,,Not applicable. No negotiated rates per contract,$138.86 ,86,,,$88.80 ,$156.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$129.17 ,80,,,$88.80 ,$156.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$88.80 ,55,,,$88.80 ,$156.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.39 ,95,,,$88.80 ,$156.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$153.39 ,95,,,$88.80 ,$156.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.10 ,75,,,$88.80 ,$156.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$137.24 ,85,,,$88.80 ,$156.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$156.62 ,97,,,$88.80 ,$156.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.80 ,55,,,$88.80 ,$156.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$145.31 ,90,,,$88.80 ,$156.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.62 ,97,,,$88.80 ,$156.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.62 ,97,,,$88.80 ,$156.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.62 ,97,,,$88.80 ,$156.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.24 ,85,,,$88.80 ,$156.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$145.31 ,90,,,$88.80 ,$156.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.80 ,55,,,$88.80 ,$156.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.39 ,90,,,$88.80 ,$156.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.80 ,55,,,$88.80 ,$156.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$150.16 ,93,,,$88.80 ,$156.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TIP CAUTERY (ELECTROSURG,8785468,CDM,270,RC,,HCPCS,outpatient,,,$49.75 ,$37.31 ,,$45.77 ,92,,,$27.36 ,$48.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.36 ,$48.26 ,other,,Not applicable. No negotiated rates per contract,$42.79 ,86,,,$27.36 ,$48.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$39.80 ,80,,,$27.36 ,$48.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.26 ,95,,,$27.36 ,$48.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.31 ,75,,,$27.36 ,$48.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.26 ,97,,,$27.36 ,$48.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.29 ,85,,,$27.36 ,$48.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$44.78 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.26 ,90,,,$27.36 ,$48.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.36 ,55,,,$27.36 ,$48.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.27 ,93,,,$27.36 ,$48.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TISUUE GRASPER WITH SHARK TEETH-SMALL,9049273,CDM,270,RC,,HCPCS,outpatient,,,"$2,290.75 ","$1,718.06 ",,"$2,107.49 ",92,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,259.91 ",55,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,259.91 ","$2,222.03 ",other,,Not applicable. No negotiated rates per contract,"$1,970.05 ",86,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,832.60 ",80,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,259.91 ",55,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,176.21 ",95,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,176.21 ",95,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,718.06 ",75,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,947.14 ",85,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,222.03 ",97,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.91 ",55,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,061.68 ",90,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,222.03 ",97,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,222.03 ",97,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,222.03 ",97,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,947.14 ",85,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,061.68 ",90,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,259.91 ",55,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,176.21 ",90,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,259.91 ",55,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,130.40 ",93,,,"$1,259.91 ","$2,222.03 ",percent of total billed charges,,93% of total billed charges for outpatient setting
TONSIL SPONGES MEDIUM (1PK/5),8977415,CDM,270,RC,,HCPCS,outpatient,,,$40.16 ,$30.12 ,,$36.95 ,92,,,$22.09 ,$38.96 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.09 ,55,,,$22.09 ,$38.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.09 ,$38.96 ,other,,Not applicable. No negotiated rates per contract,$34.54 ,86,,,$22.09 ,$38.96 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.13 ,80,,,$22.09 ,$38.96 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.09 ,55,,,$22.09 ,$38.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.15 ,95,,,$22.09 ,$38.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.15 ,95,,,$22.09 ,$38.96 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.12 ,75,,,$22.09 ,$38.96 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.14 ,85,,,$22.09 ,$38.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.96 ,97,,,$22.09 ,$38.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.09 ,55,,,$22.09 ,$38.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.14 ,90,,,$22.09 ,$38.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.96 ,97,,,$22.09 ,$38.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.96 ,97,,,$22.09 ,$38.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.96 ,97,,,$22.09 ,$38.96 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.14 ,85,,,$22.09 ,$38.96 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.14 ,90,,,$22.09 ,$38.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.09 ,55,,,$22.09 ,$38.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.15 ,90,,,$22.09 ,$38.96 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.09 ,55,,,$22.09 ,$38.96 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.35 ,93,,,$22.09 ,$38.96 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TOTAL HIP PACK 120,9009091,CDM,272,RC,,HCPCS,outpatient,,,$846.88 ,$635.16 ,,$779.13 ,92,,,$465.78 ,$821.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$465.78 ,55,,,$465.78 ,$821.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$465.78 ,$821.47 ,other,,Not applicable. No negotiated rates per contract,$728.32 ,86,,,$465.78 ,$821.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$677.50 ,80,,,$465.78 ,$821.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$465.78 ,55,,,$465.78 ,$821.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$804.54 ,95,,,$465.78 ,$821.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$804.54 ,95,,,$465.78 ,$821.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$635.16 ,75,,,$465.78 ,$821.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$719.85 ,85,,,$465.78 ,$821.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$821.47 ,97,,,$465.78 ,$821.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$465.78 ,55,,,$465.78 ,$821.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$762.19 ,90,,,$465.78 ,$821.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$821.47 ,97,,,$465.78 ,$821.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$821.47 ,97,,,$465.78 ,$821.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$821.47 ,97,,,$465.78 ,$821.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$719.85 ,85,,,$465.78 ,$821.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$762.19 ,90,,,$465.78 ,$821.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$465.78 ,55,,,$465.78 ,$821.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$804.54 ,90,,,$465.78 ,$821.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$465.78 ,55,,,$465.78 ,$821.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$787.60 ,93,,,$465.78 ,$821.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TOTAL KNEE PLUS II,9085406,CDM,270,RC,,HCPCS,outpatient,,,$390.88 ,$293.16 ,,$359.61 ,92,,,$214.98 ,$379.15 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$214.98 ,55,,,$214.98 ,$379.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$214.98 ,$379.15 ,other,,Not applicable. No negotiated rates per contract,$336.16 ,86,,,$214.98 ,$379.15 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$312.70 ,80,,,$214.98 ,$379.15 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$214.98 ,55,,,$214.98 ,$379.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.34 ,95,,,$214.98 ,$379.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$371.34 ,95,,,$214.98 ,$379.15 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$293.16 ,75,,,$214.98 ,$379.15 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$332.25 ,85,,,$214.98 ,$379.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$379.15 ,97,,,$214.98 ,$379.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.98 ,55,,,$214.98 ,$379.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$351.79 ,90,,,$214.98 ,$379.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$379.15 ,97,,,$214.98 ,$379.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.15 ,97,,,$214.98 ,$379.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$379.15 ,97,,,$214.98 ,$379.15 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$332.25 ,85,,,$214.98 ,$379.15 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.79 ,90,,,$214.98 ,$379.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.98 ,55,,,$214.98 ,$379.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.34 ,90,,,$214.98 ,$379.15 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$214.98 ,55,,,$214.98 ,$379.15 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.52 ,93,,,$214.98 ,$379.15 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TOURNIQUET 34 INCH NON-D,8787025,CDM,270,RC,,HCPCS,outpatient,,,"$1,093.61 ",$820.21 ,,"$1,006.12 ",92,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$601.49 ,55,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$601.49 ,"$1,060.80 ",other,,Not applicable. No negotiated rates per contract,$940.50 ,86,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$874.89 ,80,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$601.49 ,55,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.93 ",95,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,038.93 ",95,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$820.21 ,75,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$929.57 ,85,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,060.80 ",97,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$601.49 ,55,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$984.25 ,90,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,060.80 ",97,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.80 ",97,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,060.80 ",97,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$929.57 ,85,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$984.25 ,90,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.49 ,55,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,038.93 ",90,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$601.49 ,55,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,017.06 ",93,,,$601.49 ,"$1,060.80 ",percent of total billed charges,,93% of total billed charges for outpatient setting
TOURNIQUET CUFF DISP STERILE,8787061,CDM,270,RC,,HCPCS,outpatient,,,$203.73 ,$152.80 ,,$187.43 ,92,,,$112.05 ,$197.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$112.05 ,55,,,$112.05 ,$197.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$112.05 ,$197.62 ,other,,Not applicable. No negotiated rates per contract,$175.21 ,86,,,$112.05 ,$197.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$162.98 ,80,,,$112.05 ,$197.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$112.05 ,55,,,$112.05 ,$197.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.54 ,95,,,$112.05 ,$197.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$193.54 ,95,,,$112.05 ,$197.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$152.80 ,75,,,$112.05 ,$197.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$173.17 ,85,,,$112.05 ,$197.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$197.62 ,97,,,$112.05 ,$197.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$112.05 ,55,,,$112.05 ,$197.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.36 ,90,,,$112.05 ,$197.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$197.62 ,97,,,$112.05 ,$197.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.62 ,97,,,$112.05 ,$197.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$197.62 ,97,,,$112.05 ,$197.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.17 ,85,,,$112.05 ,$197.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.36 ,90,,,$112.05 ,$197.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.05 ,55,,,$112.05 ,$197.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.54 ,90,,,$112.05 ,$197.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$112.05 ,55,,,$112.05 ,$197.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.47 ,93,,,$112.05 ,$197.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TOURNIQUET,8783056,CDM,270,RC,,HCPCS,outpatient,,,$271.80 ,$203.85 ,,$250.06 ,92,,,$149.49 ,$263.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$149.49 ,55,,,$149.49 ,$263.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$149.49 ,$263.65 ,other,,Not applicable. No negotiated rates per contract,$233.75 ,86,,,$149.49 ,$263.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$217.44 ,80,,,$149.49 ,$263.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$149.49 ,55,,,$149.49 ,$263.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.21 ,95,,,$149.49 ,$263.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$258.21 ,95,,,$149.49 ,$263.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$203.85 ,75,,,$149.49 ,$263.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$231.03 ,85,,,$149.49 ,$263.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$263.65 ,97,,,$149.49 ,$263.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$149.49 ,55,,,$149.49 ,$263.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.62 ,90,,,$149.49 ,$263.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$263.65 ,97,,,$149.49 ,$263.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.65 ,97,,,$149.49 ,$263.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$263.65 ,97,,,$149.49 ,$263.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$231.03 ,85,,,$149.49 ,$263.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.62 ,90,,,$149.49 ,$263.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.49 ,55,,,$149.49 ,$263.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$258.21 ,90,,,$149.49 ,$263.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$149.49 ,55,,,$149.49 ,$263.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$252.77 ,93,,,$149.49 ,$263.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRACH CARE CLOSED SYSTEM FOR ADULTS,8942876,CDM,270,RC,,HCPCS,outpatient,,,$147.25 ,$110.44 ,,$135.47 ,92,,,$80.99 ,$142.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$80.99 ,55,,,$80.99 ,$142.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$80.99 ,$142.83 ,other,,Not applicable. No negotiated rates per contract,$126.64 ,86,,,$80.99 ,$142.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$117.80 ,80,,,$80.99 ,$142.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$80.99 ,55,,,$80.99 ,$142.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.89 ,95,,,$80.99 ,$142.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.89 ,95,,,$80.99 ,$142.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$110.44 ,75,,,$80.99 ,$142.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$125.16 ,85,,,$80.99 ,$142.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$142.83 ,97,,,$80.99 ,$142.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$80.99 ,55,,,$80.99 ,$142.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$132.53 ,90,,,$80.99 ,$142.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.83 ,97,,,$80.99 ,$142.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.83 ,97,,,$80.99 ,$142.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.83 ,97,,,$80.99 ,$142.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.16 ,85,,,$80.99 ,$142.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$132.53 ,90,,,$80.99 ,$142.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.99 ,55,,,$80.99 ,$142.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.89 ,90,,,$80.99 ,$142.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$80.99 ,55,,,$80.99 ,$142.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$136.94 ,93,,,$80.99 ,$142.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRACTION CERVICAL CLEVIS,8783072,CDM,270,RC,,HCPCS,outpatient,,,$450.94 ,$338.21 ,,$414.86 ,92,,,$248.02 ,$437.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$248.02 ,55,,,$248.02 ,$437.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$248.02 ,$437.41 ,other,,Not applicable. No negotiated rates per contract,$387.81 ,86,,,$248.02 ,$437.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$360.75 ,80,,,$248.02 ,$437.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$248.02 ,55,,,$248.02 ,$437.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.39 ,95,,,$248.02 ,$437.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$428.39 ,95,,,$248.02 ,$437.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$338.21 ,75,,,$248.02 ,$437.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$383.30 ,85,,,$248.02 ,$437.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$437.41 ,97,,,$248.02 ,$437.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$248.02 ,55,,,$248.02 ,$437.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$405.85 ,90,,,$248.02 ,$437.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$437.41 ,97,,,$248.02 ,$437.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.41 ,97,,,$248.02 ,$437.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$437.41 ,97,,,$248.02 ,$437.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$383.30 ,85,,,$248.02 ,$437.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$405.85 ,90,,,$248.02 ,$437.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.02 ,55,,,$248.02 ,$437.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$428.39 ,90,,,$248.02 ,$437.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$248.02 ,55,,,$248.02 ,$437.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$419.37 ,93,,,$248.02 ,$437.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAPHON EPR SYTEM (ULTRA,8783226,CDM,270,RC,,HCPCS,outpatient,,,"$19,119.85 ","$14,339.89 ",,"$17,590.26 ",92,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$10,515.92 ",55,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$10,515.92 ","$18,546.25 ",other,,Not applicable. No negotiated rates per contract,"$16,443.07 ",86,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$15,295.88 ",80,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$10,515.92 ",55,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$18,163.86 ",95,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$18,163.86 ",95,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$14,339.89 ",75,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$16,251.87 ",85,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$18,546.25 ",97,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$10,515.92 ",55,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$17,207.87 ",90,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$18,546.25 ",97,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$18,546.25 ",97,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$18,546.25 ",97,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$16,251.87 ",85,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$17,207.87 ",90,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$10,515.92 ",55,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$18,163.86 ",90,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$10,515.92 ",55,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$17,781.46 ",93,,,"$10,515.92 ","$18,546.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785359,CDM,270,RC,,HCPCS,outpatient,,,$38.59 ,$28.94 ,,$35.50 ,92,,,$21.22 ,$37.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.22 ,55,,,$21.22 ,$37.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.22 ,$37.43 ,other,,Not applicable. No negotiated rates per contract,$33.19 ,86,,,$21.22 ,$37.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$30.87 ,80,,,$21.22 ,$37.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.22 ,55,,,$21.22 ,$37.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.66 ,95,,,$21.22 ,$37.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.66 ,95,,,$21.22 ,$37.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.94 ,75,,,$21.22 ,$37.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$32.80 ,85,,,$21.22 ,$37.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.43 ,97,,,$21.22 ,$37.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.22 ,55,,,$21.22 ,$37.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.73 ,90,,,$21.22 ,$37.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.43 ,97,,,$21.22 ,$37.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.43 ,97,,,$21.22 ,$37.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.43 ,97,,,$21.22 ,$37.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.80 ,85,,,$21.22 ,$37.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.73 ,90,,,$21.22 ,$37.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.22 ,55,,,$21.22 ,$37.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.66 ,90,,,$21.22 ,$37.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.22 ,55,,,$21.22 ,$37.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.89 ,93,,,$21.22 ,$37.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY 16FR CATHETER,8785311,CDM,270,RC,,HCPCS,outpatient,,,$91.45 ,$68.59 ,,$84.13 ,92,,,$50.30 ,$88.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$50.30 ,55,,,$50.30 ,$88.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$50.30 ,$88.71 ,other,,Not applicable. No negotiated rates per contract,$78.65 ,86,,,$50.30 ,$88.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$73.16 ,80,,,$50.30 ,$88.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$50.30 ,55,,,$50.30 ,$88.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.88 ,95,,,$50.30 ,$88.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.88 ,95,,,$50.30 ,$88.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$68.59 ,75,,,$50.30 ,$88.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$77.73 ,85,,,$50.30 ,$88.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.71 ,97,,,$50.30 ,$88.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.30 ,55,,,$50.30 ,$88.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.31 ,90,,,$50.30 ,$88.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$88.71 ,97,,,$50.30 ,$88.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.71 ,97,,,$50.30 ,$88.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$88.71 ,97,,,$50.30 ,$88.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.73 ,85,,,$50.30 ,$88.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$82.31 ,90,,,$50.30 ,$88.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.30 ,55,,,$50.30 ,$88.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$86.88 ,90,,,$50.30 ,$88.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.30 ,55,,,$50.30 ,$88.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$85.05 ,93,,,$50.30 ,$88.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY ADULT LUMBAR PUNCTURE,8785155,CDM,270,RC,,HCPCS,outpatient,,,$127.95 ,$95.96 ,,$117.71 ,92,,,$70.37 ,$124.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.37 ,55,,,$70.37 ,$124.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.37 ,$124.11 ,other,,Not applicable. No negotiated rates per contract,$110.04 ,86,,,$70.37 ,$124.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.36 ,80,,,$70.37 ,$124.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.37 ,55,,,$70.37 ,$124.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.55 ,95,,,$70.37 ,$124.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.55 ,95,,,$70.37 ,$124.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.96 ,75,,,$70.37 ,$124.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.76 ,85,,,$70.37 ,$124.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.11 ,97,,,$70.37 ,$124.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.37 ,55,,,$70.37 ,$124.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.16 ,90,,,$70.37 ,$124.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.11 ,97,,,$70.37 ,$124.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.11 ,97,,,$70.37 ,$124.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.11 ,97,,,$70.37 ,$124.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.76 ,85,,,$70.37 ,$124.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.16 ,90,,,$70.37 ,$124.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.37 ,55,,,$70.37 ,$124.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.55 ,90,,,$70.37 ,$124.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.37 ,55,,,$70.37 ,$124.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.99 ,93,,,$70.37 ,$124.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY CENTRAL LINE DRESSI,8783892,CDM,270,RC,,HCPCS,outpatient,,,$33.95 ,$25.46 ,,$31.23 ,92,,,$18.67 ,$32.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.67 ,$32.93 ,other,,Not applicable. No negotiated rates per contract,$29.20 ,86,,,$18.67 ,$32.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$27.16 ,80,,,$18.67 ,$32.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.25 ,95,,,$18.67 ,$32.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.25 ,95,,,$18.67 ,$32.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$25.46 ,75,,,$18.67 ,$32.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.86 ,85,,,$18.67 ,$32.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.56 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.93 ,97,,,$18.67 ,$32.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.86 ,85,,,$18.67 ,$32.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.56 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.25 ,90,,,$18.67 ,$32.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.67 ,55,,,$18.67 ,$32.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.57 ,93,,,$18.67 ,$32.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY CHEST TUBE INSERTIO,8785347,CDM,270,RC,,HCPCS,outpatient,,,$175.09 ,$131.32 ,,$161.08 ,92,,,$96.30 ,$169.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.30 ,$169.84 ,other,,Not applicable. No negotiated rates per contract,$150.58 ,86,,,$96.30 ,$169.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.07 ,80,,,$96.30 ,$169.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.34 ,95,,,$96.30 ,$169.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.34 ,95,,,$96.30 ,$169.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.32 ,75,,,$96.30 ,$169.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.83 ,85,,,$96.30 ,$169.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.58 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.84 ,97,,,$96.30 ,$169.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.83 ,85,,,$96.30 ,$169.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.58 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.34 ,90,,,$96.30 ,$169.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.30 ,55,,,$96.30 ,$169.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.83 ,93,,,$96.30 ,$169.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY ER LACERATION,8785515,CDM,270,RC,,HCPCS,outpatient,,,$48.51 ,$36.38 ,,$44.63 ,92,,,$26.68 ,$47.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.68 ,$47.05 ,other,,Not applicable. No negotiated rates per contract,$41.72 ,86,,,$26.68 ,$47.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.81 ,80,,,$26.68 ,$47.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.08 ,95,,,$26.68 ,$47.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$46.08 ,95,,,$26.68 ,$47.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.38 ,75,,,$26.68 ,$47.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$41.23 ,85,,,$26.68 ,$47.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.66 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.05 ,97,,,$26.68 ,$47.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.23 ,85,,,$26.68 ,$47.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.66 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.08 ,90,,,$26.68 ,$47.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.68 ,55,,,$26.68 ,$47.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.11 ,93,,,$26.68 ,$47.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY IRRIGATION (MEDICHOICE),8785164,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY PED./INFANT LUMBAR PUNCTURE,8785159,CDM,270,RC,,HCPCS,outpatient,,,$82.23 ,$61.67 ,,$75.65 ,92,,,$45.23 ,$79.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$45.23 ,55,,,$45.23 ,$79.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$45.23 ,$79.76 ,other,,Not applicable. No negotiated rates per contract,$70.72 ,86,,,$45.23 ,$79.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.78 ,80,,,$45.23 ,$79.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$45.23 ,55,,,$45.23 ,$79.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.12 ,95,,,$45.23 ,$79.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.12 ,95,,,$45.23 ,$79.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.67 ,75,,,$45.23 ,$79.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.90 ,85,,,$45.23 ,$79.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$79.76 ,97,,,$45.23 ,$79.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$45.23 ,55,,,$45.23 ,$79.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.01 ,90,,,$45.23 ,$79.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$79.76 ,97,,,$45.23 ,$79.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.76 ,97,,,$45.23 ,$79.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$79.76 ,97,,,$45.23 ,$79.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.90 ,85,,,$45.23 ,$79.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.01 ,90,,,$45.23 ,$79.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.23 ,55,,,$45.23 ,$79.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.12 ,90,,,$45.23 ,$79.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$45.23 ,55,,,$45.23 ,$79.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.47 ,93,,,$45.23 ,$79.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY POWER PICC  SINGLE LUMEN (BARD ACCESS SYSTEM),8782330,CDM,270,RC,,HCPCS,outpatient,,,$566.48 ,$424.86 ,,$521.16 ,92,,,$311.56 ,$549.49 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$311.56 ,55,,,$311.56 ,$549.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$311.56 ,$549.49 ,other,,Not applicable. No negotiated rates per contract,$487.17 ,86,,,$311.56 ,$549.49 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$453.18 ,80,,,$311.56 ,$549.49 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$311.56 ,55,,,$311.56 ,$549.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.16 ,95,,,$311.56 ,$549.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$538.16 ,95,,,$311.56 ,$549.49 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$424.86 ,75,,,$311.56 ,$549.49 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$481.51 ,85,,,$311.56 ,$549.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$549.49 ,97,,,$311.56 ,$549.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$311.56 ,55,,,$311.56 ,$549.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$509.83 ,90,,,$311.56 ,$549.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$549.49 ,97,,,$311.56 ,$549.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.49 ,97,,,$311.56 ,$549.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$549.49 ,97,,,$311.56 ,$549.49 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$481.51 ,85,,,$311.56 ,$549.49 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$509.83 ,90,,,$311.56 ,$549.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.56 ,55,,,$311.56 ,$549.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$538.16 ,90,,,$311.56 ,$549.49 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$311.56 ,55,,,$311.56 ,$549.49 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$526.83 ,93,,,$311.56 ,$549.49 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY PREP EXDINE (NEW),8785498,CDM,270,RC,,HCPCS,outpatient,,,$30.98 ,$23.24 ,,$28.50 ,92,,,$17.04 ,$30.05 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.04 ,$30.05 ,other,,Not applicable. No negotiated rates per contract,$26.64 ,86,,,$17.04 ,$30.05 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.78 ,80,,,$17.04 ,$30.05 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.43 ,95,,,$17.04 ,$30.05 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.24 ,75,,,$17.04 ,$30.05 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.05 ,97,,,$17.04 ,$30.05 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.33 ,85,,,$17.04 ,$30.05 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.88 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.43 ,90,,,$17.04 ,$30.05 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.04 ,55,,,$17.04 ,$30.05 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.81 ,93,,,$17.04 ,$30.05 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY PUDENDAL BLOCK,8782476,CDM,270,RC,,HCPCS,outpatient,,,$250.13 ,$187.60 ,,$230.12 ,92,,,$137.57 ,$242.63 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$137.57 ,$242.63 ,other,,Not applicable. No negotiated rates per contract,$215.11 ,86,,,$137.57 ,$242.63 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$200.10 ,80,,,$137.57 ,$242.63 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.62 ,95,,,$137.57 ,$242.63 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$187.60 ,75,,,$137.57 ,$242.63 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.63 ,97,,,$137.57 ,$242.63 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$212.61 ,85,,,$137.57 ,$242.63 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$225.12 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$237.62 ,90,,,$137.57 ,$242.63 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$137.57 ,55,,,$137.57 ,$242.63 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$232.62 ,93,,,$137.57 ,$242.63 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY THORACENTESIS (NEW),8785046,CDM,270,RC,,HCPCS,outpatient,,,$593.88 ,$445.41 ,,$546.37 ,92,,,$326.63 ,$576.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$326.63 ,55,,,$326.63 ,$576.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$326.63 ,$576.06 ,other,,Not applicable. No negotiated rates per contract,$510.74 ,86,,,$326.63 ,$576.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$475.10 ,80,,,$326.63 ,$576.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$326.63 ,55,,,$326.63 ,$576.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$564.19 ,95,,,$326.63 ,$576.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$564.19 ,95,,,$326.63 ,$576.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$445.41 ,75,,,$326.63 ,$576.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$504.80 ,85,,,$326.63 ,$576.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$576.06 ,97,,,$326.63 ,$576.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$326.63 ,55,,,$326.63 ,$576.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$534.49 ,90,,,$326.63 ,$576.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$576.06 ,97,,,$326.63 ,$576.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$576.06 ,97,,,$326.63 ,$576.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$576.06 ,97,,,$326.63 ,$576.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$504.80 ,85,,,$326.63 ,$576.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$534.49 ,90,,,$326.63 ,$576.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$326.63 ,55,,,$326.63 ,$576.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$564.19 ,90,,,$326.63 ,$576.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$326.63 ,55,,,$326.63 ,$576.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$552.31 ,93,,,$326.63 ,$576.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY TRACHOSTOMY CARE,8785506,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY TRIPLE LUMEN CATH CVC,8782084,CDM,270,RC,,HCPCS,outpatient,,,$440.75 ,$330.56 ,,$405.49 ,92,,,$242.41 ,$427.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$242.41 ,55,,,$242.41 ,$427.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$242.41 ,$427.53 ,other,,Not applicable. No negotiated rates per contract,$379.05 ,86,,,$242.41 ,$427.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$352.60 ,80,,,$242.41 ,$427.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$242.41 ,55,,,$242.41 ,$427.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$418.71 ,95,,,$242.41 ,$427.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$418.71 ,95,,,$242.41 ,$427.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.56 ,75,,,$242.41 ,$427.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$374.64 ,85,,,$242.41 ,$427.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$427.53 ,97,,,$242.41 ,$427.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$242.41 ,55,,,$242.41 ,$427.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$396.68 ,90,,,$242.41 ,$427.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$427.53 ,97,,,$242.41 ,$427.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$427.53 ,97,,,$242.41 ,$427.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$427.53 ,97,,,$242.41 ,$427.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$374.64 ,85,,,$242.41 ,$427.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$396.68 ,90,,,$242.41 ,$427.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$242.41 ,55,,,$242.41 ,$427.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$418.71 ,90,,,$242.41 ,$427.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$242.41 ,55,,,$242.41 ,$427.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$409.90 ,93,,,$242.41 ,$427.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY UMBILLICAL VESSEL C,8785132,CDM,270,RC,,HCPCS,outpatient,,,$346.88 ,$260.16 ,,$319.13 ,92,,,$190.78 ,$336.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$190.78 ,55,,,$190.78 ,$336.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$190.78 ,$336.47 ,other,,Not applicable. No negotiated rates per contract,$298.32 ,86,,,$190.78 ,$336.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$277.50 ,80,,,$190.78 ,$336.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$190.78 ,55,,,$190.78 ,$336.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$329.54 ,95,,,$190.78 ,$336.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$329.54 ,95,,,$190.78 ,$336.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.16 ,75,,,$190.78 ,$336.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$294.85 ,85,,,$190.78 ,$336.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$336.47 ,97,,,$190.78 ,$336.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.78 ,55,,,$190.78 ,$336.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$312.19 ,90,,,$190.78 ,$336.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$336.47 ,97,,,$190.78 ,$336.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$336.47 ,97,,,$190.78 ,$336.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$336.47 ,97,,,$190.78 ,$336.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.85 ,85,,,$190.78 ,$336.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$312.19 ,90,,,$190.78 ,$336.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.78 ,55,,,$190.78 ,$336.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$329.54 ,90,,,$190.78 ,$336.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.78 ,55,,,$190.78 ,$336.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$322.60 ,93,,,$190.78 ,$336.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY URETHRAL CATHETER 14FR,8785504,CDM,270,RC,,HCPCS,outpatient,,,$32.38 ,$24.29 ,,$29.79 ,92,,,$17.81 ,$31.41 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.81 ,$31.41 ,other,,Not applicable. No negotiated rates per contract,$27.85 ,86,,,$17.81 ,$31.41 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.90 ,80,,,$17.81 ,$31.41 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.76 ,95,,,$17.81 ,$31.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.76 ,95,,,$17.81 ,$31.41 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.29 ,75,,,$17.81 ,$31.41 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.52 ,85,,,$17.81 ,$31.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.14 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.41 ,97,,,$17.81 ,$31.41 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.52 ,85,,,$17.81 ,$31.41 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.14 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.76 ,90,,,$17.81 ,$31.41 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.81 ,55,,,$17.81 ,$31.41 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.11 ,93,,,$17.81 ,$31.41 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY URINE METER,8785312,CDM,270,RC,,HCPCS,outpatient,,,$175.23 ,$131.42 ,,$161.21 ,92,,,$96.38 ,$169.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$96.38 ,55,,,$96.38 ,$169.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$96.38 ,$169.97 ,other,,Not applicable. No negotiated rates per contract,$150.70 ,86,,,$96.38 ,$169.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$140.18 ,80,,,$96.38 ,$169.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$96.38 ,55,,,$96.38 ,$169.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,95,,,$96.38 ,$169.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$166.47 ,95,,,$96.38 ,$169.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$131.42 ,75,,,$96.38 ,$169.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$148.95 ,85,,,$96.38 ,$169.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$169.97 ,97,,,$96.38 ,$169.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$96.38 ,55,,,$96.38 ,$169.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.71 ,90,,,$96.38 ,$169.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$169.97 ,97,,,$96.38 ,$169.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.97 ,97,,,$96.38 ,$169.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$169.97 ,97,,,$96.38 ,$169.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$148.95 ,85,,,$96.38 ,$169.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$157.71 ,90,,,$96.38 ,$169.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.38 ,55,,,$96.38 ,$169.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$166.47 ,90,,,$96.38 ,$169.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$96.38 ,55,,,$96.38 ,$169.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.96 ,93,,,$96.38 ,$169.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785156,CDM,270,RC,,HCPCS,outpatient,,,$178.21 ,$133.66 ,,$163.95 ,92,,,$98.02 ,$172.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$98.02 ,55,,,$98.02 ,$172.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$98.02 ,$172.86 ,other,,Not applicable. No negotiated rates per contract,$153.26 ,86,,,$98.02 ,$172.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$142.57 ,80,,,$98.02 ,$172.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$98.02 ,55,,,$98.02 ,$172.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.30 ,95,,,$98.02 ,$172.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.30 ,95,,,$98.02 ,$172.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$133.66 ,75,,,$98.02 ,$172.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$151.48 ,85,,,$98.02 ,$172.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.86 ,97,,,$98.02 ,$172.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$98.02 ,55,,,$98.02 ,$172.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.39 ,90,,,$98.02 ,$172.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$172.86 ,97,,,$98.02 ,$172.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.86 ,97,,,$98.02 ,$172.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$172.86 ,97,,,$98.02 ,$172.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.48 ,85,,,$98.02 ,$172.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$160.39 ,90,,,$98.02 ,$172.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.02 ,55,,,$98.02 ,$172.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$169.30 ,90,,,$98.02 ,$172.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$98.02 ,55,,,$98.02 ,$172.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$165.74 ,93,,,$98.02 ,$172.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785335,CDM,270,RC,,HCPCS,outpatient,,,$132.99 ,$99.74 ,,$122.35 ,92,,,$73.14 ,$129.00 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$73.14 ,55,,,$73.14 ,$129.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$73.14 ,$129.00 ,other,,Not applicable. No negotiated rates per contract,$114.37 ,86,,,$73.14 ,$129.00 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$106.39 ,80,,,$73.14 ,$129.00 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$73.14 ,55,,,$73.14 ,$129.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.34 ,95,,,$73.14 ,$129.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.34 ,95,,,$73.14 ,$129.00 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.74 ,75,,,$73.14 ,$129.00 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$113.04 ,85,,,$73.14 ,$129.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$129.00 ,97,,,$73.14 ,$129.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.14 ,55,,,$73.14 ,$129.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.69 ,90,,,$73.14 ,$129.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.00 ,97,,,$73.14 ,$129.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.00 ,97,,,$73.14 ,$129.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.00 ,97,,,$73.14 ,$129.00 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$113.04 ,85,,,$73.14 ,$129.00 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$119.69 ,90,,,$73.14 ,$129.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.14 ,55,,,$73.14 ,$129.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$126.34 ,90,,,$73.14 ,$129.00 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.14 ,55,,,$73.14 ,$129.00 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$123.68 ,93,,,$73.14 ,$129.00 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,10030768,CDM,272,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785299,CDM,270,RC,,HCPCS,outpatient,,,$283.77 ,$212.83 ,,$261.07 ,92,,,$156.07 ,$275.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$156.07 ,55,,,$156.07 ,$275.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$156.07 ,$275.26 ,other,,Not applicable. No negotiated rates per contract,$244.04 ,86,,,$156.07 ,$275.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$227.02 ,80,,,$156.07 ,$275.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$156.07 ,55,,,$156.07 ,$275.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.58 ,95,,,$156.07 ,$275.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$269.58 ,95,,,$156.07 ,$275.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$212.83 ,75,,,$156.07 ,$275.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$241.20 ,85,,,$156.07 ,$275.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$275.26 ,97,,,$156.07 ,$275.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$156.07 ,55,,,$156.07 ,$275.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$255.39 ,90,,,$156.07 ,$275.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$275.26 ,97,,,$156.07 ,$275.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.26 ,97,,,$156.07 ,$275.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$275.26 ,97,,,$156.07 ,$275.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$241.20 ,85,,,$156.07 ,$275.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$255.39 ,90,,,$156.07 ,$275.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.07 ,55,,,$156.07 ,$275.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.58 ,90,,,$156.07 ,$275.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$156.07 ,55,,,$156.07 ,$275.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.91 ,93,,,$156.07 ,$275.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,10139793,CDM,272,RC,,HCPCS,outpatient,,,$148.34 ,$111.26 ,,$136.47 ,92,,,$81.59 ,$143.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$81.59 ,55,,,$81.59 ,$143.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$81.59 ,$143.89 ,other,,Not applicable. No negotiated rates per contract,$127.57 ,86,,,$81.59 ,$143.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$118.67 ,80,,,$81.59 ,$143.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$81.59 ,55,,,$81.59 ,$143.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.92 ,95,,,$81.59 ,$143.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$140.92 ,95,,,$81.59 ,$143.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$111.26 ,75,,,$81.59 ,$143.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$126.09 ,85,,,$81.59 ,$143.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$143.89 ,97,,,$81.59 ,$143.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$81.59 ,55,,,$81.59 ,$143.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$133.51 ,90,,,$81.59 ,$143.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.89 ,97,,,$81.59 ,$143.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.89 ,97,,,$81.59 ,$143.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.89 ,97,,,$81.59 ,$143.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$126.09 ,85,,,$81.59 ,$143.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$133.51 ,90,,,$81.59 ,$143.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.59 ,55,,,$81.59 ,$143.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.92 ,90,,,$81.59 ,$143.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$81.59 ,55,,,$81.59 ,$143.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$137.96 ,93,,,$81.59 ,$143.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8782894,CDM,270,RC,,HCPCS,outpatient,,,$771.75 ,$578.81 ,,$710.01 ,92,,,$424.46 ,$748.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$424.46 ,$748.60 ,other,,Not applicable. No negotiated rates per contract,$663.71 ,86,,,$424.46 ,$748.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$617.40 ,80,,,$424.46 ,$748.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$733.16 ,95,,,$424.46 ,$748.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$578.81 ,75,,,$424.46 ,$748.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$748.60 ,97,,,$424.46 ,$748.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$655.99 ,85,,,$424.46 ,$748.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$694.58 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$733.16 ,90,,,$424.46 ,$748.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$424.46 ,55,,,$424.46 ,$748.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$717.73 ,93,,,$424.46 ,$748.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785336,CDM,270,RC,,HCPCS,outpatient,,,$121.21 ,$90.91 ,,$111.51 ,92,,,$66.67 ,$117.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.67 ,55,,,$66.67 ,$117.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.67 ,$117.57 ,other,,Not applicable. No negotiated rates per contract,$104.24 ,86,,,$66.67 ,$117.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.97 ,80,,,$66.67 ,$117.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.67 ,55,,,$66.67 ,$117.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.15 ,95,,,$66.67 ,$117.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$115.15 ,95,,,$66.67 ,$117.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.91 ,75,,,$66.67 ,$117.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$103.03 ,85,,,$66.67 ,$117.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.57 ,97,,,$66.67 ,$117.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.67 ,55,,,$66.67 ,$117.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.09 ,90,,,$66.67 ,$117.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.57 ,97,,,$66.67 ,$117.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.57 ,97,,,$66.67 ,$117.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.57 ,97,,,$66.67 ,$117.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$103.03 ,85,,,$66.67 ,$117.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$109.09 ,90,,,$66.67 ,$117.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.67 ,55,,,$66.67 ,$117.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.15 ,90,,,$66.67 ,$117.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.67 ,55,,,$66.67 ,$117.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.73 ,93,,,$66.67 ,$117.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,8785158,CDM,270,RC,,HCPCS,outpatient,,,$260.35 ,$195.26 ,,$239.52 ,92,,,$143.19 ,$252.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.19 ,55,,,$143.19 ,$252.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.19 ,$252.54 ,other,,Not applicable. No negotiated rates per contract,$223.90 ,86,,,$143.19 ,$252.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$208.28 ,80,,,$143.19 ,$252.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.19 ,55,,,$143.19 ,$252.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.33 ,95,,,$143.19 ,$252.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.33 ,95,,,$143.19 ,$252.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.26 ,75,,,$143.19 ,$252.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.30 ,85,,,$143.19 ,$252.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.54 ,97,,,$143.19 ,$252.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.19 ,55,,,$143.19 ,$252.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.32 ,90,,,$143.19 ,$252.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$252.54 ,97,,,$143.19 ,$252.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.54 ,97,,,$143.19 ,$252.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.54 ,97,,,$143.19 ,$252.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.30 ,85,,,$143.19 ,$252.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.32 ,90,,,$143.19 ,$252.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.19 ,55,,,$143.19 ,$252.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.33 ,90,,,$143.19 ,$252.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.19 ,55,,,$143.19 ,$252.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$242.13 ,93,,,$143.19 ,$252.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRAY,10627197,CDM,272,RC,,HCPCS,outpatient,,,$568.05 ,$426.04 ,,$522.61 ,92,,,$312.43 ,$551.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$312.43 ,55,,,$312.43 ,$551.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$312.43 ,$551.01 ,other,,Not applicable. No negotiated rates per contract,$488.52 ,86,,,$312.43 ,$551.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$454.44 ,80,,,$312.43 ,$551.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$312.43 ,55,,,$312.43 ,$551.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$539.65 ,95,,,$312.43 ,$551.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$539.65 ,95,,,$312.43 ,$551.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$426.04 ,75,,,$312.43 ,$551.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$482.84 ,85,,,$312.43 ,$551.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$551.01 ,97,,,$312.43 ,$551.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$312.43 ,55,,,$312.43 ,$551.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$511.25 ,90,,,$312.43 ,$551.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$551.01 ,97,,,$312.43 ,$551.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$551.01 ,97,,,$312.43 ,$551.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$551.01 ,97,,,$312.43 ,$551.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$482.84 ,85,,,$312.43 ,$551.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$511.25 ,90,,,$312.43 ,$551.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$312.43 ,55,,,$312.43 ,$551.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$539.65 ,90,,,$312.43 ,$551.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$312.43 ,55,,,$312.43 ,$551.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$528.29 ,93,,,$312.43 ,$551.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRIPLEDAM CANNULA,8942877,CDM,270,RC,,HCPCS,outpatient,,,$260.13 ,$195.10 ,,$239.32 ,92,,,$143.07 ,$252.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.07 ,$252.33 ,other,,Not applicable. No negotiated rates per contract,$223.71 ,86,,,$143.07 ,$252.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$208.10 ,80,,,$143.07 ,$252.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.10 ,75,,,$143.07 ,$252.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.92 ,93,,,$143.07 ,$252.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRIPLEDAM CANNULA,8942878,CDM,270,RC,,HCPCS,outpatient,,,$260.13 ,$195.10 ,,$239.32 ,92,,,$143.07 ,$252.33 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$143.07 ,$252.33 ,other,,Not applicable. No negotiated rates per contract,$223.71 ,86,,,$143.07 ,$252.33 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$208.10 ,80,,,$143.07 ,$252.33 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$247.12 ,95,,,$143.07 ,$252.33 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$195.10 ,75,,,$143.07 ,$252.33 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.33 ,97,,,$143.07 ,$252.33 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$221.11 ,85,,,$143.07 ,$252.33 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$234.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$247.12 ,90,,,$143.07 ,$252.33 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$143.07 ,55,,,$143.07 ,$252.33 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$241.92 ,93,,,$143.07 ,$252.33 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TROCAR  BLUNT TIP  ENDOPATH XCEL BLUE 12MM,8785252,CDM,270,RC,,HCPCS,outpatient,,,$155.00 ,$116.25 ,,$142.60 ,92,,,$85.25 ,$150.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.25 ,$150.35 ,other,,Not applicable. No negotiated rates per contract,$133.30 ,86,,,$85.25 ,$150.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.00 ,80,,,$85.25 ,$150.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.25 ,95,,,$85.25 ,$150.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$147.25 ,95,,,$85.25 ,$150.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.25 ,75,,,$85.25 ,$150.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.75 ,85,,,$85.25 ,$150.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.50 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.75 ,85,,,$85.25 ,$150.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.50 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.25 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.15 ,93,,,$85.25 ,$150.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TROCAR ENDOPATH XCEL BLADELESS (B5LT) (OR),8785250,CDM,270,RC,,HCPCS,outpatient,,,$168.93 ,$126.70 ,,$155.42 ,92,,,$92.91 ,$163.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$92.91 ,55,,,$92.91 ,$163.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$92.91 ,$163.86 ,other,,Not applicable. No negotiated rates per contract,$145.28 ,86,,,$92.91 ,$163.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$135.14 ,80,,,$92.91 ,$163.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$92.91 ,55,,,$92.91 ,$163.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.48 ,95,,,$92.91 ,$163.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$160.48 ,95,,,$92.91 ,$163.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$126.70 ,75,,,$92.91 ,$163.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$143.59 ,85,,,$92.91 ,$163.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$163.86 ,97,,,$92.91 ,$163.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$92.91 ,55,,,$92.91 ,$163.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.04 ,90,,,$92.91 ,$163.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.86 ,97,,,$92.91 ,$163.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.86 ,97,,,$92.91 ,$163.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.86 ,97,,,$92.91 ,$163.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$143.59 ,85,,,$92.91 ,$163.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.04 ,90,,,$92.91 ,$163.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.91 ,55,,,$92.91 ,$163.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$160.48 ,90,,,$92.91 ,$163.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$92.91 ,55,,,$92.91 ,$163.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.10 ,93,,,$92.91 ,$163.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TROCAR ENDOPATH XCEL BLADELESS (B12LT) (OR),8785251,CDM,270,RC,,HCPCS,outpatient,,,$171.68 ,$128.76 ,,$157.95 ,92,,,$94.42 ,$166.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.42 ,55,,,$94.42 ,$166.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.42 ,$166.53 ,other,,Not applicable. No negotiated rates per contract,$147.64 ,86,,,$94.42 ,$166.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$137.34 ,80,,,$94.42 ,$166.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.42 ,55,,,$94.42 ,$166.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.10 ,95,,,$94.42 ,$166.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$163.10 ,95,,,$94.42 ,$166.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.76 ,75,,,$94.42 ,$166.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.93 ,85,,,$94.42 ,$166.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$166.53 ,97,,,$94.42 ,$166.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.42 ,55,,,$94.42 ,$166.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$154.51 ,90,,,$94.42 ,$166.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$166.53 ,97,,,$94.42 ,$166.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.53 ,97,,,$94.42 ,$166.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$166.53 ,97,,,$94.42 ,$166.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.93 ,85,,,$94.42 ,$166.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$154.51 ,90,,,$94.42 ,$166.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.42 ,55,,,$94.42 ,$166.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$163.10 ,90,,,$94.42 ,$166.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.42 ,55,,,$94.42 ,$166.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.66 ,93,,,$94.42 ,$166.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TROCAR POINT KIRSCHNER W,8786864,CDM,270,RC,,HCPCS,outpatient,,,$490.00 ,$367.50 ,,$450.80 ,92,,,$269.50 ,$475.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$269.50 ,55,,,$269.50 ,$475.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$269.50 ,$475.30 ,other,,Not applicable. No negotiated rates per contract,$421.40 ,86,,,$269.50 ,$475.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$392.00 ,80,,,$269.50 ,$475.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$269.50 ,55,,,$269.50 ,$475.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$465.50 ,95,,,$269.50 ,$475.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$465.50 ,95,,,$269.50 ,$475.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$367.50 ,75,,,$269.50 ,$475.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$416.50 ,85,,,$269.50 ,$475.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$475.30 ,97,,,$269.50 ,$475.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$269.50 ,55,,,$269.50 ,$475.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.00 ,90,,,$269.50 ,$475.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$475.30 ,97,,,$269.50 ,$475.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$475.30 ,97,,,$269.50 ,$475.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$475.30 ,97,,,$269.50 ,$475.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$416.50 ,85,,,$269.50 ,$475.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$441.00 ,90,,,$269.50 ,$475.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.50 ,55,,,$269.50 ,$475.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$465.50 ,90,,,$269.50 ,$475.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$269.50 ,55,,,$269.50 ,$475.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$455.70 ,93,,,$269.50 ,$475.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRU SIGNAL FINGER SENSOR,8783219,CDM,270,RC,,HCPCS,outpatient,,,$733.32 ,$549.99 ,,$674.65 ,92,,,$403.33 ,$711.32 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$403.33 ,55,,,$403.33 ,$711.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$403.33 ,$711.32 ,other,,Not applicable. No negotiated rates per contract,$630.66 ,86,,,$403.33 ,$711.32 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$586.66 ,80,,,$403.33 ,$711.32 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$403.33 ,55,,,$403.33 ,$711.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$696.65 ,95,,,$403.33 ,$711.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$696.65 ,95,,,$403.33 ,$711.32 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$549.99 ,75,,,$403.33 ,$711.32 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$623.32 ,85,,,$403.33 ,$711.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$711.32 ,97,,,$403.33 ,$711.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.33 ,55,,,$403.33 ,$711.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$659.99 ,90,,,$403.33 ,$711.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$711.32 ,97,,,$403.33 ,$711.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$711.32 ,97,,,$403.33 ,$711.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$711.32 ,97,,,$403.33 ,$711.32 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$623.32 ,85,,,$403.33 ,$711.32 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$659.99 ,90,,,$403.33 ,$711.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.33 ,55,,,$403.33 ,$711.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$696.65 ,90,,,$403.33 ,$711.32 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$403.33 ,55,,,$403.33 ,$711.32 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$681.99 ,93,,,$403.33 ,$711.32 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TRU-CUT BIOSPY NEEDLE 18G x 41/2INCH,8782747,CDM,270,RC,,HCPCS,outpatient,,,$155.00 ,$116.25 ,,$142.60 ,92,,,$85.25 ,$150.35 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$85.25 ,$150.35 ,other,,Not applicable. No negotiated rates per contract,$133.30 ,86,,,$85.25 ,$150.35 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$124.00 ,80,,,$85.25 ,$150.35 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.25 ,95,,,$85.25 ,$150.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$147.25 ,95,,,$85.25 ,$150.35 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$116.25 ,75,,,$85.25 ,$150.35 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$131.75 ,85,,,$85.25 ,$150.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$139.50 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.35 ,97,,,$85.25 ,$150.35 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$131.75 ,85,,,$85.25 ,$150.35 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$139.50 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$147.25 ,90,,,$85.25 ,$150.35 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$85.25 ,55,,,$85.25 ,$150.35 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$144.15 ,93,,,$85.25 ,$150.35 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE  CUFFEDD 7.5  ENDO TRACH TUBE,8785165,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE (EAR TUBE) SHEEHY 1,8784139,CDM,270,RC,,HCPCS,outpatient,,,$114.70 ,$86.03 ,,$105.52 ,92,,,$63.09 ,$111.26 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.09 ,55,,,$63.09 ,$111.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.09 ,$111.26 ,other,,Not applicable. No negotiated rates per contract,$98.64 ,86,,,$63.09 ,$111.26 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$91.76 ,80,,,$63.09 ,$111.26 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.09 ,55,,,$63.09 ,$111.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.97 ,95,,,$63.09 ,$111.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$108.97 ,95,,,$63.09 ,$111.26 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.03 ,75,,,$63.09 ,$111.26 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.50 ,85,,,$63.09 ,$111.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.26 ,97,,,$63.09 ,$111.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.09 ,55,,,$63.09 ,$111.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.23 ,90,,,$63.09 ,$111.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.26 ,97,,,$63.09 ,$111.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.26 ,97,,,$63.09 ,$111.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.26 ,97,,,$63.09 ,$111.26 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.50 ,85,,,$63.09 ,$111.26 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.23 ,90,,,$63.09 ,$111.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.09 ,55,,,$63.09 ,$111.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.97 ,90,,,$63.09 ,$111.26 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.09 ,55,,,$63.09 ,$111.26 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.67 ,93,,,$63.09 ,$111.26 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE (EAR TUBE) VENT TUB,8784138,CDM,270,RC,,HCPCS,outpatient,,,$243.60 ,$182.70 ,,$224.11 ,92,,,$133.98 ,$236.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$133.98 ,55,,,$133.98 ,$236.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$133.98 ,$236.29 ,other,,Not applicable. No negotiated rates per contract,$209.50 ,86,,,$133.98 ,$236.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$194.88 ,80,,,$133.98 ,$236.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$133.98 ,55,,,$133.98 ,$236.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.42 ,95,,,$133.98 ,$236.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$231.42 ,95,,,$133.98 ,$236.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.70 ,75,,,$133.98 ,$236.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$207.06 ,85,,,$133.98 ,$236.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$236.29 ,97,,,$133.98 ,$236.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.98 ,55,,,$133.98 ,$236.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.24 ,90,,,$133.98 ,$236.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$236.29 ,97,,,$133.98 ,$236.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.29 ,97,,,$133.98 ,$236.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$236.29 ,97,,,$133.98 ,$236.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$207.06 ,85,,,$133.98 ,$236.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$219.24 ,90,,,$133.98 ,$236.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.98 ,55,,,$133.98 ,$236.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.42 ,90,,,$133.98 ,$236.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.98 ,55,,,$133.98 ,$236.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.55 ,93,,,$133.98 ,$236.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 2.0 ENDO TRACH TUBE UNCUFFED,8783040,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 24FR CHEST TUBE,8785017,CDM,270,RC,,HCPCS,outpatient,,,$50.24 ,$37.68 ,,$46.22 ,92,,,$27.63 ,$48.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$27.63 ,55,,,$27.63 ,$48.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$27.63 ,$48.73 ,other,,Not applicable. No negotiated rates per contract,$43.21 ,86,,,$27.63 ,$48.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$40.19 ,80,,,$27.63 ,$48.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$27.63 ,55,,,$27.63 ,$48.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.73 ,95,,,$27.63 ,$48.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$47.73 ,95,,,$27.63 ,$48.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.68 ,75,,,$27.63 ,$48.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$42.70 ,85,,,$27.63 ,$48.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$48.73 ,97,,,$27.63 ,$48.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.63 ,55,,,$27.63 ,$48.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.22 ,90,,,$27.63 ,$48.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$48.73 ,97,,,$27.63 ,$48.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.73 ,97,,,$27.63 ,$48.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$48.73 ,97,,,$27.63 ,$48.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.70 ,85,,,$27.63 ,$48.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$45.22 ,90,,,$27.63 ,$48.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.63 ,55,,,$27.63 ,$48.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.73 ,90,,,$27.63 ,$48.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.63 ,55,,,$27.63 ,$48.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.72 ,93,,,$27.63 ,$48.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 24FR CHEST TUBE THORACIC,8785354,CDM,270,RC,,HCPCS,outpatient,,,$59.65 ,$44.74 ,,$54.88 ,92,,,$32.81 ,$57.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.81 ,$57.86 ,other,,Not applicable. No negotiated rates per contract,$51.30 ,86,,,$32.81 ,$57.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.72 ,80,,,$32.81 ,$57.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.67 ,95,,,$32.81 ,$57.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.67 ,95,,,$32.81 ,$57.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.74 ,75,,,$32.81 ,$57.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.70 ,85,,,$32.81 ,$57.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.69 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.70 ,85,,,$32.81 ,$57.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.69 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.67 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.47 ,93,,,$32.81 ,$57.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 28FR CHEST TUBE,8785018,CDM,270,RC,,HCPCS,outpatient,,,$36.40 ,$27.30 ,,$33.49 ,92,,,$20.02 ,$35.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.02 ,$35.31 ,other,,Not applicable. No negotiated rates per contract,$31.30 ,86,,,$20.02 ,$35.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.12 ,80,,,$20.02 ,$35.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.30 ,75,,,$20.02 ,$35.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.85 ,93,,,$20.02 ,$35.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 28FR CHEST TUBE THORACIC,8785355,CDM,270,RC,,HCPCS,outpatient,,,$59.65 ,$44.74 ,,$54.88 ,92,,,$32.81 ,$57.86 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$32.81 ,$57.86 ,other,,Not applicable. No negotiated rates per contract,$51.30 ,86,,,$32.81 ,$57.86 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$47.72 ,80,,,$32.81 ,$57.86 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.67 ,95,,,$32.81 ,$57.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$56.67 ,95,,,$32.81 ,$57.86 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$44.74 ,75,,,$32.81 ,$57.86 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$50.70 ,85,,,$32.81 ,$57.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$53.69 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.86 ,97,,,$32.81 ,$57.86 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.70 ,85,,,$32.81 ,$57.86 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$53.69 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.67 ,90,,,$32.81 ,$57.86 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.81 ,55,,,$32.81 ,$57.86 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$55.47 ,93,,,$32.81 ,$57.86 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 3.5 UNCUFFED  ENDO TRACH TUBE,8783035,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 32FR CHEST TUBE,8785019,CDM,270,RC,,HCPCS,outpatient,,,$35.53 ,$26.65 ,,$32.69 ,92,,,$19.54 ,$34.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.54 ,55,,,$19.54 ,$34.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.54 ,$34.46 ,other,,Not applicable. No negotiated rates per contract,$30.56 ,86,,,$19.54 ,$34.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.42 ,80,,,$19.54 ,$34.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.54 ,55,,,$19.54 ,$34.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.75 ,95,,,$19.54 ,$34.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$33.75 ,95,,,$19.54 ,$34.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.65 ,75,,,$19.54 ,$34.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.20 ,85,,,$19.54 ,$34.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.46 ,97,,,$19.54 ,$34.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.54 ,55,,,$19.54 ,$34.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.98 ,90,,,$19.54 ,$34.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.46 ,97,,,$19.54 ,$34.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.46 ,97,,,$19.54 ,$34.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.46 ,97,,,$19.54 ,$34.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.20 ,85,,,$19.54 ,$34.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.98 ,90,,,$19.54 ,$34.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.54 ,55,,,$19.54 ,$34.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.75 ,90,,,$19.54 ,$34.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.54 ,55,,,$19.54 ,$34.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.04 ,93,,,$19.54 ,$34.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 32FR CHEST TUBE THO,8785356,CDM,270,RC,,HCPCS,outpatient,,,$40.43 ,$30.32 ,,$37.20 ,92,,,$22.24 ,$39.22 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$22.24 ,55,,,$22.24 ,$39.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$22.24 ,$39.22 ,other,,Not applicable. No negotiated rates per contract,$34.77 ,86,,,$22.24 ,$39.22 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$32.34 ,80,,,$22.24 ,$39.22 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$22.24 ,55,,,$22.24 ,$39.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.41 ,95,,,$22.24 ,$39.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.41 ,95,,,$22.24 ,$39.22 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.32 ,75,,,$22.24 ,$39.22 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$34.37 ,85,,,$22.24 ,$39.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.22 ,97,,,$22.24 ,$39.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$22.24 ,55,,,$22.24 ,$39.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.39 ,90,,,$22.24 ,$39.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$39.22 ,97,,,$22.24 ,$39.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.22 ,97,,,$22.24 ,$39.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$39.22 ,97,,,$22.24 ,$39.22 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.37 ,85,,,$22.24 ,$39.22 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$36.39 ,90,,,$22.24 ,$39.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.24 ,55,,,$22.24 ,$39.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.41 ,90,,,$22.24 ,$39.22 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$22.24 ,55,,,$22.24 ,$39.22 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.60 ,93,,,$22.24 ,$39.22 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 36FR CHEST TUBE,8785020,CDM,270,RC,,HCPCS,outpatient,,,$36.40 ,$27.30 ,,$33.49 ,92,,,$20.02 ,$35.31 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.02 ,$35.31 ,other,,Not applicable. No negotiated rates per contract,$31.30 ,86,,,$20.02 ,$35.31 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.12 ,80,,,$20.02 ,$35.31 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.58 ,95,,,$20.02 ,$35.31 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.30 ,75,,,$20.02 ,$35.31 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.31 ,97,,,$20.02 ,$35.31 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.94 ,85,,,$20.02 ,$35.31 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.76 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.58 ,90,,,$20.02 ,$35.31 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.02 ,55,,,$20.02 ,$35.31 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.85 ,93,,,$20.02 ,$35.31 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 36FR CHEST TUBE TH,8785357,CDM,270,RC,,HCPCS,outpatient,,,$80.21 ,$60.16 ,,$73.79 ,92,,,$44.12 ,$77.80 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.12 ,55,,,$44.12 ,$77.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.12 ,$77.80 ,other,,Not applicable. No negotiated rates per contract,$68.98 ,86,,,$44.12 ,$77.80 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.17 ,80,,,$44.12 ,$77.80 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.12 ,55,,,$44.12 ,$77.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.20 ,95,,,$44.12 ,$77.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.20 ,95,,,$44.12 ,$77.80 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.16 ,75,,,$44.12 ,$77.80 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.18 ,85,,,$44.12 ,$77.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.80 ,97,,,$44.12 ,$77.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.12 ,55,,,$44.12 ,$77.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.19 ,90,,,$44.12 ,$77.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.80 ,97,,,$44.12 ,$77.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.80 ,97,,,$44.12 ,$77.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.80 ,97,,,$44.12 ,$77.80 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.18 ,85,,,$44.12 ,$77.80 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.19 ,90,,,$44.12 ,$77.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.12 ,55,,,$44.12 ,$77.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.20 ,90,,,$44.12 ,$77.80 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.12 ,55,,,$44.12 ,$77.80 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.60 ,93,,,$44.12 ,$77.80 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 5.0 ENDO TRACH TUBE,8785329,CDM,270,RC,,HCPCS,outpatient,,,$33.16 ,$24.87 ,,$30.51 ,92,,,$18.24 ,$32.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.24 ,$32.17 ,other,,Not applicable. No negotiated rates per contract,$28.52 ,86,,,$18.24 ,$32.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.53 ,80,,,$18.24 ,$32.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,95,,,$18.24 ,$32.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.50 ,95,,,$18.24 ,$32.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.87 ,75,,,$18.24 ,$32.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.19 ,85,,,$18.24 ,$32.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.84 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.19 ,85,,,$18.24 ,$32.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.84 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.84 ,93,,,$18.24 ,$32.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 5.5 ENDO TRACH TUBE,8785330,CDM,270,RC,,HCPCS,outpatient,,,$33.16 ,$24.87 ,,$30.51 ,92,,,$18.24 ,$32.17 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$18.24 ,$32.17 ,other,,Not applicable. No negotiated rates per contract,$28.52 ,86,,,$18.24 ,$32.17 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$26.53 ,80,,,$18.24 ,$32.17 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,95,,,$18.24 ,$32.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$31.50 ,95,,,$18.24 ,$32.17 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.87 ,75,,,$18.24 ,$32.17 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$28.19 ,85,,,$18.24 ,$32.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.84 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$32.17 ,97,,,$18.24 ,$32.17 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.19 ,85,,,$18.24 ,$32.17 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.84 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$31.50 ,90,,,$18.24 ,$32.17 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$18.24 ,55,,,$18.24 ,$32.17 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.84 ,93,,,$18.24 ,$32.17 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 5FR FEEDING TUBE,8781938,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 6.0 ENDO TRACH TUBE,8785331,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 6.5 ENDO TRACH TUBE,8785332,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 7.0 ENDO TRACH TUBE,8785333,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 8.0 ENDO TRACH TUBE,8785358,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 8.5 ENDO TRACH TUBE,8785334,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE 8FR FEEDING TUBE,8781937,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE CENTRIFUGE OPTICUL,8782548,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE ESOPHAGEAL( BLAKEMO,8785074,CDM,270,RC,,HCPCS,outpatient,,,"$1,516.10 ","$1,137.08 ",,"$1,394.81 ",92,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$833.86 ,55,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$833.86 ,"$1,470.62 ",other,,Not applicable. No negotiated rates per contract,"$1,303.85 ",86,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,212.88 ",80,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$833.86 ,55,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,440.30 ",95,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,440.30 ",95,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,137.08 ",75,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,288.69 ",85,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,470.62 ",97,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$833.86 ,55,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,364.49 ",90,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,470.62 ",97,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,470.62 ",97,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,470.62 ",97,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,288.69 ",85,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,364.49 ",90,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$833.86 ,55,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,440.30 ",90,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$833.86 ,55,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,409.97 ",93,,,$833.86 ,"$1,470.62 ",percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE PEDIATRIC ENDO TRAC,8783059,CDM,270,RC,,HCPCS,outpatient,,,$35.79 ,$26.84 ,,$32.93 ,92,,,$19.68 ,$34.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$19.68 ,$34.72 ,other,,Not applicable. No negotiated rates per contract,$30.78 ,86,,,$19.68 ,$34.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$28.63 ,80,,,$19.68 ,$34.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.00 ,95,,,$19.68 ,$34.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.84 ,75,,,$19.68 ,$34.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$34.72 ,97,,,$19.68 ,$34.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.42 ,85,,,$19.68 ,$34.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$32.21 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.00 ,90,,,$19.68 ,$34.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$19.68 ,55,,,$19.68 ,$34.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.28 ,93,,,$19.68 ,$34.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE TRACH PEDIATRIC SIZE 3.5 (ER),8785169,CDM,270,RC,,HCPCS,outpatient,,,$215.04 ,$161.28 ,,$197.84 ,92,,,$118.27 ,$208.59 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$118.27 ,55,,,$118.27 ,$208.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$118.27 ,$208.59 ,other,,Not applicable. No negotiated rates per contract,$184.93 ,86,,,$118.27 ,$208.59 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$172.03 ,80,,,$118.27 ,$208.59 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$118.27 ,55,,,$118.27 ,$208.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.29 ,95,,,$118.27 ,$208.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$204.29 ,95,,,$118.27 ,$208.59 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.28 ,75,,,$118.27 ,$208.59 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$182.78 ,85,,,$118.27 ,$208.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$208.59 ,97,,,$118.27 ,$208.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$118.27 ,55,,,$118.27 ,$208.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.54 ,90,,,$118.27 ,$208.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$208.59 ,97,,,$118.27 ,$208.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.59 ,97,,,$118.27 ,$208.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$208.59 ,97,,,$118.27 ,$208.59 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.78 ,85,,,$118.27 ,$208.59 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$193.54 ,90,,,$118.27 ,$208.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.27 ,55,,,$118.27 ,$208.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$204.29 ,90,,,$118.27 ,$208.59 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$118.27 ,55,,,$118.27 ,$208.59 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$199.99 ,93,,,$118.27 ,$208.59 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE TRACH PEDIATRIC SIZE 5.0 (ER),8785171,CDM,270,RC,,HCPCS,outpatient,,,$234.10 ,$175.58 ,,$215.37 ,92,,,$128.76 ,$227.08 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.76 ,55,,,$128.76 ,$227.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.76 ,$227.08 ,other,,Not applicable. No negotiated rates per contract,$201.33 ,86,,,$128.76 ,$227.08 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$187.28 ,80,,,$128.76 ,$227.08 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.76 ,55,,,$128.76 ,$227.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.40 ,95,,,$128.76 ,$227.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.40 ,95,,,$128.76 ,$227.08 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$175.58 ,75,,,$128.76 ,$227.08 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.99 ,85,,,$128.76 ,$227.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$227.08 ,97,,,$128.76 ,$227.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.76 ,55,,,$128.76 ,$227.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$210.69 ,90,,,$128.76 ,$227.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$227.08 ,97,,,$128.76 ,$227.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.08 ,97,,,$128.76 ,$227.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$227.08 ,97,,,$128.76 ,$227.08 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.99 ,85,,,$128.76 ,$227.08 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$210.69 ,90,,,$128.76 ,$227.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.76 ,55,,,$128.76 ,$227.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$222.40 ,90,,,$128.76 ,$227.08 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.76 ,55,,,$128.76 ,$227.08 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$217.71 ,93,,,$128.76 ,$227.08 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE UNCUFFED 2.5 ENDO TRACH TUBE,8783039,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE UNCUFFED 3.0 ENDO TRACH TUBE,8783036,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE UNCUFFED 4.0 ENDO TRACH TUBE,8783038,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE,8785168,CDM,270,RC,,HCPCS,outpatient,,,$316.04 ,$237.03 ,,$290.76 ,92,,,$173.82 ,$306.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$173.82 ,55,,,$173.82 ,$306.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$173.82 ,$306.56 ,other,,Not applicable. No negotiated rates per contract,$271.79 ,86,,,$173.82 ,$306.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$252.83 ,80,,,$173.82 ,$306.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$173.82 ,55,,,$173.82 ,$306.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.24 ,95,,,$173.82 ,$306.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$300.24 ,95,,,$173.82 ,$306.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$237.03 ,75,,,$173.82 ,$306.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$268.63 ,85,,,$173.82 ,$306.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$306.56 ,97,,,$173.82 ,$306.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$173.82 ,55,,,$173.82 ,$306.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$284.44 ,90,,,$173.82 ,$306.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$306.56 ,97,,,$173.82 ,$306.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.56 ,97,,,$173.82 ,$306.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$306.56 ,97,,,$173.82 ,$306.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.63 ,85,,,$173.82 ,$306.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$284.44 ,90,,,$173.82 ,$306.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.82 ,55,,,$173.82 ,$306.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$300.24 ,90,,,$173.82 ,$306.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$173.82 ,55,,,$173.82 ,$306.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$293.92 ,93,,,$173.82 ,$306.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE,8784142,CDM,270,RC,,HCPCS,outpatient,,,$127.10 ,$95.33 ,,$116.93 ,92,,,$69.91 ,$123.29 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$69.91 ,55,,,$69.91 ,$123.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$69.91 ,$123.29 ,other,,Not applicable. No negotiated rates per contract,$109.31 ,86,,,$69.91 ,$123.29 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$101.68 ,80,,,$69.91 ,$123.29 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$69.91 ,55,,,$69.91 ,$123.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.75 ,95,,,$69.91 ,$123.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$120.75 ,95,,,$69.91 ,$123.29 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.33 ,75,,,$69.91 ,$123.29 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.04 ,85,,,$69.91 ,$123.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.29 ,97,,,$69.91 ,$123.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.91 ,55,,,$69.91 ,$123.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.39 ,90,,,$69.91 ,$123.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.29 ,97,,,$69.91 ,$123.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.29 ,97,,,$69.91 ,$123.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.29 ,97,,,$69.91 ,$123.29 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.04 ,85,,,$69.91 ,$123.29 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$114.39 ,90,,,$69.91 ,$123.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.91 ,55,,,$69.91 ,$123.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$120.75 ,90,,,$69.91 ,$123.29 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$69.91 ,55,,,$69.91 ,$123.29 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.20 ,93,,,$69.91 ,$123.29 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBE,8785170,CDM,270,RC,,HCPCS,outpatient,,,$210.76 ,$158.07 ,,$193.90 ,92,,,$115.92 ,$204.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$115.92 ,55,,,$115.92 ,$204.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$115.92 ,$204.44 ,other,,Not applicable. No negotiated rates per contract,$181.25 ,86,,,$115.92 ,$204.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$168.61 ,80,,,$115.92 ,$204.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$115.92 ,55,,,$115.92 ,$204.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.22 ,95,,,$115.92 ,$204.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$200.22 ,95,,,$115.92 ,$204.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$158.07 ,75,,,$115.92 ,$204.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$179.15 ,85,,,$115.92 ,$204.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$204.44 ,97,,,$115.92 ,$204.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.92 ,55,,,$115.92 ,$204.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$189.68 ,90,,,$115.92 ,$204.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.44 ,97,,,$115.92 ,$204.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.44 ,97,,,$115.92 ,$204.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.44 ,97,,,$115.92 ,$204.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$179.15 ,85,,,$115.92 ,$204.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$189.68 ,90,,,$115.92 ,$204.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.92 ,55,,,$115.92 ,$204.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$200.22 ,90,,,$115.92 ,$204.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.92 ,55,,,$115.92 ,$204.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$196.01 ,93,,,$115.92 ,$204.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING EXTENSION 6FT. (2,8942879,CDM,270,RC,,HCPCS,outpatient,,,$169.65 ,$127.24 ,,$156.08 ,92,,,$93.31 ,$164.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$93.31 ,$164.56 ,other,,Not applicable. No negotiated rates per contract,$145.90 ,86,,,$93.31 ,$164.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$135.72 ,80,,,$93.31 ,$164.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,95,,,$93.31 ,$164.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.17 ,95,,,$93.31 ,$164.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$127.24 ,75,,,$93.31 ,$164.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$144.20 ,85,,,$93.31 ,$164.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$152.69 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.56 ,97,,,$93.31 ,$164.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.20 ,85,,,$93.31 ,$164.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$152.69 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.17 ,90,,,$93.31 ,$164.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.31 ,55,,,$93.31 ,$164.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$157.77 ,93,,,$93.31 ,$164.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING HIGH FLOW INSUFFLATION  (N   abslolete as of 1/4/2023,8786764,CDM,270,RC,,HCPCS,outpatient,,,$127.80 ,$95.85 ,,$117.58 ,92,,,$70.29 ,$123.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.29 ,55,,,$70.29 ,$123.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.29 ,$123.97 ,other,,Not applicable. No negotiated rates per contract,$109.91 ,86,,,$70.29 ,$123.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.24 ,80,,,$70.29 ,$123.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.29 ,55,,,$70.29 ,$123.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.41 ,95,,,$70.29 ,$123.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.41 ,95,,,$70.29 ,$123.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$95.85 ,75,,,$70.29 ,$123.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.63 ,85,,,$70.29 ,$123.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$123.97 ,97,,,$70.29 ,$123.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.29 ,55,,,$70.29 ,$123.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.02 ,90,,,$70.29 ,$123.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$123.97 ,97,,,$70.29 ,$123.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.97 ,97,,,$70.29 ,$123.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$123.97 ,97,,,$70.29 ,$123.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.63 ,85,,,$70.29 ,$123.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.02 ,90,,,$70.29 ,$123.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.29 ,55,,,$70.29 ,$123.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.41 ,90,,,$70.29 ,$123.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.29 ,55,,,$70.29 ,$123.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$118.85 ,93,,,$70.29 ,$123.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING NON-CON 1/4 X 100,8785153,CDM,270,RC,,HCPCS,outpatient,,,$68.48 ,$51.36 ,,$63.00 ,92,,,$37.66 ,$66.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.66 ,55,,,$37.66 ,$66.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.66 ,$66.43 ,other,,Not applicable. No negotiated rates per contract,$58.89 ,86,,,$37.66 ,$66.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$54.78 ,80,,,$37.66 ,$66.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.66 ,55,,,$37.66 ,$66.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.06 ,95,,,$37.66 ,$66.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.06 ,95,,,$37.66 ,$66.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.36 ,75,,,$37.66 ,$66.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.21 ,85,,,$37.66 ,$66.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.43 ,97,,,$37.66 ,$66.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.66 ,55,,,$37.66 ,$66.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$61.63 ,90,,,$37.66 ,$66.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.43 ,97,,,$37.66 ,$66.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.43 ,97,,,$37.66 ,$66.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.43 ,97,,,$37.66 ,$66.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.21 ,85,,,$37.66 ,$66.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$61.63 ,90,,,$37.66 ,$66.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.66 ,55,,,$37.66 ,$66.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.06 ,90,,,$37.66 ,$66.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.66 ,55,,,$37.66 ,$66.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.69 ,93,,,$37.66 ,$66.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING,8786257,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING,8782519,CDM,270,RC,,HCPCS,outpatient,,,$256.87 ,$192.65 ,,$236.32 ,92,,,$141.28 ,$249.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$141.28 ,55,,,$141.28 ,$249.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$141.28 ,$249.16 ,other,,Not applicable. No negotiated rates per contract,$220.91 ,86,,,$141.28 ,$249.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$205.50 ,80,,,$141.28 ,$249.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$141.28 ,55,,,$141.28 ,$249.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.03 ,95,,,$141.28 ,$249.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$244.03 ,95,,,$141.28 ,$249.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$192.65 ,75,,,$141.28 ,$249.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$218.34 ,85,,,$141.28 ,$249.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$249.16 ,97,,,$141.28 ,$249.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$141.28 ,55,,,$141.28 ,$249.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$231.18 ,90,,,$141.28 ,$249.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$249.16 ,97,,,$141.28 ,$249.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.16 ,97,,,$141.28 ,$249.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$249.16 ,97,,,$141.28 ,$249.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.34 ,85,,,$141.28 ,$249.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$231.18 ,90,,,$141.28 ,$249.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.28 ,55,,,$141.28 ,$249.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$244.03 ,90,,,$141.28 ,$249.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$141.28 ,55,,,$141.28 ,$249.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$238.89 ,93,,,$141.28 ,$249.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING,8785750,CDM,270,RC,,HCPCS,outpatient,,,$74.00 ,$55.50 ,,$68.08 ,92,,,$40.70 ,$71.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$40.70 ,55,,,$40.70 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$40.70 ,$71.78 ,other,,Not applicable. No negotiated rates per contract,$63.64 ,86,,,$40.70 ,$71.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$59.20 ,80,,,$40.70 ,$71.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$40.70 ,55,,,$40.70 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.30 ,95,,,$40.70 ,$71.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$70.30 ,95,,,$40.70 ,$71.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$55.50 ,75,,,$40.70 ,$71.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$62.90 ,85,,,$40.70 ,$71.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$71.78 ,97,,,$40.70 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.70 ,55,,,$40.70 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.60 ,90,,,$40.70 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$71.78 ,97,,,$40.70 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.78 ,97,,,$40.70 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$71.78 ,97,,,$40.70 ,$71.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$62.90 ,85,,,$40.70 ,$71.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.60 ,90,,,$40.70 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.70 ,55,,,$40.70 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.30 ,90,,,$40.70 ,$71.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$40.70 ,55,,,$40.70 ,$71.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.82 ,93,,,$40.70 ,$71.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TUBING,8786290,CDM,270,RC,,HCPCS,outpatient,,,$43.75 ,$32.81 ,,$40.25 ,92,,,$24.06 ,$42.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.06 ,55,,,$24.06 ,$42.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.06 ,$42.44 ,other,,Not applicable. No negotiated rates per contract,$37.63 ,86,,,$24.06 ,$42.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.00 ,80,,,$24.06 ,$42.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.06 ,55,,,$24.06 ,$42.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.56 ,95,,,$24.06 ,$42.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.56 ,95,,,$24.06 ,$42.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.81 ,75,,,$24.06 ,$42.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.19 ,85,,,$24.06 ,$42.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.44 ,97,,,$24.06 ,$42.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.06 ,55,,,$24.06 ,$42.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.38 ,90,,,$24.06 ,$42.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.44 ,97,,,$24.06 ,$42.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.44 ,97,,,$24.06 ,$42.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.44 ,97,,,$24.06 ,$42.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.19 ,85,,,$24.06 ,$42.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.38 ,90,,,$24.06 ,$42.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.06 ,55,,,$24.06 ,$42.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.56 ,90,,,$24.06 ,$42.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.06 ,55,,,$24.06 ,$42.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.69 ,93,,,$24.06 ,$42.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UC SPIDER 2 FOR LATERAL OR BEUC,8786673,CDM,270,RC,,HCPCS,outpatient,,,"$1,062.50 ",$796.88 ,,$977.50 ,92,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$584.38 ,55,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$584.38 ,"$1,030.63 ",other,,Not applicable. No negotiated rates per contract,$913.75 ,86,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$850.00 ,80,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$584.38 ,55,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,009.38 ",95,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,009.38 ",95,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$796.88 ,75,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$903.13 ,85,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,030.63 ",97,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$584.38 ,55,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$956.25 ,90,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,030.63 ",97,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,030.63 ",97,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,030.63 ",97,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$903.13 ,85,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,85% of total billed charges for outpatient setting,$956.25 ,90,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$584.38 ,55,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,009.38 ",90,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$584.38 ,55,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$988.13 ,93,,,$584.38 ,"$1,030.63 ",percent of total billed charges,,93% of total billed charges for outpatient setting
ULTRA SLING 1V LARGE,9328586,CDM,272,RC,,HCPCS,outpatient,,,$403.65 ,$302.74 ,,$371.36 ,92,,,$222.01 ,$391.54 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.01 ,55,,,$222.01 ,$391.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.01 ,$391.54 ,other,,Not applicable. No negotiated rates per contract,$347.14 ,86,,,$222.01 ,$391.54 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$322.92 ,80,,,$222.01 ,$391.54 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.01 ,55,,,$222.01 ,$391.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.47 ,95,,,$222.01 ,$391.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$383.47 ,95,,,$222.01 ,$391.54 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$302.74 ,75,,,$222.01 ,$391.54 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$343.10 ,85,,,$222.01 ,$391.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.54 ,97,,,$222.01 ,$391.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.01 ,55,,,$222.01 ,$391.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$363.29 ,90,,,$222.01 ,$391.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$391.54 ,97,,,$222.01 ,$391.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.54 ,97,,,$222.01 ,$391.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$391.54 ,97,,,$222.01 ,$391.54 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$343.10 ,85,,,$222.01 ,$391.54 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$363.29 ,90,,,$222.01 ,$391.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.01 ,55,,,$222.01 ,$391.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$383.47 ,90,,,$222.01 ,$391.54 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.01 ,55,,,$222.01 ,$391.54 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$375.39 ,93,,,$222.01 ,$391.54 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ULTRA SLING 1V MED,9328585,CDM,270,RC,,HCPCS,outpatient,,,$466.75 ,$350.06 ,,$429.41 ,92,,,$256.71 ,$452.75 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$256.71 ,55,,,$256.71 ,$452.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$256.71 ,$452.75 ,other,,Not applicable. No negotiated rates per contract,$401.41 ,86,,,$256.71 ,$452.75 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$373.40 ,80,,,$256.71 ,$452.75 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$256.71 ,55,,,$256.71 ,$452.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$443.41 ,95,,,$256.71 ,$452.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$443.41 ,95,,,$256.71 ,$452.75 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$350.06 ,75,,,$256.71 ,$452.75 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$396.74 ,85,,,$256.71 ,$452.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$452.75 ,97,,,$256.71 ,$452.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$256.71 ,55,,,$256.71 ,$452.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$420.08 ,90,,,$256.71 ,$452.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$452.75 ,97,,,$256.71 ,$452.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.75 ,97,,,$256.71 ,$452.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$452.75 ,97,,,$256.71 ,$452.75 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$396.74 ,85,,,$256.71 ,$452.75 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$420.08 ,90,,,$256.71 ,$452.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.71 ,55,,,$256.71 ,$452.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$443.41 ,90,,,$256.71 ,$452.75 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$256.71 ,55,,,$256.71 ,$452.75 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$434.08 ,93,,,$256.71 ,$452.75 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UNDERCAST PADDING STERILE (6IN X 4YDS),8785522,CDM,270,RC,,HCPCS,outpatient,,,$60.64 ,$45.48 ,,$55.79 ,92,,,$33.35 ,$58.82 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$33.35 ,55,,,$33.35 ,$58.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$33.35 ,$58.82 ,other,,Not applicable. No negotiated rates per contract,$52.15 ,86,,,$33.35 ,$58.82 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$48.51 ,80,,,$33.35 ,$58.82 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$33.35 ,55,,,$33.35 ,$58.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.61 ,95,,,$33.35 ,$58.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.61 ,95,,,$33.35 ,$58.82 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.48 ,75,,,$33.35 ,$58.82 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$51.54 ,85,,,$33.35 ,$58.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$58.82 ,97,,,$33.35 ,$58.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.35 ,55,,,$33.35 ,$58.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$54.58 ,90,,,$33.35 ,$58.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$58.82 ,97,,,$33.35 ,$58.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.82 ,97,,,$33.35 ,$58.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.82 ,97,,,$33.35 ,$58.82 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$51.54 ,85,,,$33.35 ,$58.82 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$54.58 ,90,,,$33.35 ,$58.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.35 ,55,,,$33.35 ,$58.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$57.61 ,90,,,$33.35 ,$58.82 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$33.35 ,55,,,$33.35 ,$58.82 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$56.40 ,93,,,$33.35 ,$58.82 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UNIVERSAL ANESTHESIA SET,8782567,CDM,270,RC,,HCPCS,outpatient,,,$30.01 ,$22.51 ,,$27.61 ,92,,,$16.51 ,$29.11 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$16.51 ,$29.11 ,other,,Not applicable. No negotiated rates per contract,$25.81 ,86,,,$16.51 ,$29.11 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.01 ,80,,,$16.51 ,$29.11 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$28.51 ,95,,,$16.51 ,$29.11 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$22.51 ,75,,,$16.51 ,$29.11 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$29.11 ,97,,,$16.51 ,$29.11 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$25.51 ,85,,,$16.51 ,$29.11 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.01 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.51 ,90,,,$16.51 ,$29.11 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$16.51 ,55,,,$16.51 ,$29.11 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.91 ,93,,,$16.51 ,$29.11 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UPGRADE THE PHILIPS CARD,8786250,CDM,270,RC,,HCPCS,outpatient,,,"$66,731.00 ","$50,048.25 ",,"$61,392.52 ",92,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$36,702.05 ",55,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$36,702.05 ","$64,729.07 ",other,,Not applicable. No negotiated rates per contract,"$57,388.66 ",86,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$53,384.80 ",80,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$36,702.05 ",55,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$63,394.45 ",95,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$63,394.45 ",95,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$50,048.25 ",75,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$56,721.35 ",85,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$64,729.07 ",97,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$36,702.05 ",55,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$60,057.90 ",90,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$64,729.07 ",97,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$64,729.07 ",97,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$64,729.07 ",97,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$56,721.35 ",85,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$60,057.90 ",90,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$36,702.05 ",55,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$63,394.45 ",90,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$36,702.05 ",55,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$62,059.83 ",93,,,"$36,702.05 ","$64,729.07 ",percent of total billed charges,,93% of total billed charges for outpatient setting
UROLOGY-BED PAN,8785175,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UROLOGY-ENEMA BUCKET,8785048,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
UROLOGY-FRACTURED BED PAN (H100-10),8785174,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VA-LCP 2-COL DSTL RADPL,8786871,CDM,270,RC,,HCPCS,outpatient,,,"$4,084.68 ","$3,063.51 ",,"$3,757.91 ",92,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,246.57 ",55,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,246.57 ","$3,962.14 ",other,,Not applicable. No negotiated rates per contract,"$3,512.82 ",86,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,267.74 ",80,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,246.57 ",55,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,880.45 ",95,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,880.45 ",95,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,063.51 ",75,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,471.98 ",85,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,962.14 ",97,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,246.57 ",55,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,676.21 ",90,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,962.14 ",97,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,962.14 ",97,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,962.14 ",97,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,471.98 ",85,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,676.21 ",90,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,246.57 ",55,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,880.45 ",90,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,246.57 ",55,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,798.75 ",93,,,"$2,246.57 ","$3,962.14 ",percent of total billed charges,,93% of total billed charges for outpatient setting
VASOPRESS  REGULAR CALF/KNEE DVT SYSTEM(GREEN),8781913,CDM,270,RC,,HCPCS,outpatient,,,$81.35 ,$61.01 ,,$74.84 ,92,,,$44.74 ,$78.91 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.74 ,55,,,$44.74 ,$78.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.74 ,$78.91 ,other,,Not applicable. No negotiated rates per contract,$69.96 ,86,,,$44.74 ,$78.91 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$65.08 ,80,,,$44.74 ,$78.91 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.74 ,55,,,$44.74 ,$78.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.28 ,95,,,$44.74 ,$78.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$77.28 ,95,,,$44.74 ,$78.91 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$61.01 ,75,,,$44.74 ,$78.91 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$69.15 ,85,,,$44.74 ,$78.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.91 ,97,,,$44.74 ,$78.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.74 ,55,,,$44.74 ,$78.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.22 ,90,,,$44.74 ,$78.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$78.91 ,97,,,$44.74 ,$78.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.91 ,97,,,$44.74 ,$78.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$78.91 ,97,,,$44.74 ,$78.91 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$69.15 ,85,,,$44.74 ,$78.91 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.22 ,90,,,$44.74 ,$78.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.74 ,55,,,$44.74 ,$78.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$77.28 ,90,,,$44.74 ,$78.91 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.74 ,55,,,$44.74 ,$78.91 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$75.66 ,93,,,$44.74 ,$78.91 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VASOPRESS DVT SYSTEM FOOT GARMENT (VP520L) (OR),8781934,CDM,270,RC,,HCPCS,outpatient,,,$98.04 ,$73.53 ,,$90.20 ,92,,,$53.92 ,$95.10 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$53.92 ,55,,,$53.92 ,$95.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$53.92 ,$95.10 ,other,,Not applicable. No negotiated rates per contract,$84.31 ,86,,,$53.92 ,$95.10 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$78.43 ,80,,,$53.92 ,$95.10 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$53.92 ,55,,,$53.92 ,$95.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.14 ,95,,,$53.92 ,$95.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.14 ,95,,,$53.92 ,$95.10 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.53 ,75,,,$53.92 ,$95.10 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$83.33 ,85,,,$53.92 ,$95.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$95.10 ,97,,,$53.92 ,$95.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$53.92 ,55,,,$53.92 ,$95.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$88.24 ,90,,,$53.92 ,$95.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$95.10 ,97,,,$53.92 ,$95.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.10 ,97,,,$53.92 ,$95.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$95.10 ,97,,,$53.92 ,$95.10 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.33 ,85,,,$53.92 ,$95.10 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$88.24 ,90,,,$53.92 ,$95.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.92 ,55,,,$53.92 ,$95.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$93.14 ,90,,,$53.92 ,$95.10 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$53.92 ,55,,,$53.92 ,$95.10 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$91.18 ,93,,,$53.92 ,$95.10 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VASOPRESS REGULAR FOOT  DVT SYSTEM FOOT GARMENT (VP520) BLUE  (OR),8781933,CDM,270,RC,,HCPCS,outpatient,,,$89.13 ,$66.85 ,,$82.00 ,92,,,$49.02 ,$86.46 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$49.02 ,55,,,$49.02 ,$86.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$49.02 ,$86.46 ,other,,Not applicable. No negotiated rates per contract,$76.65 ,86,,,$49.02 ,$86.46 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$71.30 ,80,,,$49.02 ,$86.46 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$49.02 ,55,,,$49.02 ,$86.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.67 ,95,,,$49.02 ,$86.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$84.67 ,95,,,$49.02 ,$86.46 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$66.85 ,75,,,$49.02 ,$86.46 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$75.76 ,85,,,$49.02 ,$86.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$86.46 ,97,,,$49.02 ,$86.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$49.02 ,55,,,$49.02 ,$86.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.22 ,90,,,$49.02 ,$86.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$86.46 ,97,,,$49.02 ,$86.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.46 ,97,,,$49.02 ,$86.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$86.46 ,97,,,$49.02 ,$86.46 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$75.76 ,85,,,$49.02 ,$86.46 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$80.22 ,90,,,$49.02 ,$86.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.02 ,55,,,$49.02 ,$86.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$84.67 ,90,,,$49.02 ,$86.46 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$49.02 ,55,,,$49.02 ,$86.46 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.89 ,93,,,$49.02 ,$86.46 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VENTRALEX HERNIA PATCH,9452714,CDM,278,RC,55143,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
VENTRIO HERNIA PATCH SMA,8782322,CDM,270,RC,,HCPCS,outpatient,,,"$3,952.50 ","$2,964.38 ",,"$3,636.30 ",92,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,173.88 ",55,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,173.88 ","$3,833.93 ",other,,Not applicable. No negotiated rates per contract,"$3,399.15 ",86,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,162.00 ",80,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,173.88 ",55,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,754.88 ",95,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,754.88 ",95,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,964.38 ",75,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,359.63 ",85,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,833.93 ",97,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,173.88 ",55,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,557.25 ",90,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,833.93 ",97,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,833.93 ",97,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,833.93 ",97,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,359.63 ",85,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$3,557.25 ",90,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,173.88 ",55,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,754.88 ",90,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,173.88 ",55,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$3,675.83 ",93,,,"$2,173.88 ","$3,833.93 ",percent of total billed charges,,93% of total billed charges for outpatient setting
VENTURI MASK KIT,8784216,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
VERSA,8784136,CDM,270,RC,52411,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
VISIONBLUE PREFILLED SYR,8782978,CDM,270,RC,,HCPCS,outpatient,,,$399.60 ,$299.70 ,,$367.63 ,92,,,$219.78 ,$387.61 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$219.78 ,55,,,$219.78 ,$387.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$219.78 ,$387.61 ,other,,Not applicable. No negotiated rates per contract,$343.66 ,86,,,$219.78 ,$387.61 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$319.68 ,80,,,$219.78 ,$387.61 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$219.78 ,55,,,$219.78 ,$387.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.62 ,95,,,$219.78 ,$387.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$379.62 ,95,,,$219.78 ,$387.61 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$299.70 ,75,,,$219.78 ,$387.61 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$339.66 ,85,,,$219.78 ,$387.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$387.61 ,97,,,$219.78 ,$387.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$219.78 ,55,,,$219.78 ,$387.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$359.64 ,90,,,$219.78 ,$387.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$387.61 ,97,,,$219.78 ,$387.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.61 ,97,,,$219.78 ,$387.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$387.61 ,97,,,$219.78 ,$387.61 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$339.66 ,85,,,$219.78 ,$387.61 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$359.64 ,90,,,$219.78 ,$387.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.78 ,55,,,$219.78 ,$387.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$379.62 ,90,,,$219.78 ,$387.61 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$219.78 ,55,,,$219.78 ,$387.61 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$371.63 ,93,,,$219.78 ,$387.61 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER  MED TALL LEG WALKER,8785177,CDM,270,RC,,HCPCS,outpatient,,,$197.71 ,$148.28 ,,$181.89 ,92,,,$108.74 ,$191.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$108.74 ,55,,,$108.74 ,$191.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$108.74 ,$191.78 ,other,,Not applicable. No negotiated rates per contract,$170.03 ,86,,,$108.74 ,$191.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$158.17 ,80,,,$108.74 ,$191.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$108.74 ,55,,,$108.74 ,$191.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.82 ,95,,,$108.74 ,$191.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$187.82 ,95,,,$108.74 ,$191.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$148.28 ,75,,,$108.74 ,$191.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$168.05 ,85,,,$108.74 ,$191.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$191.78 ,97,,,$108.74 ,$191.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.74 ,55,,,$108.74 ,$191.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$177.94 ,90,,,$108.74 ,$191.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.78 ,97,,,$108.74 ,$191.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.78 ,97,,,$108.74 ,$191.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.78 ,97,,,$108.74 ,$191.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$168.05 ,85,,,$108.74 ,$191.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$177.94 ,90,,,$108.74 ,$191.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.74 ,55,,,$108.74 ,$191.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.82 ,90,,,$108.74 ,$191.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$108.74 ,55,,,$108.74 ,$191.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$183.87 ,93,,,$108.74 ,$191.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER LARGE RANGE OF MO,8785079,CDM,270,RC,,HCPCS,outpatient,,,$461.69 ,$346.27 ,,$424.75 ,92,,,$253.93 ,$447.84 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$253.93 ,55,,,$253.93 ,$447.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$253.93 ,$447.84 ,other,,Not applicable. No negotiated rates per contract,$397.05 ,86,,,$253.93 ,$447.84 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$369.35 ,80,,,$253.93 ,$447.84 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$253.93 ,55,,,$253.93 ,$447.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.61 ,95,,,$253.93 ,$447.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$438.61 ,95,,,$253.93 ,$447.84 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$346.27 ,75,,,$253.93 ,$447.84 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$392.44 ,85,,,$253.93 ,$447.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$447.84 ,97,,,$253.93 ,$447.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$253.93 ,55,,,$253.93 ,$447.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$415.52 ,90,,,$253.93 ,$447.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$447.84 ,97,,,$253.93 ,$447.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.84 ,97,,,$253.93 ,$447.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$447.84 ,97,,,$253.93 ,$447.84 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.44 ,85,,,$253.93 ,$447.84 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$415.52 ,90,,,$253.93 ,$447.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.93 ,55,,,$253.93 ,$447.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$438.61 ,90,,,$253.93 ,$447.84 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$253.93 ,55,,,$253.93 ,$447.84 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$429.37 ,93,,,$253.93 ,$447.84 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER LG LOW CUT WALKER (W0900BLK),8785195,CDM,270,RC,,HCPCS,outpatient,,,$275.57 ,$206.68 ,,$253.52 ,92,,,$151.56 ,$267.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$151.56 ,$267.30 ,other,,Not applicable. No negotiated rates per contract,$236.99 ,86,,,$151.56 ,$267.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$220.46 ,80,,,$151.56 ,$267.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.79 ,95,,,$151.56 ,$267.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$261.79 ,95,,,$151.56 ,$267.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$206.68 ,75,,,$151.56 ,$267.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$234.23 ,85,,,$151.56 ,$267.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.01 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$234.23 ,85,,,$151.56 ,$267.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$248.01 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.79 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.28 ,93,,,$151.56 ,$267.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER LG TALL LEG WALKER,8785181,CDM,270,RC,,HCPCS,outpatient,,,$237.87 ,$178.40 ,,$218.84 ,92,,,$130.83 ,$230.73 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$130.83 ,55,,,$130.83 ,$230.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$130.83 ,$230.73 ,other,,Not applicable. No negotiated rates per contract,$204.57 ,86,,,$130.83 ,$230.73 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$190.30 ,80,,,$130.83 ,$230.73 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$130.83 ,55,,,$130.83 ,$230.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.98 ,95,,,$130.83 ,$230.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$225.98 ,95,,,$130.83 ,$230.73 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$178.40 ,75,,,$130.83 ,$230.73 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$202.19 ,85,,,$130.83 ,$230.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$230.73 ,97,,,$130.83 ,$230.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$130.83 ,55,,,$130.83 ,$230.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.08 ,90,,,$130.83 ,$230.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.73 ,97,,,$130.83 ,$230.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.73 ,97,,,$130.83 ,$230.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.73 ,97,,,$130.83 ,$230.73 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$202.19 ,85,,,$130.83 ,$230.73 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$214.08 ,90,,,$130.83 ,$230.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$130.83 ,55,,,$130.83 ,$230.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.98 ,90,,,$130.83 ,$230.73 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$130.83 ,55,,,$130.83 ,$230.73 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.22 ,93,,,$130.83 ,$230.73 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER MED LOW CUT WALKER,8785189,CDM,270,RC,,HCPCS,outpatient,,,$189.23 ,$141.92 ,,$174.09 ,92,,,$104.08 ,$183.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.08 ,$183.55 ,other,,Not applicable. No negotiated rates per contract,$162.74 ,86,,,$104.08 ,$183.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.38 ,80,,,$104.08 ,$183.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.92 ,75,,,$104.08 ,$183.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.98 ,93,,,$104.08 ,$183.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER SM LOW CUT WALKER,8785194,CDM,270,RC,,HCPCS,outpatient,,,$189.23 ,$141.92 ,,$174.09 ,92,,,$104.08 ,$183.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.08 ,$183.55 ,other,,Not applicable. No negotiated rates per contract,$162.74 ,86,,,$104.08 ,$183.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.38 ,80,,,$104.08 ,$183.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.92 ,75,,,$104.08 ,$183.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.98 ,93,,,$104.08 ,$183.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER XLG LOW CUT WALKER,8785190,CDM,270,RC,,HCPCS,outpatient,,,$189.23 ,$141.92 ,,$174.09 ,92,,,$104.08 ,$183.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$104.08 ,$183.55 ,other,,Not applicable. No negotiated rates per contract,$162.74 ,86,,,$104.08 ,$183.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$151.38 ,80,,,$104.08 ,$183.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$179.77 ,95,,,$104.08 ,$183.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$141.92 ,75,,,$104.08 ,$183.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$183.55 ,97,,,$104.08 ,$183.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$160.85 ,85,,,$104.08 ,$183.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$170.31 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$179.77 ,90,,,$104.08 ,$183.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$104.08 ,55,,,$104.08 ,$183.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$175.98 ,93,,,$104.08 ,$183.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER XSM LOW CUT WALKE,8785188,CDM,270,RC,,HCPCS,outpatient,,,$252.16 ,$189.12 ,,$231.99 ,92,,,$138.69 ,$244.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$138.69 ,55,,,$138.69 ,$244.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$138.69 ,$244.60 ,other,,Not applicable. No negotiated rates per contract,$216.86 ,86,,,$138.69 ,$244.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$201.73 ,80,,,$138.69 ,$244.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$138.69 ,55,,,$138.69 ,$244.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.55 ,95,,,$138.69 ,$244.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$239.55 ,95,,,$138.69 ,$244.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$189.12 ,75,,,$138.69 ,$244.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$214.34 ,85,,,$138.69 ,$244.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$244.60 ,97,,,$138.69 ,$244.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$138.69 ,55,,,$138.69 ,$244.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$226.94 ,90,,,$138.69 ,$244.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$244.60 ,97,,,$138.69 ,$244.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.60 ,97,,,$138.69 ,$244.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$244.60 ,97,,,$138.69 ,$244.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$214.34 ,85,,,$138.69 ,$244.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.94 ,90,,,$138.69 ,$244.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.69 ,55,,,$138.69 ,$244.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$239.55 ,90,,,$138.69 ,$244.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$138.69 ,55,,,$138.69 ,$244.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$234.51 ,93,,,$138.69 ,$244.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER(MCARE CODE ONLY) E0130,8971131,CDM,270,RC,E0130,HCPCS,outpatient,,,$236.00 ,$177.00 ,,$217.12 ,92,,,$129.80 ,$228.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$129.80 ,55,,,$129.80 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$129.80 ,$228.92 ,other,,Not applicable. No negotiated rates per contract,$202.96 ,86,,,$129.80 ,$228.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$188.80 ,80,,,$129.80 ,$228.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$129.80 ,55,,,$129.80 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,95,,,$129.80 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$224.20 ,95,,,$129.80 ,$228.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$177.00 ,75,,,$129.80 ,$228.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$200.60 ,85,,,$129.80 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$228.92 ,97,,,$129.80 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$129.80 ,55,,,$129.80 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$212.40 ,90,,,$129.80 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$228.92 ,97,,,$129.80 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$129.80 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$228.92 ,97,,,$129.80 ,$228.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$200.60 ,85,,,$129.80 ,$228.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$212.40 ,90,,,$129.80 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$129.80 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.20 ,90,,,$129.80 ,$228.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$129.80 ,55,,,$129.80 ,$228.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$219.48 ,93,,,$129.80 ,$228.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER,8785180,CDM,270,RC,,HCPCS,outpatient,,,$225.62 ,$169.22 ,,$207.57 ,92,,,$124.09 ,$218.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$124.09 ,55,,,$124.09 ,$218.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$124.09 ,$218.85 ,other,,Not applicable. No negotiated rates per contract,$194.03 ,86,,,$124.09 ,$218.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$180.50 ,80,,,$124.09 ,$218.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$124.09 ,55,,,$124.09 ,$218.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.34 ,95,,,$124.09 ,$218.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.34 ,95,,,$124.09 ,$218.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$169.22 ,75,,,$124.09 ,$218.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$191.78 ,85,,,$124.09 ,$218.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.85 ,97,,,$124.09 ,$218.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.09 ,55,,,$124.09 ,$218.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$203.06 ,90,,,$124.09 ,$218.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$218.85 ,97,,,$124.09 ,$218.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.85 ,97,,,$124.09 ,$218.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$218.85 ,97,,,$124.09 ,$218.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.78 ,85,,,$124.09 ,$218.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$203.06 ,90,,,$124.09 ,$218.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.09 ,55,,,$124.09 ,$218.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$214.34 ,90,,,$124.09 ,$218.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.09 ,55,,,$124.09 ,$218.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.83 ,93,,,$124.09 ,$218.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER,8785182,CDM,270,RC,,HCPCS,outpatient,,,$275.57 ,$206.68 ,,$253.52 ,92,,,$151.56 ,$267.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$151.56 ,$267.30 ,other,,Not applicable. No negotiated rates per contract,$236.99 ,86,,,$151.56 ,$267.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$220.46 ,80,,,$151.56 ,$267.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.79 ,95,,,$151.56 ,$267.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$261.79 ,95,,,$151.56 ,$267.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$206.68 ,75,,,$151.56 ,$267.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$234.23 ,85,,,$151.56 ,$267.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$248.01 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$267.30 ,97,,,$151.56 ,$267.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$234.23 ,85,,,$151.56 ,$267.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$248.01 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.79 ,90,,,$151.56 ,$267.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$151.56 ,55,,,$151.56 ,$267.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$256.28 ,93,,,$151.56 ,$267.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKING BOOT L4386,8971152,CDM,270,RC,L4386,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$128.15 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.15 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$200.38 ,86,,,$128.15 ,$226.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.40 ,80,,,$128.15 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$128.15 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$128.15 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WAND,8783732,CDM,270,RC,,HCPCS,outpatient,,,$950.00 ,$712.50 ,,$874.00 ,92,,,$522.50 ,$921.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$522.50 ,$921.50 ,other,,Not applicable. No negotiated rates per contract,$817.00 ,86,,,$522.50 ,$921.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$760.00 ,80,,,$522.50 ,$921.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$712.50 ,75,,,$522.50 ,$921.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$883.50 ,93,,,$522.50 ,$921.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WAND,8783731,CDM,270,RC,,HCPCS,outpatient,,,$950.00 ,$712.50 ,,$874.00 ,92,,,$522.50 ,$921.50 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$522.50 ,$921.50 ,other,,Not applicable. No negotiated rates per contract,$817.00 ,86,,,$522.50 ,$921.50 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$760.00 ,80,,,$522.50 ,$921.50 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$902.50 ,95,,,$522.50 ,$921.50 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$712.50 ,75,,,$522.50 ,$921.50 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$921.50 ,97,,,$522.50 ,$921.50 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$807.50 ,85,,,$522.50 ,$921.50 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$855.00 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$902.50 ,90,,,$522.50 ,$921.50 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$522.50 ,55,,,$522.50 ,$921.50 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$883.50 ,93,,,$522.50 ,$921.50 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WATER BATH THERMO SCIENT,8783175,CDM,270,RC,,HCPCS,outpatient,,,"$6,469.26 ","$4,851.95 ",,"$5,951.72 ",92,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,558.09 ",55,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,558.09 ","$6,275.18 ",other,,Not applicable. No negotiated rates per contract,"$5,563.56 ",86,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,175.41 ",80,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,558.09 ",55,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,145.80 ",95,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,145.80 ",95,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,851.95 ",75,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,498.87 ",85,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,275.18 ",97,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,558.09 ",55,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$5,822.33 ",90,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,275.18 ",97,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,275.18 ",97,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,275.18 ",97,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,498.87 ",85,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$5,822.33 ",90,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,558.09 ",55,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,145.80 ",90,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,558.09 ",55,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,016.41 ",93,,,"$3,558.09 ","$6,275.18 ",percent of total billed charges,,93% of total billed charges for outpatient setting
WATER TUBE,8784771,CDM,270,RC,,HCPCS,outpatient,,,$151.00 ,$113.25 ,,$138.92 ,92,,,$83.05 ,$146.47 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$83.05 ,$146.47 ,other,,Not applicable. No negotiated rates per contract,$129.86 ,86,,,$83.05 ,$146.47 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$120.80 ,80,,,$83.05 ,$146.47 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$143.45 ,95,,,$83.05 ,$146.47 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.25 ,75,,,$83.05 ,$146.47 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$146.47 ,97,,,$83.05 ,$146.47 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.35 ,85,,,$83.05 ,$146.47 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$135.90 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$143.45 ,90,,,$83.05 ,$146.47 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$83.05 ,55,,,$83.05 ,$146.47 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$140.43 ,93,,,$83.05 ,$146.47 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WAYNE PNEUMOTHORAX TRAY,9522671,CDM,270,RC,,HCPCS,outpatient,,,$946.31 ,$709.73 ,,$870.61 ,92,,,$520.47 ,$917.92 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$520.47 ,55,,,$520.47 ,$917.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$520.47 ,$917.92 ,other,,Not applicable. No negotiated rates per contract,$813.83 ,86,,,$520.47 ,$917.92 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$757.05 ,80,,,$520.47 ,$917.92 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$520.47 ,55,,,$520.47 ,$917.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.99 ,95,,,$520.47 ,$917.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$898.99 ,95,,,$520.47 ,$917.92 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$709.73 ,75,,,$520.47 ,$917.92 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$804.36 ,85,,,$520.47 ,$917.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$917.92 ,97,,,$520.47 ,$917.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$520.47 ,55,,,$520.47 ,$917.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$851.68 ,90,,,$520.47 ,$917.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$917.92 ,97,,,$520.47 ,$917.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$917.92 ,97,,,$520.47 ,$917.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$917.92 ,97,,,$520.47 ,$917.92 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$804.36 ,85,,,$520.47 ,$917.92 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$851.68 ,90,,,$520.47 ,$917.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$520.47 ,55,,,$520.47 ,$917.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$898.99 ,90,,,$520.47 ,$917.92 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$520.47 ,55,,,$520.47 ,$917.92 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$880.07 ,93,,,$520.47 ,$917.92 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"WEBRIL 6"" UNDERCAST PADDING LATEX FREE",8989381,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WOUND DRESSING,9337016,CDM,270,RC,,HCPCS,outpatient,,,"$12,996.50 ","$9,747.38 ",,"$11,956.78 ",92,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$7,148.08 ",55,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$7,148.08 ","$12,606.61 ",other,,Not applicable. No negotiated rates per contract,"$11,176.99 ",86,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$10,397.20 ",80,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$7,148.08 ",55,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$12,346.68 ",95,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$12,346.68 ",95,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$9,747.38 ",75,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$11,047.03 ",85,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$12,606.61 ",97,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$7,148.08 ",55,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$11,696.85 ",90,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$12,606.61 ",97,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$12,606.61 ",97,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$12,606.61 ",97,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$11,047.03 ",85,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$11,696.85 ",90,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,148.08 ",55,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$12,346.68 ",90,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$7,148.08 ",55,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$12,086.75 ",93,,,"$7,148.08 ","$12,606.61 ",percent of total billed charges,,93% of total billed charges for outpatient setting
WOUND SUCTION EVACUATOR 100CC,8782337,CDM,270,RC,,HCPCS,outpatient,,,$36.75 ,$27.56 ,,$33.81 ,92,,,$20.21 ,$35.65 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.21 ,55,,,$20.21 ,$35.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.21 ,$35.65 ,other,,Not applicable. No negotiated rates per contract,$31.61 ,86,,,$20.21 ,$35.65 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.40 ,80,,,$20.21 ,$35.65 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.21 ,55,,,$20.21 ,$35.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.91 ,95,,,$20.21 ,$35.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$34.91 ,95,,,$20.21 ,$35.65 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.56 ,75,,,$20.21 ,$35.65 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.24 ,85,,,$20.21 ,$35.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.65 ,97,,,$20.21 ,$35.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.21 ,55,,,$20.21 ,$35.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.08 ,90,,,$20.21 ,$35.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.65 ,97,,,$20.21 ,$35.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.65 ,97,,,$20.21 ,$35.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.65 ,97,,,$20.21 ,$35.65 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.24 ,85,,,$20.21 ,$35.65 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.08 ,90,,,$20.21 ,$35.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.21 ,55,,,$20.21 ,$35.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.91 ,90,,,$20.21 ,$35.65 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.21 ,55,,,$20.21 ,$35.65 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.18 ,93,,,$20.21 ,$35.65 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WOUND THERAPY SYSTEM,8785138,CDM,270,RC,,HCPCS,outpatient,,,$953.70 ,$715.28 ,,$877.40 ,92,,,$524.54 ,$925.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$524.54 ,55,,,$524.54 ,$925.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$524.54 ,$925.09 ,other,,Not applicable. No negotiated rates per contract,$820.18 ,86,,,$524.54 ,$925.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$762.96 ,80,,,$524.54 ,$925.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$524.54 ,55,,,$524.54 ,$925.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$906.02 ,95,,,$524.54 ,$925.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$906.02 ,95,,,$524.54 ,$925.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$715.28 ,75,,,$524.54 ,$925.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$810.65 ,85,,,$524.54 ,$925.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$925.09 ,97,,,$524.54 ,$925.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$524.54 ,55,,,$524.54 ,$925.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$858.33 ,90,,,$524.54 ,$925.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$925.09 ,97,,,$524.54 ,$925.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$925.09 ,97,,,$524.54 ,$925.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$925.09 ,97,,,$524.54 ,$925.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$810.65 ,85,,,$524.54 ,$925.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$858.33 ,90,,,$524.54 ,$925.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$524.54 ,55,,,$524.54 ,$925.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$906.02 ,90,,,$524.54 ,$925.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$524.54 ,55,,,$524.54 ,$925.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$886.94 ,93,,,$524.54 ,$925.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WRAP AROUND LENS,8786818,CDM,270,RC,,HCPCS,outpatient,,,$747.70 ,$560.78 ,,$687.88 ,92,,,$411.24 ,$725.27 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$411.24 ,55,,,$411.24 ,$725.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$411.24 ,$725.27 ,other,,Not applicable. No negotiated rates per contract,$643.02 ,86,,,$411.24 ,$725.27 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$598.16 ,80,,,$411.24 ,$725.27 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$411.24 ,55,,,$411.24 ,$725.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$710.32 ,95,,,$411.24 ,$725.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$710.32 ,95,,,$411.24 ,$725.27 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$560.78 ,75,,,$411.24 ,$725.27 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$635.55 ,85,,,$411.24 ,$725.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$725.27 ,97,,,$411.24 ,$725.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$411.24 ,55,,,$411.24 ,$725.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$672.93 ,90,,,$411.24 ,$725.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$725.27 ,97,,,$411.24 ,$725.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$725.27 ,97,,,$411.24 ,$725.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$725.27 ,97,,,$411.24 ,$725.27 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$635.55 ,85,,,$411.24 ,$725.27 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$672.93 ,90,,,$411.24 ,$725.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$411.24 ,55,,,$411.24 ,$725.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$710.32 ,90,,,$411.24 ,$725.27 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$411.24 ,55,,,$411.24 ,$725.27 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.36 ,93,,,$411.24 ,$725.27 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WRENCH KIT TORQUE (5873W,8784135,CDM,270,RC,,HCPCS,outpatient,,,$297.00 ,$222.75 ,,$273.24 ,92,,,$163.35 ,$288.09 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$163.35 ,55,,,$163.35 ,$288.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$163.35 ,$288.09 ,other,,Not applicable. No negotiated rates per contract,$255.42 ,86,,,$163.35 ,$288.09 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$237.60 ,80,,,$163.35 ,$288.09 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$163.35 ,55,,,$163.35 ,$288.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$282.15 ,95,,,$163.35 ,$288.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$282.15 ,95,,,$163.35 ,$288.09 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$222.75 ,75,,,$163.35 ,$288.09 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$252.45 ,85,,,$163.35 ,$288.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$288.09 ,97,,,$163.35 ,$288.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.35 ,55,,,$163.35 ,$288.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$267.30 ,90,,,$163.35 ,$288.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$288.09 ,97,,,$163.35 ,$288.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$288.09 ,97,,,$163.35 ,$288.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$288.09 ,97,,,$163.35 ,$288.09 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$252.45 ,85,,,$163.35 ,$288.09 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$267.30 ,90,,,$163.35 ,$288.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.35 ,55,,,$163.35 ,$288.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$282.15 ,90,,,$163.35 ,$288.09 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$163.35 ,55,,,$163.35 ,$288.09 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$276.21 ,93,,,$163.35 ,$288.09 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WRIST EXTENSION DYNAMIC,8786129,CDM,270,RC,,HCPCS,outpatient,,,$474.81 ,$356.11 ,,$436.83 ,92,,,$261.15 ,$460.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$261.15 ,55,,,$261.15 ,$460.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$261.15 ,$460.57 ,other,,Not applicable. No negotiated rates per contract,$408.34 ,86,,,$261.15 ,$460.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$379.85 ,80,,,$261.15 ,$460.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$261.15 ,55,,,$261.15 ,$460.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.07 ,95,,,$261.15 ,$460.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$451.07 ,95,,,$261.15 ,$460.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$356.11 ,75,,,$261.15 ,$460.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$403.59 ,85,,,$261.15 ,$460.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$460.57 ,97,,,$261.15 ,$460.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$261.15 ,55,,,$261.15 ,$460.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$427.33 ,90,,,$261.15 ,$460.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$460.57 ,97,,,$261.15 ,$460.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.57 ,97,,,$261.15 ,$460.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$460.57 ,97,,,$261.15 ,$460.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$403.59 ,85,,,$261.15 ,$460.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$427.33 ,90,,,$261.15 ,$460.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.15 ,55,,,$261.15 ,$460.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$451.07 ,90,,,$261.15 ,$460.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$261.15 ,55,,,$261.15 ,$460.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$441.57 ,93,,,$261.15 ,$460.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"WRIST SPLINT ULTRALITE LEFT SMALL 8"" (0815-10-510)",8786149,CDM,270,RC,,HCPCS,outpatient,,,$120.59 ,$90.44 ,,$110.94 ,92,,,$66.32 ,$116.97 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.32 ,55,,,$66.32 ,$116.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.32 ,$116.97 ,other,,Not applicable. No negotiated rates per contract,$103.71 ,86,,,$66.32 ,$116.97 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.47 ,80,,,$66.32 ,$116.97 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.32 ,55,,,$66.32 ,$116.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.56 ,95,,,$66.32 ,$116.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.56 ,95,,,$66.32 ,$116.97 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.44 ,75,,,$66.32 ,$116.97 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.50 ,85,,,$66.32 ,$116.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.97 ,97,,,$66.32 ,$116.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.32 ,55,,,$66.32 ,$116.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.53 ,90,,,$66.32 ,$116.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$116.97 ,97,,,$66.32 ,$116.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.97 ,97,,,$66.32 ,$116.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$116.97 ,97,,,$66.32 ,$116.97 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.50 ,85,,,$66.32 ,$116.97 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.53 ,90,,,$66.32 ,$116.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.32 ,55,,,$66.32 ,$116.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.56 ,90,,,$66.32 ,$116.97 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.32 ,55,,,$66.32 ,$116.97 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.15 ,93,,,$66.32 ,$116.97 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"WRIST SPLINT ULTRALITE LEFT SMALL 11"" (0816-10-510)",8786150,CDM,270,RC,,HCPCS,outpatient,,,$118.96 ,$89.22 ,,$109.44 ,92,,,$65.43 ,$115.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.43 ,$115.39 ,other,,Not applicable. No negotiated rates per contract,$102.31 ,86,,,$65.43 ,$115.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.17 ,80,,,$65.43 ,$115.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.01 ,95,,,$65.43 ,$115.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.01 ,95,,,$65.43 ,$115.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.22 ,75,,,$65.43 ,$115.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.12 ,85,,,$65.43 ,$115.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.06 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.12 ,85,,,$65.43 ,$115.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.06 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.01 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.63 ,93,,,$65.43 ,$115.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WRIST SPLINT,8787011,CDM,270,RC,,HCPCS,outpatient,,,$43.89 ,$32.92 ,,$40.38 ,92,,,$24.14 ,$42.57 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$24.14 ,$42.57 ,other,,Not applicable. No negotiated rates per contract,$37.75 ,86,,,$24.14 ,$42.57 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$35.11 ,80,,,$24.14 ,$42.57 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.70 ,95,,,$24.14 ,$42.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$41.70 ,95,,,$24.14 ,$42.57 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.92 ,75,,,$24.14 ,$42.57 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$37.31 ,85,,,$24.14 ,$42.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.50 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.57 ,97,,,$24.14 ,$42.57 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.31 ,85,,,$24.14 ,$42.57 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$39.50 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$41.70 ,90,,,$24.14 ,$42.57 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.14 ,55,,,$24.14 ,$42.57 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.82 ,93,,,$24.14 ,$42.57 ,percent of total billed charges,,93% of total billed charges for outpatient setting
"WRIST SUPPORT 10"" SPLINT",8786146,CDM,270,RC,,HCPCS,outpatient,,,$124.08 ,$93.06 ,,$114.15 ,92,,,$68.24 ,$120.36 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$68.24 ,55,,,$68.24 ,$120.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$68.24 ,$120.36 ,other,,Not applicable. No negotiated rates per contract,$106.71 ,86,,,$68.24 ,$120.36 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$99.26 ,80,,,$68.24 ,$120.36 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$68.24 ,55,,,$68.24 ,$120.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.88 ,95,,,$68.24 ,$120.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$117.88 ,95,,,$68.24 ,$120.36 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$93.06 ,75,,,$68.24 ,$120.36 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$105.47 ,85,,,$68.24 ,$120.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$120.36 ,97,,,$68.24 ,$120.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.24 ,55,,,$68.24 ,$120.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$111.67 ,90,,,$68.24 ,$120.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$120.36 ,97,,,$68.24 ,$120.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.36 ,97,,,$68.24 ,$120.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$120.36 ,97,,,$68.24 ,$120.36 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.47 ,85,,,$68.24 ,$120.36 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.67 ,90,,,$68.24 ,$120.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.24 ,55,,,$68.24 ,$120.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$117.88 ,90,,,$68.24 ,$120.36 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$68.24 ,55,,,$68.24 ,$120.36 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.39 ,93,,,$68.24 ,$120.36 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WRSIT BRACE ULTRALITE LA,8784563,CDM,270,RC,,HCPCS,outpatient,,,$118.96 ,$89.22 ,,$109.44 ,92,,,$65.43 ,$115.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$65.43 ,$115.39 ,other,,Not applicable. No negotiated rates per contract,$102.31 ,86,,,$65.43 ,$115.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$95.17 ,80,,,$65.43 ,$115.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.01 ,95,,,$65.43 ,$115.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$113.01 ,95,,,$65.43 ,$115.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$89.22 ,75,,,$65.43 ,$115.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$101.12 ,85,,,$65.43 ,$115.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$107.06 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$115.39 ,97,,,$65.43 ,$115.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.12 ,85,,,$65.43 ,$115.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.06 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$113.01 ,90,,,$65.43 ,$115.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$65.43 ,55,,,$65.43 ,$115.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$110.63 ,93,,,$65.43 ,$115.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
XEROFORM OCCLUSIVE PETRO,8785597,CDM,270,RC,,HCPCS,outpatient,,,$25.29 ,$18.97 ,,$23.27 ,92,,,$13.91 ,$24.53 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.91 ,55,,,$13.91 ,$24.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.91 ,$24.53 ,other,,Not applicable. No negotiated rates per contract,$21.75 ,86,,,$13.91 ,$24.53 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.23 ,80,,,$13.91 ,$24.53 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.91 ,55,,,$13.91 ,$24.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.03 ,95,,,$13.91 ,$24.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.03 ,95,,,$13.91 ,$24.53 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.97 ,75,,,$13.91 ,$24.53 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.50 ,85,,,$13.91 ,$24.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.53 ,97,,,$13.91 ,$24.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.91 ,55,,,$13.91 ,$24.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.76 ,90,,,$13.91 ,$24.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.53 ,97,,,$13.91 ,$24.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.53 ,97,,,$13.91 ,$24.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.53 ,97,,,$13.91 ,$24.53 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.50 ,85,,,$13.91 ,$24.53 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.76 ,90,,,$13.91 ,$24.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.91 ,55,,,$13.91 ,$24.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$24.03 ,90,,,$13.91 ,$24.53 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.91 ,55,,,$13.91 ,$24.53 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.52 ,93,,,$13.91 ,$24.53 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Y-KNOT FLEX ALL SUTURE A,8782882,CDM,270,RC,,HCPCS,outpatient,,,"$1,499.32 ","$1,124.49 ",,"$1,379.37 ",92,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$824.63 ,55,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$824.63 ,"$1,454.34 ",other,,Not applicable. No negotiated rates per contract,"$1,289.42 ",86,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,199.46 ",80,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$824.63 ,55,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,424.35 ",95,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,424.35 ",95,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,124.49 ",75,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,274.42 ",85,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,454.34 ",97,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$824.63 ,55,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,349.39 ",90,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,454.34 ",97,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,454.34 ",97,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,454.34 ",97,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,274.42 ",85,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,349.39 ",90,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$824.63 ,55,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,424.35 ",90,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$824.63 ,55,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,394.37 ",93,,,$824.63 ,"$1,454.34 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Y-KNOT FLEX DISP. DRILL,8782883,CDM,270,RC,,HCPCS,outpatient,,,$404.53 ,$303.40 ,,$372.17 ,92,,,$222.49 ,$392.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$222.49 ,55,,,$222.49 ,$392.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$222.49 ,$392.39 ,other,,Not applicable. No negotiated rates per contract,$347.90 ,86,,,$222.49 ,$392.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$323.62 ,80,,,$222.49 ,$392.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$222.49 ,55,,,$222.49 ,$392.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.30 ,95,,,$222.49 ,$392.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$384.30 ,95,,,$222.49 ,$392.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$303.40 ,75,,,$222.49 ,$392.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$343.85 ,85,,,$222.49 ,$392.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$392.39 ,97,,,$222.49 ,$392.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$222.49 ,55,,,$222.49 ,$392.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$364.08 ,90,,,$222.49 ,$392.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$392.39 ,97,,,$222.49 ,$392.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.39 ,97,,,$222.49 ,$392.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$392.39 ,97,,,$222.49 ,$392.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$343.85 ,85,,,$222.49 ,$392.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$364.08 ,90,,,$222.49 ,$392.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.49 ,55,,,$222.49 ,$392.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$384.30 ,90,,,$222.49 ,$392.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$222.49 ,55,,,$222.49 ,$392.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$376.21 ,93,,,$222.49 ,$392.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YANKAUERS STERILE OPEN/S,8942880,CDM,270,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YANKUER STERILE OPEN/STRAIGHT TIP (LEFT HOSE),9169010,CDM,272,RC,,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ZIMMER BIOMET ALLPOLY PAT  VE 35MM DIA(OR),8787042,CDM,270,RC,,HCPCS,outpatient,,,"$2,125.00 ","$1,593.75 ",,"$1,955.00 ",92,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,168.75 ",55,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,168.75 ","$2,061.25 ",other,,Not applicable. No negotiated rates per contract,"$1,827.50 ",86,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,700.00 ",80,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,168.75 ",55,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,018.75 ",95,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$2,018.75 ",95,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,593.75 ",75,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,806.25 ",85,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,061.25 ",97,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,168.75 ",55,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,912.50 ",90,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,061.25 ",97,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,061.25 ",97,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,061.25 ",97,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,806.25 ",85,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,912.50 ",90,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,168.75 ",55,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$2,018.75 ",90,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,168.75 ",55,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,976.25 ",93,,,"$1,168.75 ","$2,061.25 ",percent of total billed charges,,93% of total billed charges for outpatient setting
dressing wound and burn medihoney 2 x2,8958217,CDM,270,RC,,HCPCS,outpatient,,,$51.56 ,$38.67 ,,$47.44 ,92,,,$28.36 ,$50.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.36 ,55,,,$28.36 ,$50.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.36 ,$50.01 ,other,,Not applicable. No negotiated rates per contract,$44.34 ,86,,,$28.36 ,$50.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.25 ,80,,,$28.36 ,$50.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.36 ,55,,,$28.36 ,$50.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.98 ,95,,,$28.36 ,$50.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$48.98 ,95,,,$28.36 ,$50.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$38.67 ,75,,,$28.36 ,$50.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$43.83 ,85,,,$28.36 ,$50.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.01 ,97,,,$28.36 ,$50.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.36 ,55,,,$28.36 ,$50.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.40 ,90,,,$28.36 ,$50.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.01 ,97,,,$28.36 ,$50.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.01 ,97,,,$28.36 ,$50.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.01 ,97,,,$28.36 ,$50.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$43.83 ,85,,,$28.36 ,$50.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.40 ,90,,,$28.36 ,$50.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.36 ,55,,,$28.36 ,$50.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.98 ,90,,,$28.36 ,$50.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.36 ,55,,,$28.36 ,$50.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$47.95 ,93,,,$28.36 ,$50.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
microport tib base cocr non por size 6+,8942834,CDM,270,RC,,HCPCS,outpatient,,,"$6,750.00 ","$5,062.50 ",,"$6,210.00 ",92,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$3,712.50 ","$6,547.50 ",other,,Not applicable. No negotiated rates per contract,"$5,805.00 ",86,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$5,400.00 ",80,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$6,412.50 ",95,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$5,062.50 ",75,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$6,547.50 ",97,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$5,737.50 ",85,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$6,075.00 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,412.50 ",90,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$3,712.50 ",55,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$6,277.50 ",93,,,"$3,712.50 ","$6,547.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Injection Steroid Epidural,8777280,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Repair Hernia Ventral with Mesh,8703506,CDM,975,RC,49591,HCPCS,outpatient,,,"$1,076.00 ",$807.00 ,,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursible per contract terms,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursible per contract terms,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursable per contract terms,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,022.20 ",95,,,$430.40 ,"$1,076.00 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,076.00 ",100,,,$430.40 ,"$1,076.00 ",fee schedule,,100% Humana physician fee schedule,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursable per contract terms,$645.60 ,60,,,$430.40 ,"$1,076.00 ",percent of total billed charges,,60% of total billed charges for physician settings,$645.60 ,60,,,$430.40 ,"$1,076.00 ",percent of total billed charges,,60% of total billed charges for physician settings,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursable per contract terms,,,,,$430.40 ,"$1,076.00 ",other,,Not separately reimbursible. Not contracted for physician rates,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,"$1,022.20 ",95,,,$430.40 ,"$1,076.00 ",percent of total billed charges,,95% of total billed charges,,,,,$430.40 ,"$1,076.00 ",other,,Not seperately reimbursable per CMS Medicare reimbursement methodology,$430.40 ,40,,,$430.40 ,"$1,076.00 ",percent of total billed charges,,40% of total billed charges for physician setting
Total Shoulder Arthroplasty,8668942,CDM,975,RC,23472,HCPCS,outpatient,,,"$5,072.00 ","$3,804.00 ",,"$1,980.22 ",135,cms physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,486.37 ","$4,818.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,807.77 ",100,,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$2,938.60 ",100,physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,155.24 ",145,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$4,818.40 ",95,,,"$1,486.37 ","$4,818.40 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,486.37 ","$4,818.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$2,126.80 ",100,,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% Humana physician fee schedule,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,486.37 ","$4,818.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$2,902.00 ",100,,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% Midlands Choice physician fee schedule,"$3,043.20 ",60,,,"$1,486.37 ","$4,818.40 ",percent of total billed charges,,60% of total billed charges for physician settings,"$3,043.20 ",60,,,"$1,486.37 ","$4,818.40 ",percent of total billed charges,,60% of total billed charges for physician settings,"$2,080.92 ",140,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,486.37 ","$4,818.40 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$4,818.40 ",95,,,"$1,486.37 ","$4,818.40 ",percent of total billed charges,,95% of total billed charges,"$1,486.37 ",100,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,854.29 ",124.753,CMS physician fee schedule,,"$1,486.37 ","$4,818.40 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
YAG Laser Procedure,8503449,CDM,761,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Level 1,1378485,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Level 2,1378486,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Level 3,1378487,CDM,360,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
11421 Excision SNHFG- 0.6 to 1.0cm,9092009,CDM,360,RC,11421,HCPCS,outpatient,,,"$2,021.00 ","$1,515.75 ",,"$1,859.32 ",92,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,111.55 ",55,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,111.55 ","$1,960.37 ",other,,Not applicable. No negotiated rates per contract,"$1,738.06 ",86,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,616.80 ",80,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,111.55 ",55,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,919.95 ",95,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,919.95 ",95,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,515.75 ",75,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,717.85 ",85,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,960.37 ",97,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,111.55 ",55,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,818.90 ",90,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,960.37 ",97,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,960.37 ",97,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,960.37 ",97,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,717.85 ",85,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,818.90 ",90,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,111.55 ",55,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,919.95 ",90,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,111.55 ",55,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,879.53 ",93,,,"$1,111.55 ","$1,960.37 ",percent of total billed charges,,93% of total billed charges for outpatient setting
20552 INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee,8022752,CDM,450,RC,20552,HCPCS,outpatient,,,$177.00 ,$132.75 ,,$162.84 ,92,,,$97.35 ,$171.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.35 ,$171.69 ,other,,Not applicable. No negotiated rates per contract,$152.22 ,86,,,$97.35 ,$171.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$141.60 ,80,,,$97.35 ,$171.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,95,,,$97.35 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.15 ,95,,,$97.35 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.75 ,75,,,$97.35 ,$171.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$150.45 ,85,,,$97.35 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.30 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.45 ,85,,,$97.35 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.30 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.61 ,93,,,$97.35 ,$171.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
20600 ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US TechFee,8022754,CDM,450,RC,20600,HCPCS,outpatient,,,$170.00 ,$127.50 ,,$156.40 ,92,,,$93.50 ,$164.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$93.50 ,55,,,$93.50 ,$164.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$93.50 ,$164.90 ,other,,Not applicable. No negotiated rates per contract,$146.20 ,86,,,$93.50 ,$164.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$136.00 ,80,,,$93.50 ,$164.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$93.50 ,55,,,$93.50 ,$164.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.50 ,95,,,$93.50 ,$164.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$161.50 ,95,,,$93.50 ,$164.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$127.50 ,75,,,$93.50 ,$164.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$144.50 ,85,,,$93.50 ,$164.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$164.90 ,97,,,$93.50 ,$164.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.50 ,55,,,$93.50 ,$164.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.00 ,90,,,$93.50 ,$164.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$164.90 ,97,,,$93.50 ,$164.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.90 ,97,,,$93.50 ,$164.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.90 ,97,,,$93.50 ,$164.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$144.50 ,85,,,$93.50 ,$164.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.00 ,90,,,$93.50 ,$164.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.50 ,55,,,$93.50 ,$164.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$161.50 ,90,,,$93.50 ,$164.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$93.50 ,55,,,$93.50 ,$164.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$158.10 ,93,,,$93.50 ,$164.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting
20605 ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US TechFee,8022755,CDM,450,RC,20605,HCPCS,outpatient,,,$177.00 ,$132.75 ,,$162.84 ,92,,,$97.35 ,$171.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$97.35 ,$171.69 ,other,,Not applicable. No negotiated rates per contract,$152.22 ,86,,,$97.35 ,$171.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$141.60 ,80,,,$97.35 ,$171.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,95,,,$97.35 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$168.15 ,95,,,$97.35 ,$171.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$132.75 ,75,,,$97.35 ,$171.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$150.45 ,85,,,$97.35 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.30 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$171.69 ,97,,,$97.35 ,$171.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.45 ,85,,,$97.35 ,$171.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$159.30 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$168.15 ,90,,,$97.35 ,$171.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$97.35 ,55,,,$97.35 ,$171.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$164.61 ,93,,,$97.35 ,$171.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
20610 ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US TechFee,8022756,CDM,450,RC,20610,HCPCS,outpatient,,,$208.00 ,$156.00 ,,$191.36 ,92,,,$114.40 ,$201.76 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$114.40 ,$201.76 ,other,,Not applicable. No negotiated rates per contract,$178.88 ,86,,,$114.40 ,$201.76 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$166.40 ,80,,,$114.40 ,$201.76 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$197.60 ,95,,,$114.40 ,$201.76 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$156.00 ,75,,,$114.40 ,$201.76 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$201.76 ,97,,,$114.40 ,$201.76 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$176.80 ,85,,,$114.40 ,$201.76 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$187.20 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$197.60 ,90,,,$114.40 ,$201.76 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$114.40 ,55,,,$114.40 ,$201.76 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$193.44 ,93,,,$114.40 ,$201.76 ,percent of total billed charges,,93% of total billed charges for outpatient setting
20CC STERILE SYRINGE,9025455,CDM,270,RC,A4213,HCPCS,outpatient,,,$43.00 ,$32.25 ,,$39.56 ,92,,,$23.65 ,$41.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.65 ,$41.71 ,other,,Not applicable. No negotiated rates per contract,$36.98 ,86,,,$23.65 ,$41.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.40 ,80,,,$23.65 ,$41.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.85 ,95,,,$23.65 ,$41.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.85 ,95,,,$23.65 ,$41.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.25 ,75,,,$23.65 ,$41.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.55 ,85,,,$23.65 ,$41.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.70 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.55 ,85,,,$23.65 ,$41.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.70 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.85 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.99 ,93,,,$23.65 ,$41.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
28230 Incision of foot tendon(s),9092010,CDM,360,RC,28230,HCPCS,outpatient,,,"$4,490.00 ","$3,367.50 ",,"$4,130.80 ",92,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$2,469.50 ",55,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$2,469.50 ","$4,355.30 ",other,,Not applicable. No negotiated rates per contract,"$3,861.40 ",86,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$3,592.00 ",80,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$2,469.50 ",55,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,265.50 ",95,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$4,265.50 ",95,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$3,367.50 ",75,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$3,816.50 ",85,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,355.30 ",97,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,469.50 ",55,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,041.00 ",90,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$4,355.30 ",97,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,355.30 ",97,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$4,355.30 ",97,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$3,816.50 ",85,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$4,041.00 ",90,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,469.50 ",55,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,265.50 ",90,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,469.50 ",55,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$4,175.70 ",93,,,"$2,469.50 ","$4,355.30 ",percent of total billed charges,,93% of total billed charges for outpatient setting
29881 KNEE ARTHRO W/MENISCECTMY MED OR LAT,9012500,CDM,975,RC,29881,HCPCS,outpatient,,,"$1,993.00 ","$1,494.75 ",,$854.71 ,135,cms physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,135% of 2011 CMS physician fee schedule,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$561.98 ,"$1,893.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$674.74 ,100,,,$561.98 ,"$1,893.35 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,092.00 ",100,physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$814.87 ,145,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$1,893.35 ",95,,,$561.98 ,"$1,893.35 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,$561.98 ,"$1,893.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$793.69 ,100,,,$561.98 ,"$1,893.35 ",fee schedule,,100% Humana physician fee schedule,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,$561.98 ,"$1,893.35 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,078.98 ",100,,,$561.98 ,"$1,893.35 ",fee schedule,,100% Midlands Choice physician fee schedule,$618.96 ,100,,,$561.98 ,"$1,893.35 ",fee schedule,,100% Multiplan physician fee schedule,$618.96 ,100,,,$561.98 ,"$1,893.35 ",fee schedule,,100% Multiplan physician fee schedule,$786.77 ,140,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,$561.98 ,"$1,893.35 ",other,,Not separately reimbursible. Not contracted for physician rates,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,893.35 ",95,,,$561.98 ,"$1,893.35 ",percent of total billed charges,,95% of total billed charges,$561.98 ,100,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,100% CMS Medicare physician fee schedule ,$701.09 ,124.753,CMS physician fee schedule,,$561.98 ,"$1,893.35 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
29888 ACL RECON W ANTERIOR TIBIALIS ALLOGRAPH,9012503,CDM,975,RC,29888,HCPCS,outpatient,,,"$4,054.00 ","$3,040.50 ",,"$1,307.92 ",135,cms physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,135% of 2011 CMS physician fee schedule,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,007.60 ","$3,851.30 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,221.07 ",100,,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% of the Blue Cross physician fee schedule,"$1,982.40 ",100,physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% of Work Comp physician fee schedule. Multiple discount rules may apply,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,461.02 ",145,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,145% CMS Medicare physician fee schedule ,"$3,851.30 ",95,,,"$1,007.60 ","$3,851.30 ",percent of total billed charges,,95% of total billed charges for physician setting,,,,,"$1,007.60 ","$3,851.30 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,436.67 ",100,,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% Humana physician fee schedule,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,,,,,"$1,007.60 ","$3,851.30 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,961.18 ",100,,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% Midlands Choice physician fee schedule,"$1,126.22 ",100,,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% Multiplan physician fee schedule,"$1,126.22 ",100,,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% Multiplan physician fee schedule,"$1,410.64 ",140,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,140% CMS Medicare physician fee schedule ,,,,,"$1,007.60 ","$3,851.30 ",other,,Not separately reimbursible. Not contracted for physician rates,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$3,851.30 ",95,,,"$1,007.60 ","$3,851.30 ",percent of total billed charges,,95% of total billed charges,"$1,007.60 ",100,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,100% CMS Medicare physician fee schedule ,"$1,257.01 ",124.753,CMS physician fee schedule,,"$1,007.60 ","$3,851.30 ",fee schedule,,124.753% CMS Medicare physician fee schedule 
41010 Incision of tongue fold,9142214,CDM,521,RC,41010,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
62270 SPINAL PUNCTURE LUMBAR DIAGNOSTIC TechFee,8211342,CDM,450,RC,62270,HCPCS,outpatient,,,$435.00 ,$326.25 ,,$400.20 ,92,,,$239.25 ,$421.95 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$239.25 ,$421.95 ,other,,Not applicable. No negotiated rates per contract,$374.10 ,86,,,$239.25 ,$421.95 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$348.00 ,80,,,$239.25 ,$421.95 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$413.25 ,95,,,$239.25 ,$421.95 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$326.25 ,75,,,$239.25 ,$421.95 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$421.95 ,97,,,$239.25 ,$421.95 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$369.75 ,85,,,$239.25 ,$421.95 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$391.50 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$413.25 ,90,,,$239.25 ,$421.95 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$239.25 ,55,,,$239.25 ,$421.95 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$404.55 ,93,,,$239.25 ,$421.95 ,percent of total billed charges,,93% of total billed charges for outpatient setting
62321 INJ CERVICAL/THORACIC EPIDURAL W IMAGE,9012532,CDM,360,RC,62321,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
62323 EPIDURAL STEROID INJ W IMAGE,9012533,CDM,360,RC,62323,HCPCS,outpatient,,,"$2,071.00 ","$1,553.25 ",,"$1,905.32 ",92,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,92% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,"$1,139.05 ","$2,008.87 ",other,,Not applicable. No negotiated rates per contract,"$1,781.06 ",86,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,656.80 ",80,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,80% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,967.45 ",95,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,553.25 ",75,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$2,008.87 ",97,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,760.35 ",85,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,863.90 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,967.45 ",90,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,139.05 ",55,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,926.03 ",93,,,"$1,139.05 ","$2,008.87 ",percent of total billed charges,,93% of total billed charges for outpatient setting
66821 YAG/LASER CAPSULOTOM,9012551,CDM,360,RC,66821,HCPCS,outpatient,,,"$1,298.00 ",$973.50 ,,"$1,194.16 ",92,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$713.90 ,"$1,259.06 ",other,,Not applicable. No negotiated rates per contract,"$1,116.28 ",86,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,86% of total billed charges for outpatient setting,"$1,038.40 ",80,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",95,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,233.10 ",95,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$973.50 ,75,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,168.20 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,259.06 ",97,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,103.30 ",85,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,168.20 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,233.10 ",90,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$713.90 ,55,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,207.14 ",93,,,$713.90 ,"$1,259.06 ",percent of total billed charges,,93% of total billed charges for outpatient setting
A4466 Elastic garment/covering,9025461,CDM,270,RC,A4466,HCPCS,outpatient,,,$111.00 ,$83.25 ,,$102.12 ,92,,,$61.05 ,$107.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$61.05 ,$107.67 ,other,,Not applicable. No negotiated rates per contract,$95.46 ,86,,,$61.05 ,$107.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.80 ,80,,,$61.05 ,$107.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.45 ,95,,,$61.05 ,$107.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.45 ,95,,,$61.05 ,$107.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.25 ,75,,,$61.05 ,$107.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$94.35 ,85,,,$61.05 ,$107.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.90 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.35 ,85,,,$61.05 ,$107.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.90 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.45 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.23 ,93,,,$61.05 ,$107.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
A4467 Elastic garment/covering,9042946,CDM,270,RC,A4467,HCPCS,outpatient,,,$115.00 ,$86.25 ,,$105.80 ,92,,,$63.25 ,$111.55 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$63.25 ,$111.55 ,other,,Not applicable. No negotiated rates per contract,$98.90 ,86,,,$63.25 ,$111.55 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$92.00 ,80,,,$63.25 ,$111.55 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$109.25 ,95,,,$63.25 ,$111.55 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$86.25 ,75,,,$63.25 ,$111.55 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$111.55 ,97,,,$63.25 ,$111.55 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$97.75 ,85,,,$63.25 ,$111.55 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$103.50 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$109.25 ,90,,,$63.25 ,$111.55 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$63.25 ,55,,,$63.25 ,$111.55 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$106.95 ,93,,,$63.25 ,$111.55 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ACE BANDAGE ANY SIZE,9025469,CDM,270,RC,A6450,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$15.40 ,$27.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$15.40 ,$27.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$15.40 ,$27.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$15.40 ,$27.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.04 ,93,,,$15.40 ,$27.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
AIRCAST/ANKLE,9025492,CDM,270,RC,L4350,HCPCS,outpatient,,,$69.00 ,$51.75 ,,$63.48 ,92,,,$37.95 ,$66.93 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$37.95 ,$66.93 ,other,,Not applicable. No negotiated rates per contract,$59.34 ,86,,,$37.95 ,$66.93 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$55.20 ,80,,,$37.95 ,$66.93 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.55 ,95,,,$37.95 ,$66.93 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$51.75 ,75,,,$37.95 ,$66.93 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.93 ,97,,,$37.95 ,$66.93 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$58.65 ,85,,,$37.95 ,$66.93 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$62.10 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.55 ,90,,,$37.95 ,$66.93 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.95 ,55,,,$37.95 ,$66.93 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$64.17 ,93,,,$37.95 ,$66.93 ,percent of total billed charges,,93% of total billed charges for outpatient setting
ANKLE BRACE,9025482,CDM,270,RC,L1906,HCPCS,outpatient,,,$192.00 ,$144.00 ,,$176.64 ,92,,,$105.60 ,$186.24 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$105.60 ,55,,,$105.60 ,$186.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$105.60 ,$186.24 ,other,,Not applicable. No negotiated rates per contract,$165.12 ,86,,,$105.60 ,$186.24 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$153.60 ,80,,,$105.60 ,$186.24 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$105.60 ,55,,,$105.60 ,$186.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.40 ,95,,,$105.60 ,$186.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.40 ,95,,,$105.60 ,$186.24 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$144.00 ,75,,,$105.60 ,$186.24 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$163.20 ,85,,,$105.60 ,$186.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$186.24 ,97,,,$105.60 ,$186.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$105.60 ,55,,,$105.60 ,$186.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.80 ,90,,,$105.60 ,$186.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$186.24 ,97,,,$105.60 ,$186.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.24 ,97,,,$105.60 ,$186.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$186.24 ,97,,,$105.60 ,$186.24 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$163.20 ,85,,,$105.60 ,$186.24 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$172.80 ,90,,,$105.60 ,$186.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.60 ,55,,,$105.60 ,$186.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$182.40 ,90,,,$105.60 ,$186.24 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$105.60 ,55,,,$105.60 ,$186.24 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$178.56 ,93,,,$105.60 ,$186.24 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Abdominal Binder - YUMA,9025476,CDM,270,RC,L0625,HCPCS,outpatient,,,$286.00 ,$214.50 ,,$263.12 ,92,,,$157.30 ,$277.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$157.30 ,55,,,$157.30 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$157.30 ,$277.42 ,other,,Not applicable. No negotiated rates per contract,$245.96 ,86,,,$157.30 ,$277.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$228.80 ,80,,,$157.30 ,$277.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$157.30 ,55,,,$157.30 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.70 ,95,,,$157.30 ,$277.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.70 ,95,,,$157.30 ,$277.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$214.50 ,75,,,$157.30 ,$277.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$243.10 ,85,,,$157.30 ,$277.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$277.42 ,97,,,$157.30 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$157.30 ,55,,,$157.30 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.40 ,90,,,$157.30 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$277.42 ,97,,,$157.30 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.42 ,97,,,$157.30 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$277.42 ,97,,,$157.30 ,$277.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$243.10 ,85,,,$157.30 ,$277.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$257.40 ,90,,,$157.30 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.30 ,55,,,$157.30 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$271.70 ,90,,,$157.30 ,$277.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$157.30 ,55,,,$157.30 ,$277.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$265.98 ,93,,,$157.30 ,$277.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CALVICLE SPLINT,9025485,CDM,270,RC,L3650,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CAST MATERIALS-SHORT ARM,9025464,CDM,270,RC,A4590,HCPCS,outpatient,,,$194.00 ,$145.50 ,,$178.48 ,92,,,$106.70 ,$188.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$106.70 ,$188.18 ,other,,Not applicable. No negotiated rates per contract,$166.84 ,86,,,$106.70 ,$188.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$155.20 ,80,,,$106.70 ,$188.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,95,,,$106.70 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.30 ,95,,,$106.70 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.50 ,75,,,$106.70 ,$188.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.90 ,85,,,$106.70 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.60 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.90 ,85,,,$106.70 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.42 ,93,,,$106.70 ,$188.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATH SECURE,9025456,CDM,270,RC,A4333,HCPCS,outpatient,,,$37.00 ,$27.75 ,,$34.04 ,92,,,$20.35 ,$35.89 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$20.35 ,$35.89 ,other,,Not applicable. No negotiated rates per contract,$31.82 ,86,,,$20.35 ,$35.89 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$29.60 ,80,,,$20.35 ,$35.89 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$35.15 ,95,,,$20.35 ,$35.89 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$27.75 ,75,,,$20.35 ,$35.89 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$35.89 ,97,,,$20.35 ,$35.89 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.45 ,85,,,$20.35 ,$35.89 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$33.30 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.15 ,90,,,$20.35 ,$35.89 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$20.35 ,55,,,$20.35 ,$35.89 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$34.41 ,93,,,$20.35 ,$35.89 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER FOLEY 20FR,9025472,CDM,270,RC,C1758,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$15.40 ,$27.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$15.40 ,$27.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$15.40 ,$27.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$15.40 ,$27.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.04 ,93,,,$15.40 ,$27.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER TRAY 16FR,9025458,CDM,270,RC,A4354,HCPCS,outpatient,,,$110.00 ,$82.50 ,,$101.20 ,92,,,$60.50 ,$106.70 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$60.50 ,$106.70 ,other,,Not applicable. No negotiated rates per contract,$94.60 ,86,,,$60.50 ,$106.70 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.00 ,80,,,$60.50 ,$106.70 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$104.50 ,95,,,$60.50 ,$106.70 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.50 ,75,,,$60.50 ,$106.70 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,97,,,$60.50 ,$106.70 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$93.50 ,85,,,$60.50 ,$106.70 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.00 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$104.50 ,90,,,$60.50 ,$106.70 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$60.50 ,55,,,$60.50 ,$106.70 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$102.30 ,93,,,$60.50 ,$106.70 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CATHETER/BLADDER IRRIGATION,9025459,CDM,270,RC,A4355,HCPCS,outpatient,,,$39.00 ,$29.25 ,,$35.88 ,92,,,$21.45 ,$37.83 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.45 ,$37.83 ,other,,Not applicable. No negotiated rates per contract,$33.54 ,86,,,$21.45 ,$37.83 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$31.20 ,80,,,$21.45 ,$37.83 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$37.05 ,95,,,$21.45 ,$37.83 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.25 ,75,,,$21.45 ,$37.83 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$37.83 ,97,,,$21.45 ,$37.83 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$33.15 ,85,,,$21.45 ,$37.83 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$35.10 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$37.05 ,90,,,$21.45 ,$37.83 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$21.45 ,55,,,$21.45 ,$37.83 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$36.27 ,93,,,$21.45 ,$37.83 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CERVICAL COLLAR,9025474,CDM,270,RC,L0120,HCPCS,outpatient,,,$194.00 ,$145.50 ,,$178.48 ,92,,,$106.70 ,$188.18 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$106.70 ,$188.18 ,other,,Not applicable. No negotiated rates per contract,$166.84 ,86,,,$106.70 ,$188.18 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$155.20 ,80,,,$106.70 ,$188.18 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,95,,,$106.70 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$184.30 ,95,,,$106.70 ,$188.18 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$145.50 ,75,,,$106.70 ,$188.18 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$164.90 ,85,,,$106.70 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$174.60 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$188.18 ,97,,,$106.70 ,$188.18 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$164.90 ,85,,,$106.70 ,$188.18 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$174.60 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$184.30 ,90,,,$106.70 ,$188.18 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$106.70 ,55,,,$106.70 ,$188.18 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$180.42 ,93,,,$106.70 ,$188.18 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CLAVICLE STRAP,9025486,CDM,270,RC,L3660,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
CTS WRIST SUPPORT,9025490,CDM,274,RC,L3908,HCPCS,both,,,$43.00 ,$32.25 ,,$39.56 ,92,,,$23.65 ,$41.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$23.65 ,$41.71 ,other,,Not applicable. No negotiated rates per contract,$36.98 ,86,,,$23.65 ,$41.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$34.40 ,80,,,$23.65 ,$41.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.85 ,95,,,$23.65 ,$41.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$40.85 ,95,,,$23.65 ,$41.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$32.25 ,75,,,$23.65 ,$41.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$36.55 ,85,,,$23.65 ,$41.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$38.70 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.71 ,97,,,$23.65 ,$41.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$36.55 ,85,,,$23.65 ,$41.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$38.70 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$40.85 ,90,,,$23.65 ,$41.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$23.65 ,55,,,$23.65 ,$41.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$39.99 ,93,,,$23.65 ,$41.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HEELBO PAD,9025484,CDM,270,RC,L3480,HCPCS,outpatient,,,$87.00 ,$65.25 ,,$80.04 ,92,,,$47.85 ,$84.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.85 ,$84.39 ,other,,Not applicable. No negotiated rates per contract,$74.82 ,86,,,$47.85 ,$84.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.60 ,80,,,$47.85 ,$84.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.25 ,75,,,$47.85 ,$84.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,93,,,$47.85 ,$84.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
HFO,9025491,CDM,270,RC,L3923,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
HINGED KNEE SUPPORT W/OPEN,9025477,CDM,270,RC,L1810,HCPCS,outpatient,,,$277.00 ,$207.75 ,,$254.84 ,92,,,$152.35 ,$268.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$152.35 ,55,,,$152.35 ,$268.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$152.35 ,$268.69 ,other,,Not applicable. No negotiated rates per contract,$238.22 ,86,,,$152.35 ,$268.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$221.60 ,80,,,$152.35 ,$268.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$152.35 ,55,,,$152.35 ,$268.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.15 ,95,,,$152.35 ,$268.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$263.15 ,95,,,$152.35 ,$268.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$207.75 ,75,,,$152.35 ,$268.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$235.45 ,85,,,$152.35 ,$268.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$268.69 ,97,,,$152.35 ,$268.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$152.35 ,55,,,$152.35 ,$268.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$249.30 ,90,,,$152.35 ,$268.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$268.69 ,97,,,$152.35 ,$268.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.69 ,97,,,$152.35 ,$268.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$268.69 ,97,,,$152.35 ,$268.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.45 ,85,,,$152.35 ,$268.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$249.30 ,90,,,$152.35 ,$268.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.35 ,55,,,$152.35 ,$268.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$263.15 ,90,,,$152.35 ,$268.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$152.35 ,55,,,$152.35 ,$268.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$257.61 ,93,,,$152.35 ,$268.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Hydrocolld drg filler paste,9025468,CDM,270,RC,A6240,HCPCS,outpatient,,,$186.00 ,$139.50 ,,$171.12 ,92,,,$102.30 ,$180.42 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$102.30 ,$180.42 ,other,,Not applicable. No negotiated rates per contract,$159.96 ,86,,,$102.30 ,$180.42 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$148.80 ,80,,,$102.30 ,$180.42 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$176.70 ,95,,,$102.30 ,$180.42 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$139.50 ,75,,,$102.30 ,$180.42 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$180.42 ,97,,,$102.30 ,$180.42 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$158.10 ,85,,,$102.30 ,$180.42 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$167.40 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$176.70 ,90,,,$102.30 ,$180.42 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$102.30 ,55,,,$102.30 ,$180.42 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$172.98 ,93,,,$102.30 ,$180.42 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE IMMOBILIZER - YUMA,9025479,CDM,270,RC,L1830,HCPCS,outpatient,,,$259.00 ,$194.25 ,,$238.28 ,92,,,$142.45 ,$251.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.45 ,$251.23 ,other,,Not applicable. No negotiated rates per contract,$222.74 ,86,,,$142.45 ,$251.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.20 ,80,,,$142.45 ,$251.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.25 ,75,,,$142.45 ,$251.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.87 ,93,,,$142.45 ,$251.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KNEE SPLINT/PNEUMATIC,9025493,CDM,270,RC,,HCPCS,outpatient,,,$362.00 ,$271.50 ,,$333.04 ,92,,,$199.10 ,$351.14 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$199.10 ,55,,,$199.10 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$199.10 ,$351.14 ,other,,Not applicable. No negotiated rates per contract,$311.32 ,86,,,$199.10 ,$351.14 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$289.60 ,80,,,$199.10 ,$351.14 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$199.10 ,55,,,$199.10 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$343.90 ,95,,,$199.10 ,$351.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$343.90 ,95,,,$199.10 ,$351.14 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$271.50 ,75,,,$199.10 ,$351.14 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$307.70 ,85,,,$199.10 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$351.14 ,97,,,$199.10 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$199.10 ,55,,,$199.10 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$325.80 ,90,,,$199.10 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$351.14 ,97,,,$199.10 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$199.10 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$351.14 ,97,,,$199.10 ,$351.14 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$307.70 ,85,,,$199.10 ,$351.14 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$325.80 ,90,,,$199.10 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$199.10 ,55,,,$199.10 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$343.90 ,90,,,$199.10 ,$351.14 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$199.10 ,55,,,$199.10 ,$351.14 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$336.66 ,93,,,$199.10 ,$351.14 ,percent of total billed charges,,93% of total billed charges for outpatient setting
KO adj jnt pos rigid support,9025480,CDM,270,RC,L1832,HCPCS,outpatient,,,$371.00 ,$278.25 ,,$341.32 ,92,,,$204.05 ,$359.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$204.05 ,55,,,$204.05 ,$359.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$204.05 ,$359.87 ,other,,Not applicable. No negotiated rates per contract,$319.06 ,86,,,$204.05 ,$359.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$296.80 ,80,,,$204.05 ,$359.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$204.05 ,55,,,$204.05 ,$359.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.45 ,95,,,$204.05 ,$359.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$352.45 ,95,,,$204.05 ,$359.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$278.25 ,75,,,$204.05 ,$359.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$315.35 ,85,,,$204.05 ,$359.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$359.87 ,97,,,$204.05 ,$359.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.05 ,55,,,$204.05 ,$359.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$333.90 ,90,,,$204.05 ,$359.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$359.87 ,97,,,$204.05 ,$359.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$359.87 ,97,,,$204.05 ,$359.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$359.87 ,97,,,$204.05 ,$359.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$315.35 ,85,,,$204.05 ,$359.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$333.90 ,90,,,$204.05 ,$359.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.05 ,55,,,$204.05 ,$359.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$352.45 ,90,,,$204.05 ,$359.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$204.05 ,55,,,$204.05 ,$359.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$345.03 ,93,,,$204.05 ,$359.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Knee,9025481,CDM,270,RC,L1833,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
Neopreme Knee Support,9025478,CDM,274,RC,L1820,HCPCS,both,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$66.55 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.55 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$104.06 ,86,,,$66.55 ,$117.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.80 ,80,,,$66.55 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$66.55 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$66.55 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Non-pneum walk boot pre ots,9025495,CDM,270,RC,L4387,HCPCS,outpatient,,,$241.00 ,$180.75 ,,$221.72 ,92,,,$132.55 ,$233.77 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$132.55 ,$233.77 ,other,,Not applicable. No negotiated rates per contract,$207.26 ,86,,,$132.55 ,$233.77 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$192.80 ,80,,,$132.55 ,$233.77 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,95,,,$132.55 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$228.95 ,95,,,$132.55 ,$233.77 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$180.75 ,75,,,$132.55 ,$233.77 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$204.85 ,85,,,$132.55 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.90 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$233.77 ,97,,,$132.55 ,$233.77 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$204.85 ,85,,,$132.55 ,$233.77 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$216.90 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$228.95 ,90,,,$132.55 ,$233.77 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$132.55 ,55,,,$132.55 ,$233.77 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$224.13 ,93,,,$132.55 ,$233.77 ,percent of total billed charges,,93% of total billed charges for outpatient setting
OXYGEN CANNULA,9025465,CDM,270,RC,A4615,HCPCS,outpatient,,,$32.00 ,$24.00 ,,$29.44 ,92,,,$17.60 ,$31.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.60 ,55,,,$17.60 ,$31.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.60 ,$31.04 ,other,,Not applicable. No negotiated rates per contract,$27.52 ,86,,,$17.60 ,$31.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$25.60 ,80,,,$17.60 ,$31.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.60 ,55,,,$17.60 ,$31.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.40 ,95,,,$17.60 ,$31.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$30.40 ,95,,,$17.60 ,$31.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$24.00 ,75,,,$17.60 ,$31.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$27.20 ,85,,,$17.60 ,$31.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$31.04 ,97,,,$17.60 ,$31.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.60 ,55,,,$17.60 ,$31.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.80 ,90,,,$17.60 ,$31.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$31.04 ,97,,,$17.60 ,$31.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.04 ,97,,,$17.60 ,$31.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$31.04 ,97,,,$17.60 ,$31.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.20 ,85,,,$17.60 ,$31.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$28.80 ,90,,,$17.60 ,$31.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.60 ,55,,,$17.60 ,$31.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$30.40 ,90,,,$17.60 ,$31.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.60 ,55,,,$17.60 ,$31.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.76 ,93,,,$17.60 ,$31.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Post Op Shoe,9025483,CDM,270,RC,L3260,HCPCS,outpatient,,,$87.00 ,$65.25 ,,$80.04 ,92,,,$47.85 ,$84.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.85 ,$84.39 ,other,,Not applicable. No negotiated rates per contract,$74.82 ,86,,,$47.85 ,$84.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.60 ,80,,,$47.85 ,$84.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.25 ,75,,,$47.85 ,$84.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,93,,,$47.85 ,$84.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
RIB BELT - YUMA,9025475,CDM,270,RC,L0220,HCPCS,outpatient,,,$80.00 ,$60.00 ,,$73.60 ,92,,,$44.00 ,$77.60 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$44.00 ,55,,,$44.00 ,$77.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$44.00 ,$77.60 ,other,,Not applicable. No negotiated rates per contract,$68.80 ,86,,,$44.00 ,$77.60 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$64.00 ,80,,,$44.00 ,$77.60 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$44.00 ,55,,,$44.00 ,$77.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.00 ,95,,,$44.00 ,$77.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$76.00 ,95,,,$44.00 ,$77.60 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$60.00 ,75,,,$44.00 ,$77.60 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$68.00 ,85,,,$44.00 ,$77.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$77.60 ,97,,,$44.00 ,$77.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.00 ,55,,,$44.00 ,$77.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.00 ,90,,,$44.00 ,$77.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$77.60 ,97,,,$44.00 ,$77.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.60 ,97,,,$44.00 ,$77.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$77.60 ,97,,,$44.00 ,$77.60 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$68.00 ,85,,,$44.00 ,$77.60 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$72.00 ,90,,,$44.00 ,$77.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.00 ,55,,,$44.00 ,$77.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$76.00 ,90,,,$44.00 ,$77.60 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$44.00 ,55,,,$44.00 ,$77.60 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$74.40 ,93,,,$44.00 ,$77.60 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SHOULDER IMMOBILIZER,9025487,CDM,270,RC,L3670,HCPCS,outpatient,,,$87.00 ,$65.25 ,,$80.04 ,92,,,$47.85 ,$84.39 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$47.85 ,$84.39 ,other,,Not applicable. No negotiated rates per contract,$74.82 ,86,,,$47.85 ,$84.39 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$69.60 ,80,,,$47.85 ,$84.39 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$82.65 ,95,,,$47.85 ,$84.39 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$65.25 ,75,,,$47.85 ,$84.39 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$84.39 ,97,,,$47.85 ,$84.39 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.95 ,85,,,$47.85 ,$84.39 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$78.30 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$82.65 ,90,,,$47.85 ,$84.39 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$47.85 ,55,,,$47.85 ,$84.39 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$80.91 ,93,,,$47.85 ,$84.39 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SLINGS,9025462,CDM,270,RC,A4565,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$50.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPICA SPLINT,9025489,CDM,270,RC,L3808,HCPCS,outpatient,,,$111.00 ,$83.25 ,,$102.12 ,92,,,$61.05 ,$107.67 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$61.05 ,$107.67 ,other,,Not applicable. No negotiated rates per contract,$95.46 ,86,,,$61.05 ,$107.67 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$88.80 ,80,,,$61.05 ,$107.67 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.45 ,95,,,$61.05 ,$107.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$105.45 ,95,,,$61.05 ,$107.67 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$83.25 ,75,,,$61.05 ,$107.67 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$94.35 ,85,,,$61.05 ,$107.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.90 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$107.67 ,97,,,$61.05 ,$107.67 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.35 ,85,,,$61.05 ,$107.67 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$99.90 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$105.45 ,90,,,$61.05 ,$107.67 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$61.05 ,55,,,$61.05 ,$107.67 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$103.23 ,93,,,$61.05 ,$107.67 ,percent of total billed charges,,93% of total billed charges for outpatient setting
SPLINT,9025463,CDM,270,RC,A4570,HCPCS,outpatient,,,$171.00 ,$128.25 ,,$157.32 ,92,,,$94.05 ,$165.87 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$94.05 ,55,,,$94.05 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$94.05 ,$165.87 ,other,,Not applicable. No negotiated rates per contract,$147.06 ,86,,,$94.05 ,$165.87 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$136.80 ,80,,,$94.05 ,$165.87 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$94.05 ,55,,,$94.05 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,95,,,$94.05 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$162.45 ,95,,,$94.05 ,$165.87 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$128.25 ,75,,,$94.05 ,$165.87 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$145.35 ,85,,,$94.05 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$165.87 ,97,,,$94.05 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$94.05 ,55,,,$94.05 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$153.90 ,90,,,$94.05 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$165.87 ,97,,,$94.05 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$94.05 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$165.87 ,97,,,$94.05 ,$165.87 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$145.35 ,85,,,$94.05 ,$165.87 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$153.90 ,90,,,$94.05 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$94.05 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$162.45 ,90,,,$94.05 ,$165.87 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$94.05 ,55,,,$94.05 ,$165.87 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$159.03 ,93,,,$94.05 ,$165.87 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE KNEE ANY SIZE,9025470,CDM,270,RC,A6532,HCPCS,outpatient,,,$76.00 ,$57.00 ,,$69.92 ,92,,,$41.80 ,$73.72 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$41.80 ,55,,,$41.80 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$41.80 ,$73.72 ,other,,Not applicable. No negotiated rates per contract,$65.36 ,86,,,$41.80 ,$73.72 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$60.80 ,80,,,$41.80 ,$73.72 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$41.80 ,55,,,$41.80 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,95,,,$41.80 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$72.20 ,95,,,$41.80 ,$73.72 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.00 ,75,,,$41.80 ,$73.72 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$64.60 ,85,,,$41.80 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$73.72 ,97,,,$41.80 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$41.80 ,55,,,$41.80 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$68.40 ,90,,,$41.80 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$73.72 ,97,,,$41.80 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$41.80 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$73.72 ,97,,,$41.80 ,$73.72 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$64.60 ,85,,,$41.80 ,$73.72 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$68.40 ,90,,,$41.80 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$41.80 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$72.20 ,90,,,$41.80 ,$73.72 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$41.80 ,55,,,$41.80 ,$73.72 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$70.68 ,93,,,$41.80 ,$73.72 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TED HOSE THIGH ANY SIZE,9025471,CDM,270,RC,A6534,HCPCS,outpatient,,,$121.00 ,$90.75 ,,$111.32 ,92,,,$66.55 ,$117.37 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$66.55 ,$117.37 ,other,,Not applicable. No negotiated rates per contract,$104.06 ,86,,,$66.55 ,$117.37 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$96.80 ,80,,,$66.55 ,$117.37 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$114.95 ,95,,,$66.55 ,$117.37 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$90.75 ,75,,,$66.55 ,$117.37 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$117.37 ,97,,,$66.55 ,$117.37 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$102.85 ,85,,,$66.55 ,$117.37 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$108.90 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$114.95 ,90,,,$66.55 ,$117.37 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$66.55 ,55,,,$66.55 ,$117.37 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$112.53 ,93,,,$66.55 ,$117.37 ,percent of total billed charges,,93% of total billed charges for outpatient setting
TENNIS ELBOW BRACE,9025488,CDM,270,RC,L3702,HCPCS,outpatient,,,$48.00 ,$36.00 ,,$44.16 ,92,,,$26.40 ,$46.56 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$26.40 ,55,,,$26.40 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$26.40 ,$46.56 ,other,,Not applicable. No negotiated rates per contract,$41.28 ,86,,,$26.40 ,$46.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$38.40 ,80,,,$26.40 ,$46.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$26.40 ,55,,,$26.40 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,95,,,$26.40 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$45.60 ,95,,,$26.40 ,$46.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$36.00 ,75,,,$26.40 ,$46.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$40.80 ,85,,,$26.40 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.56 ,97,,,$26.40 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.40 ,55,,,$26.40 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$43.20 ,90,,,$26.40 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$46.56 ,97,,,$26.40 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$26.40 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$46.56 ,97,,,$26.40 ,$46.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$40.80 ,85,,,$26.40 ,$46.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$43.20 ,90,,,$26.40 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$26.40 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$45.60 ,90,,,$26.40 ,$46.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$26.40 ,55,,,$26.40 ,$46.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$44.64 ,93,,,$26.40 ,$46.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
U BAG,9025467,CDM,270,RC,A5112,HCPCS,outpatient,,,$52.00 ,$39.00 ,,$47.84 ,92,,,$28.60 ,$50.44 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$28.60 ,$50.44 ,other,,Not applicable. No negotiated rates per contract,$44.72 ,86,,,$28.60 ,$50.44 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$41.60 ,80,,,$28.60 ,$50.44 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$49.40 ,95,,,$28.60 ,$50.44 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$39.00 ,75,,,$28.60 ,$50.44 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$50.44 ,97,,,$28.60 ,$50.44 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$44.20 ,85,,,$28.60 ,$50.44 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$46.80 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$49.40 ,90,,,$28.60 ,$50.44 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$28.60 ,55,,,$28.60 ,$50.44 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$48.36 ,93,,,$28.60 ,$50.44 ,percent of total billed charges,,93% of total billed charges for outpatient setting
U BAG - INFANT,9025457,CDM,270,RC,A4335,HCPCS,outpatient,,,$28.00 ,$21.00 ,,$25.76 ,92,,,$15.40 ,$27.16 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$15.40 ,$27.16 ,other,,Not applicable. No negotiated rates per contract,$24.08 ,86,,,$15.40 ,$27.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$22.40 ,80,,,$15.40 ,$27.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$26.60 ,95,,,$15.40 ,$27.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$21.00 ,75,,,$15.40 ,$27.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$27.16 ,97,,,$15.40 ,$27.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$23.80 ,85,,,$15.40 ,$27.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$25.20 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.60 ,90,,,$15.40 ,$27.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$15.40 ,55,,,$15.40 ,$27.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$26.04 ,93,,,$15.40 ,$27.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Urinary leg or abdomen bag,9025460,CDM,270,RC,A4358,HCPCS,outpatient,,,$25.00 ,$18.75 ,,$23.00 ,92,,,$13.75 ,$24.25 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$13.75 ,$24.25 ,other,,Not applicable. No negotiated rates per contract,$21.50 ,86,,,$13.75 ,$24.25 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$20.00 ,80,,,$13.75 ,$24.25 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.75 ,95,,,$13.75 ,$24.25 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$18.75 ,75,,,$13.75 ,$24.25 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$24.25 ,97,,,$13.75 ,$24.25 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$21.25 ,85,,,$13.75 ,$24.25 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$22.50 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.75 ,90,,,$13.75 ,$24.25 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$13.75 ,55,,,$13.75 ,$24.25 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$23.25 ,93,,,$13.75 ,$24.25 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Variable concentration mask,9025466,CDM,270,RC,A4620,HCPCS,outpatient,,,$31.00 ,$23.25 ,,$28.52 ,92,,,$17.05 ,$30.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$17.05 ,55,,,$17.05 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$17.05 ,$30.07 ,other,,Not applicable. No negotiated rates per contract,$26.66 ,86,,,$17.05 ,$30.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$24.80 ,80,,,$17.05 ,$30.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$17.05 ,55,,,$17.05 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.45 ,95,,,$17.05 ,$30.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$29.45 ,95,,,$17.05 ,$30.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$23.25 ,75,,,$17.05 ,$30.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$26.35 ,85,,,$17.05 ,$30.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$30.07 ,97,,,$17.05 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$17.05 ,55,,,$17.05 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$27.90 ,90,,,$17.05 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$30.07 ,97,,,$17.05 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.07 ,97,,,$17.05 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$30.07 ,97,,,$17.05 ,$30.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$26.35 ,85,,,$17.05 ,$30.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$27.90 ,90,,,$17.05 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.05 ,55,,,$17.05 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$29.45 ,90,,,$17.05 ,$30.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$17.05 ,55,,,$17.05 ,$30.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$28.83 ,93,,,$17.05 ,$30.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKER(MCARE CODE ONLY),9025473,CDM,270,RC,E0130,HCPCS,outpatient,,,$243.00 ,$182.25 ,,$223.56 ,92,,,$133.65 ,$235.71 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$133.65 ,$235.71 ,other,,Not applicable. No negotiated rates per contract,$208.98 ,86,,,$133.65 ,$235.71 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$194.40 ,80,,,$133.65 ,$235.71 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,95,,,$133.65 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$230.85 ,95,,,$133.65 ,$235.71 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$182.25 ,75,,,$133.65 ,$235.71 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$206.55 ,85,,,$133.65 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$218.70 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$235.71 ,97,,,$133.65 ,$235.71 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$206.55 ,85,,,$133.65 ,$235.71 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$218.70 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$230.85 ,90,,,$133.65 ,$235.71 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$133.65 ,55,,,$133.65 ,$235.71 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$225.99 ,93,,,$133.65 ,$235.71 ,percent of total billed charges,,93% of total billed charges for outpatient setting
WALKING BOOT,9025494,CDM,270,RC,L4386,HCPCS,outpatient,,,$233.00 ,$174.75 ,,$214.36 ,92,,,$128.15 ,$226.01 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$128.15 ,$226.01 ,other,,Not applicable. No negotiated rates per contract,$200.38 ,86,,,$128.15 ,$226.01 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$186.40 ,80,,,$128.15 ,$226.01 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$221.35 ,95,,,$128.15 ,$226.01 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$174.75 ,75,,,$128.15 ,$226.01 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$226.01 ,97,,,$128.15 ,$226.01 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$198.05 ,85,,,$128.15 ,$226.01 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$209.70 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$221.35 ,90,,,$128.15 ,$226.01 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$128.15 ,55,,,$128.15 ,$226.01 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$216.69 ,93,,,$128.15 ,$226.01 ,percent of total billed charges,,93% of total billed charges for outpatient setting
YUMA Postop,8705969,CDM,710,RC,,HCPCS,outpatient,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
95079 Ingestion Challenge each additional 60 minutes,3996345,CDM,924,RC,95079,HCPCS,outpatient,,,$274.00 ,$205.50 ,,$252.08 ,92,,,$150.70 ,$265.78 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$150.70 ,55,,,$150.70 ,$265.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$150.70 ,$265.78 ,other,,Not applicable. No negotiated rates per contract,$235.64 ,86,,,$150.70 ,$265.78 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$219.20 ,80,,,$150.70 ,$265.78 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$150.70 ,55,,,$150.70 ,$265.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.30 ,95,,,$150.70 ,$265.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$260.30 ,95,,,$150.70 ,$265.78 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$205.50 ,75,,,$150.70 ,$265.78 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$232.90 ,85,,,$150.70 ,$265.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$265.78 ,97,,,$150.70 ,$265.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$150.70 ,55,,,$150.70 ,$265.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.60 ,90,,,$150.70 ,$265.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$265.78 ,97,,,$150.70 ,$265.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.78 ,97,,,$150.70 ,$265.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$265.78 ,97,,,$150.70 ,$265.78 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$232.90 ,85,,,$150.70 ,$265.78 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$246.60 ,90,,,$150.70 ,$265.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.70 ,55,,,$150.70 ,$265.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$260.30 ,90,,,$150.70 ,$265.78 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$150.70 ,55,,,$150.70 ,$265.78 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$254.82 ,93,,,$150.70 ,$265.78 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Bladder Irrigation,8730530,CDM,761,RC,51700,HCPCS,outpatient,,,$732.00 ,$549.00 ,,$673.44 ,92,,,$402.60 ,$710.04 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$402.60 ,$710.04 ,other,,Not applicable. No negotiated rates per contract,$629.52 ,86,,,$402.60 ,$710.04 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$585.60 ,80,,,$402.60 ,$710.04 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.40 ,95,,,$402.60 ,$710.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$695.40 ,95,,,$402.60 ,$710.04 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$549.00 ,75,,,$402.60 ,$710.04 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$622.20 ,85,,,$402.60 ,$710.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$658.80 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$710.04 ,97,,,$402.60 ,$710.04 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$622.20 ,85,,,$402.60 ,$710.04 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$658.80 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$695.40 ,90,,,$402.60 ,$710.04 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$402.60 ,55,,,$402.60 ,$710.04 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$680.76 ,93,,,$402.60 ,$710.04 ,percent of total billed charges,,93% of total billed charges for outpatient setting
CPT Oscillatory Therapy,4629702,CDM,410,RC,94669,HCPCS,outpatient,,,$331.00 ,$248.25 ,,$304.52 ,92,,,$182.05 ,$321.07 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$182.05 ,55,,,$182.05 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$182.05 ,$321.07 ,other,,Not applicable. No negotiated rates per contract,$284.66 ,86,,,$182.05 ,$321.07 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$264.80 ,80,,,$182.05 ,$321.07 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$182.05 ,55,,,$182.05 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,95,,,$182.05 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.45 ,95,,,$182.05 ,$321.07 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$248.25 ,75,,,$182.05 ,$321.07 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$281.35 ,85,,,$182.05 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$321.07 ,97,,,$182.05 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$182.05 ,55,,,$182.05 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$297.90 ,90,,,$182.05 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$321.07 ,97,,,$182.05 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$182.05 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$321.07 ,97,,,$182.05 ,$321.07 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.35 ,85,,,$182.05 ,$321.07 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$297.90 ,90,,,$182.05 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$182.05 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$314.45 ,90,,,$182.05 ,$321.07 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$182.05 ,55,,,$182.05 ,$321.07 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$307.83 ,93,,,$182.05 ,$321.07 ,percent of total billed charges,,93% of total billed charges for outpatient setting
EKG POC,8149580,CDM,521,RC,93005,HCPCS,outpatient,,,,,,,,,,$197.64 ,$197.64 ,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,,Not seperately reimbursible per contract terms,,,,,$197.64 ,$197.64 ,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,$197.64 ,100,,,$197.64 ,$197.64 ,case rate,,100% of clinic case rate per visit,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,$197.64 ,$197.64 ,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,$197.64 ,$197.64 ,other,,Not Seperately reimbursable per table 3 in the contract
Hemoccult Stool POC,8528846,CDM,270,RC,,HCPCS,outpatient,,,$77.00 ,$57.75 ,,$70.84 ,92,,,$42.35 ,$74.69 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$42.35 ,$74.69 ,other,,Not applicable. No negotiated rates per contract,$66.22 ,86,,,$42.35 ,$74.69 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$61.60 ,80,,,$42.35 ,$74.69 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,95,,,$42.35 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$73.15 ,95,,,$42.35 ,$74.69 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$57.75 ,75,,,$42.35 ,$74.69 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$65.45 ,85,,,$42.35 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$69.30 ,90,,,$42.35 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$74.69 ,97,,,$42.35 ,$74.69 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$65.45 ,85,,,$42.35 ,$74.69 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$69.30 ,90,,,$42.35 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$73.15 ,90,,,$42.35 ,$74.69 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$42.35 ,55,,,$42.35 ,$74.69 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$71.61 ,93,,,$42.35 ,$74.69 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Holter Monitor,5128782,CDM,731,RC,93225,HCPCS,outpatient,,,$348.00 ,$261.00 ,,$320.16 ,92,,,$191.40 ,$337.56 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$191.40 ,$337.56 ,other,,Not applicable. No negotiated rates per contract,$299.28 ,86,,,$191.40 ,$337.56 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$278.40 ,80,,,$191.40 ,$337.56 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$330.60 ,95,,,$191.40 ,$337.56 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$261.00 ,75,,,$191.40 ,$337.56 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$337.56 ,97,,,$191.40 ,$337.56 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$295.80 ,85,,,$191.40 ,$337.56 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$313.20 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$330.60 ,90,,,$191.40 ,$337.56 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$191.40 ,55,,,$191.40 ,$337.56 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$323.64 ,93,,,$191.40 ,$337.56 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Pulse Oximetry Continuous,7750607,CDM,460,RC,94762,HCPCS,outpatient,,,$419.00 ,$314.25 ,,$385.48 ,92,,,$230.45 ,$406.43 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$230.45 ,55,,,$230.45 ,$406.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$230.45 ,$406.43 ,other,,Not applicable. No negotiated rates per contract,$360.34 ,86,,,$230.45 ,$406.43 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$335.20 ,80,,,$230.45 ,$406.43 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$230.45 ,55,,,$230.45 ,$406.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.05 ,95,,,$230.45 ,$406.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$398.05 ,95,,,$230.45 ,$406.43 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$314.25 ,75,,,$230.45 ,$406.43 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$356.15 ,85,,,$230.45 ,$406.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$406.43 ,97,,,$230.45 ,$406.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$230.45 ,55,,,$230.45 ,$406.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$377.10 ,90,,,$230.45 ,$406.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$406.43 ,97,,,$230.45 ,$406.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.43 ,97,,,$230.45 ,$406.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$406.43 ,97,,,$230.45 ,$406.43 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$356.15 ,85,,,$230.45 ,$406.43 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$377.10 ,90,,,$230.45 ,$406.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.45 ,55,,,$230.45 ,$406.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$398.05 ,90,,,$230.45 ,$406.43 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$230.45 ,55,,,$230.45 ,$406.43 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$389.67 ,93,,,$230.45 ,$406.43 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Rhythm Strip,5360837,CDM,730,RC,93041,HCPCS,outpatient,,,$128.00 ,$96.00 ,,$117.76 ,92,,,$70.40 ,$124.16 ,percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$70.40 ,55,,,$70.40 ,$124.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$70.40 ,$124.16 ,other,,Not applicable. No negotiated rates per contract,$110.08 ,86,,,$70.40 ,$124.16 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$102.40 ,80,,,$70.40 ,$124.16 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.40 ,55,,,$70.40 ,$124.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.60 ,95,,,$70.40 ,$124.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$121.60 ,95,,,$70.40 ,$124.16 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.00 ,75,,,$70.40 ,$124.16 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$108.80 ,85,,,$70.40 ,$124.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$124.16 ,97,,,$70.40 ,$124.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.40 ,55,,,$70.40 ,$124.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$115.20 ,90,,,$70.40 ,$124.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$124.16 ,97,,,$70.40 ,$124.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.16 ,97,,,$70.40 ,$124.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$124.16 ,97,,,$70.40 ,$124.16 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$108.80 ,85,,,$70.40 ,$124.16 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$115.20 ,90,,,$70.40 ,$124.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.40 ,55,,,$70.40 ,$124.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$121.60 ,90,,,$70.40 ,$124.16 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.40 ,55,,,$70.40 ,$124.16 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.04 ,93,,,$70.40 ,$124.16 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Straight Catheter Insertion,8587930,CDM,450,RC,51701,HCPCS,outpatient,,,$290.00 ,$217.50 ,,$266.80 ,92,,,$159.50 ,$281.30 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$159.50 ,$281.30 ,other,,Not applicable. No negotiated rates per contract,$249.40 ,86,,,$159.50 ,$281.30 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$232.00 ,80,,,$159.50 ,$281.30 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$275.50 ,95,,,$159.50 ,$281.30 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$217.50 ,75,,,$159.50 ,$281.30 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$281.30 ,97,,,$159.50 ,$281.30 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$246.50 ,85,,,$159.50 ,$281.30 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$261.00 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$275.50 ,90,,,$159.50 ,$281.30 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$159.50 ,55,,,$159.50 ,$281.30 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$269.70 ,93,,,$159.50 ,$281.30 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Stress Test,8211657,CDM,482,RC,93017,HCPCS,outpatient,,,"$1,150.00 ",$862.50 ,,"$1,058.00 ",92,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,92% of billed charges for Cardiac Studies rate,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$632.50 ,"$1,115.50 ",other,,Not applicable. No negotiated rates per contract,$989.00 ,86,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$920.00 ,80,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,092.50 ",95,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$862.50 ,75,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,75% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,115.50 ",97,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$977.50 ,85,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,035.00 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,092.50 ",90,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$632.50 ,55,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,069.50 ",93,,,$632.50 ,"$1,115.50 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Suction Activity,4662543,CDM,270,RC,,HCPCS,outpatient,,,$105.00 ,$78.75 ,,$96.60 ,92,,,$57.75 ,$101.85 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$57.75 ,55,,,$57.75 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$57.75 ,$101.85 ,other,,Not applicable. No negotiated rates per contract,$90.30 ,86,,,$57.75 ,$101.85 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$84.00 ,80,,,$57.75 ,$101.85 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$57.75 ,55,,,$57.75 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,95,,,$57.75 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$99.75 ,95,,,$57.75 ,$101.85 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$78.75 ,75,,,$57.75 ,$101.85 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$89.25 ,85,,,$57.75 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$101.85 ,97,,,$57.75 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$57.75 ,55,,,$57.75 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$94.50 ,90,,,$57.75 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$101.85 ,97,,,$57.75 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$57.75 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$101.85 ,97,,,$57.75 ,$101.85 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$89.25 ,85,,,$57.75 ,$101.85 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$94.50 ,90,,,$57.75 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$57.75 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$99.75 ,90,,,$57.75 ,$101.85 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$57.75 ,55,,,$57.75 ,$101.85 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$97.65 ,93,,,$57.75 ,$101.85 ,percent of total billed charges,,93% of total billed charges for outpatient setting
Transfuse Cryoprecipitate Product,7894717,CDM,391,RC,36430,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Transfuse Fresh Frozen Plasma,7894718,CDM,391,RC,36430,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Transfuse Platelet Product,7894719,CDM,391,RC,36430,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Transfuse Red Blood Cells Leukoreduced,7894720,CDM,391,RC,36430,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Transfuse Red Blood Cells,8199385,CDM,391,RC,36430,HCPCS,outpatient,,,"$1,242.00 ",$931.50 ,,"$1,142.64 ",92,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,92% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$683.10 ,"$1,204.74 ",other,,Not applicable. No negotiated rates per contract,"$1,068.12 ",86,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,86% of total billed charges for outpatient setting,$993.60 ,80,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,80% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,"$1,179.90 ",95,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,95% of total billed charges for outpatient setting,$931.50 ,75,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,75% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,204.74 ",97,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,97% of total billed charges for outpatient setting,"$1,055.70 ",85,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,85% of total billed charges for outpatient setting,"$1,117.80 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,179.90 ",90,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,90% of total billed charges for outpatient setting,$683.10 ,55,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,"$1,155.06 ",93,,,$683.10 ,"$1,204.74 ",percent of total billed charges,,93% of total billed charges for outpatient setting
Urinary Catheter Insertion,609643,CDM,272,RC,,HCPCS,outpatient,,,$346.00 ,$259.50 ,,$318.32 ,92,,,$190.30 ,$335.62 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$190.30 ,$335.62 ,other,,Not applicable. No negotiated rates per contract,$297.56 ,86,,,$190.30 ,$335.62 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$276.80 ,80,,,$190.30 ,$335.62 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$328.70 ,95,,,$190.30 ,$335.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$328.70 ,95,,,$190.30 ,$335.62 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$259.50 ,75,,,$190.30 ,$335.62 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$294.10 ,85,,,$190.30 ,$335.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$311.40 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$335.62 ,97,,,$190.30 ,$335.62 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$294.10 ,85,,,$190.30 ,$335.62 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$311.40 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$328.70 ,90,,,$190.30 ,$335.62 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$190.30 ,55,,,$190.30 ,$335.62 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$321.78 ,93,,,$190.30 ,$335.62 ,percent of total billed charges,,93% of total billed charges for outpatient setting
triamcinolone,1647097,CDM,636,RC,,HCPCS,both,,,,,,,,,,,,other,Not applicable for 92% of charges due to charge amount,92% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,,Not seperately reimbursible per contract terms,,,,,,,other,Not applicable for 80% of charges due to charge amount,80% of total billed charges for outpatient setting,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 75% of charges due to charge amount,75% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 97% of charges due to charge amount,97% of total billed charges,,,,,,,other,Not applicable for 85% of charges due to charge amount,85% of total billed charges,,,,,,,other,Not applicable for 90% of charges due to charge amount,90% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 95% of charges due to charge amount,95% of total billed charges,,,,,,,other,Not applicable for 55% of charges due to charge amount,"55% of total billed charges, which is 100 percent of CMS Medicare OP CCR rate",,,,,,,other,Not applicable for 93% of charges due to charge amount,93% of total billed charges
97605 NEGATIVE PRESSURE WOUND THERAPY CHARGE,8730544,CDM,761,RC,97605,HCPCS,outpatient,,,$259.00 ,$194.25 ,,$238.28 ,92,,,$142.45 ,$251.23 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$142.45 ,$251.23 ,other,,Not applicable. No negotiated rates per contract,$222.74 ,86,,,$142.45 ,$251.23 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$207.20 ,80,,,$142.45 ,$251.23 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$246.05 ,95,,,$142.45 ,$251.23 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$194.25 ,75,,,$142.45 ,$251.23 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$251.23 ,97,,,$142.45 ,$251.23 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$220.15 ,85,,,$142.45 ,$251.23 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$233.10 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$246.05 ,90,,,$142.45 ,$251.23 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$142.45 ,55,,,$142.45 ,$251.23 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$240.87 ,93,,,$142.45 ,$251.23 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97606 NEG PRESS WOUND THERAPY>50CM CHARGE,8669291,CDM,761,RC,97606,HCPCS,outpatient,,,$498.00 ,$373.50 ,,$458.16 ,92,,,$273.90 ,$483.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.90 ,$483.06 ,other,,Not applicable. No negotiated rates per contract,$428.28 ,86,,,$273.90 ,$483.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$398.40 ,80,,,$273.90 ,$483.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$473.10 ,95,,,$273.90 ,$483.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$473.10 ,95,,,$273.90 ,$483.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.50 ,75,,,$273.90 ,$483.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$423.30 ,85,,,$273.90 ,$483.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.20 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$423.30 ,85,,,$273.90 ,$483.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$448.20 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$473.10 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$463.14 ,93,,,$273.90 ,$483.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
97606 NEG PRESSURE WOUND THERAPY > 50 CM CHARGE,8045920,CDM,761,RC,97606,HCPCS,outpatient,,,$498.00 ,$373.50 ,,$458.16 ,92,,,$273.90 ,$483.06 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$273.90 ,$483.06 ,other,,Not applicable. No negotiated rates per contract,$428.28 ,86,,,$273.90 ,$483.06 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$398.40 ,80,,,$273.90 ,$483.06 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$473.10 ,95,,,$273.90 ,$483.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$473.10 ,95,,,$273.90 ,$483.06 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$373.50 ,75,,,$273.90 ,$483.06 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$423.30 ,85,,,$273.90 ,$483.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$448.20 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$483.06 ,97,,,$273.90 ,$483.06 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$423.30 ,85,,,$273.90 ,$483.06 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$448.20 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$473.10 ,90,,,$273.90 ,$483.06 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$273.90 ,55,,,$273.90 ,$483.06 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$463.14 ,93,,,$273.90 ,$483.06 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99211 1ST HOUR TREATMENT ROOM CHARGE,8951296,CDM,761,RC,99211,HCPCS,outpatient,,,$129.00 ,$96.75 ,,$118.68 ,92,,,$21.73 ,$125.13 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$70.95 ,55,,,$21.73 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.73 ,$125.13 ,other,,Not applicable. No negotiated rates per contract,$110.94 ,86,,,$21.73 ,$125.13 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$103.20 ,80,,,$21.73 ,$125.13 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$70.95 ,55,,,$21.73 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$125.13 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$122.55 ,95,,,$21.73 ,$125.13 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$96.75 ,75,,,$21.73 ,$125.13 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$109.65 ,85,,,$21.73 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$125.13 ,97,,,$21.73 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$70.95 ,55,,,$21.73 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$116.10 ,90,,,$21.73 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$125.13 ,97,,,$21.73 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$21.73 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$125.13 ,97,,,$21.73 ,$125.13 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$109.65 ,85,,,$21.73 ,$125.13 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$116.10 ,90,,,$21.73 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$21.73 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$122.55 ,90,,,$21.73 ,$125.13 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$70.95 ,55,,,$21.73 ,$125.13 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$119.97 ,93,,,$21.73 ,$125.13 ,percent of total billed charges,,93% of total billed charges for outpatient setting
99211 2ND HOUR TREATMENT ROOM CHARGE,8951297,CDM,761,RC,99211,HCPCS,outpatient,,,$70.00 ,$52.50 ,,$64.40 ,92,,,$21.73 ,$67.90 ,percent of total billed charges,,92% of total billed charges for outpatient setting,$38.50 ,55,,,$21.73 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,,,,,$21.73 ,$67.90 ,other,,Not applicable. No negotiated rates per contract,$60.20 ,86,,,$21.73 ,$67.90 ,percent of total billed charges,,86% of total billed charges for outpatient setting,$56.00 ,80,,,$21.73 ,$67.90 ,percent of total billed charges,,80% of total billed charges for outpatient setting,$38.50 ,55,,,$21.73 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$21.73 ,100,,,$21.73 ,$67.90 ,fee schedule,,100% of Cigna Behavioral Health fee schedule,$66.50 ,95,,,$21.73 ,$67.90 ,percent of total billed charges,,95% of total billed charges for outpatient setting,$52.50 ,75,,,$21.73 ,$67.90 ,percent of total billed charges,,75% of total billed charges for outpatient setting,$59.50 ,85,,,$21.73 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$67.90 ,97,,,$21.73 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$38.50 ,55,,,$21.73 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$63.00 ,90,,,$21.73 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$67.90 ,97,,,$21.73 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$21.73 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$67.90 ,97,,,$21.73 ,$67.90 ,percent of total billed charges,,97% of total billed charges for outpatient setting,$59.50 ,85,,,$21.73 ,$67.90 ,percent of total billed charges,,85% of total billed charges for outpatient setting,$63.00 ,90,,,$21.73 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$21.73 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$66.50 ,90,,,$21.73 ,$67.90 ,percent of total billed charges,,90% of total billed charges for outpatient setting,$38.50 ,55,,,$21.73 ,$67.90 ,percent of total billed charges,,55% of total billed charges for outpatient setting which is 100% of CAH Medicare outpatient CCR,$65.10 ,93,,,$21.73 ,$67.90 ,percent of total billed charges,,93% of total billed charges for outpatient setting